Esophagus
Miscellaneous
TNM staging of esophageal carcinomas

Author: Raul S. Gonzalez, M.D. (see Authors page)

Revised: 10 July 2018, last major update June 2018

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Staging[TI] esophageal carcinoma[TI]

Cite this page: Gonzalez, R.S. TNM staging of esophageal carcinomas. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusstaging.html. Accessed August 20th, 2018.

Pathologic TNM staging of carcinomas of the esophagus, AJCC 8th edition
Definition / general
  • All carcinomas of the esophagus, including poorly differentiated neuroendocrine carcinomas, are covered by this staging system
  • Esophagus cancers are defined as having an epicenter within the esophagus, within the gastroesophageal junction or no more than 2 cm into the proximal stomach
  • Well differentiated neuroendocrine tumors of the true esophagus are extremely rare and do not have a separate staging system, unlike other gastrointestinal organs
  • Well differentiated neuroendocrine tumors of the gastroesophageal junction and cardia are staged using the stomach neuroendocrine system
Essential features
ICD-10 coding
  • C15.9: Malignant neoplasm of esophagus, unspecified
Primary tumor (pT)
  • TX: Tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: High grade dysplasia, defined as malignant cells confined to the epithelium by the basement membrane
  • T1: Tumor invades the lamina propria, muscularis mucosae or submucosa
    • T1a: Tumor invades the lamina propria or muscularis mucosae
    • T1b: Tumor invades the submucosa
  • T2: Tumor invades the muscularis propria
  • T3: Tumor invades adventitia
  • T4: Tumor invades adjacent structures
    • T4a: Tumor invades the pleura, pericardium, azygos vein, diaphragm or peritoneum
    • T4b: Tumor invades other adjacent structures, such as the aorta, vertebral body or airway
Regional lymph nodes (pN)
  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis in 1 or 2 regional lymph nodes
  • N2: Metastasis in 3 - 6 regional lymph nodes
  • N3: Metastasis in 7+ regional lymph nodes

  • Notes: regional lymph nodes include lower cervical paratracheal, upper / lower paratracheal, subcarinal, upper / middle / lower thoracic paraesophageal, pulmonary ligament, diaphragmatic, paradarcial, left gastric, common hepatic, splenic, celiac and cervical periesophageal level VI / VII nodes
Distant metastasis (pM)
  • M0: No distant metastasis
  • M1: Distant metastasis
Location (squamous cell carcinoma only)
  • X: Location unknown
  • Upper: Cervical esophagus to lower border of azygous vein
  • Middle: Lower border of azygous vein to lower border of inferior pulmonary vein
  • Lower: Lower border of inferior pulmonary vein to stomach, including gastroesophageal junction
Prefixes
  • y: Preoperative radiotherapy or chemotherapy
  • r: Recurrent tumor stage
  • m: Multiple / skip lesions
Stage grouping
Squamous cell carcinoma, clinical (cTNM)
Stage 0: cTis cN0 cM0
Stage I: cT1 cN0 - 1 cM0
Stage II: cT2 cN0 - 1 cM0
cT3 cN0 cM0
Stage III: cT3 cN1 cM0
cT1 - 3 cN2 cM0
Stage IVA: cT4 cN0 - 2 cM0
any cT cN3 cM0
Stage IVB: any cT any cN cM1

Squamous cell carcinoma, pathological (pTNM)
Stage 0: pTis pN0 pM0 G N/A any location
Stage IA: pT1a pN0 pM0 G1, GX any location
Stage IB: pT1a pN0 pM0 G2 - 3 any location
pT1b pN0 pM0 G1 - 3, GX any location
pT2 pN0 pM0 G1 any location
Stage IIA: pT2 pN0 pM0 G2 - 3, GX any location
pT3 pN0 pM0 any G lower
pT3 pN0 pM0 G1 upper / middle
Stage IIB: pT3 pN0 pM0 G2 - 3 upper / middle
pT3 pN0 pM0 GX any location
pT3 pN0 pM0 any G location X
pT1 pN1 pM0 any G any location
Stage IIIA: pT1 pN2 pM0 any G any location
pT2 pN1 pM0 any G any location
Stage IIIB: pT2 pN2 pM0 any G any location
pT3 pN1 - 2 pM0 any G any location
pT4a pN0 - 1 pM0 any G any location
Stage IVA: pT4a pN2 pM0 any G any location
pT4b pN0 - 2 pM0 any G any location
any pT pN3 pM0 any G any location
Stage IVB: any pT any pN pM1 any G any location

 Squamous cell carcinoma, postneoadjuvant therapy (ypTNM)
Stage I: ypT0 - 2 ypN0 ypM0
Stage II: ypT3 ypN0 ypM0
Stage IIIA: ypT0 - 2 ypN1 ypM0
Stage IIIB: ypT3 ypN1 ypM0
ypT0 - 3 ypN2 ypM0
ypT4a ypN0 ypM0
Stage IVA: ypT4a ypN1 - 2, X ypM0
ypT4b ypN0 - 2 ypM0
any ypT ypN3 ypM0
Stage IVB: any ypT any ypN ypM1

Adenocarcinoma, clinical (cTNM)
Stage 0: cTis cN0 cM0
Stage I: cT1 cN0 cM0
Stage IIA: cT1 cN1 cM0
Stage IIB: cT2 cN0 cM0
Stage III: cT2 cN1 cM0
cT3 cN0 - 1 cM0
cT4a cN0 - 1 cM0
Stage IVA: cT1 - 4a cN2 cM0
cT4b cN0 - 2 cM0
any cT cN3 cM0
Stage IVB: any cT any cN cM1

Adenocarcinoma, pathological (pTNM)
Stage 0: pTis pN0 pM0 G N/A
Stage IA: pT1a pN0 pM0 G1, GX
Stage IB: pT1a pN0 pM0 G2
pT1b pN0 pM0 G1 - 2, GX
Stage IC: pT1 pN0 pM0 G3
pT2 pN0 pM0 G1 - 2
Stage IIA: pT2 pN0 pM0 G3, GX
Stage IIB: pT1 pN1 pM0 any G
pT3 pN0 pM0 any G
Stage IIIA: pT1 pN2 pM0 any G
pT2 pN1 pM0 any G
Stage IIIB: pT2 pN2 pM0 any G
pT3 pN1 - 2 pM0 any G
pT4a pN0 - 1 pM0 any G
Stage IVA: pT4a pN2 pM0 any G
pT4b pN0 - 2 pM0 any G
any pT pN3 pM0 any G
Stage IVB: any pT any pN pM1 any G

Adenocarcinoma, postneoadjuvant therapy (ypTNM)
(same as for squamous cell carcinoma)
Stage I: ypT0 - 2 ypN0 ypM0
Stage II: ypT3 ypN0 ypM0
Stage IIIA: ypT0 - 2 ypN1 ypM0
Stage IIIB: ypT3 ypN1 ypM0
ypT0 - 3 ypN2 ypM0
ypT4a ypN0 ypM0
Stage IVA: ypT4a ypN1 - 2, X ypM0
ypT4b ypN0 - 2 ypM0
any ypT ypN3 ypM0
Stage IVB: any ypT any ypN ypM1
Registry data collection variables
  • Squamous cell carcinoma:
    • Clinical staging modalities (endoscopy and biopsy, EUS, EUS-FNA, CT, PET / CT)
    • Tumor length
    • Depth of invasion
    • Number of nodes involved, clinical
    • Number of nodes involved, pathological
    • Location of nodal disease, clinical
    • Location of nodal disease, pathological
    • Sites of metastases, if applicable
    • Presence of skip lesions: T(m)
    • Perineural invasion
    • LVI (lymphatic, vascular, both)
    • Extranodal extension
    • Type of surgery
    • Chemotherapy
    • Chemoradiation therapy (for ypTNM)
    • Surgical margin (negative, microscopic, macroscopic)
  • Adenocarcinoma:
    • Clinical staging modalities (endoscopy and biopsy, EUS, EUS-FNA, CT, PET / CT)
    • Tumor length
    • Depth of invasion
    • Number of nodes involved, clinical
    • Number of nodes involved, pathological
    • Location of nodal disease, clinical
    • Location of nodal disease, pathological
    • Sites of metastases, if applicable
    • Presence of skip lesions: T(m)
    • Perineural invasion
    • LVI (lymphatic, vascular, both)
    • Extranodal extension
    • HER2 status (positive or negative)
    • Type of surgery
    • Chemotherapy
    • Chemoradiation therapy (for ypTNM)
    • Surgical margin (negative, microscopic, macroscopic)
Histologic grade
  • GX: Grade not available
  • G1: Well differentiated
  • G2: Moderately differentiated
  • G3: Poorly differentiated
Histopathologic type
  • Squamous:
    • Squamous cell carcinoma
    • Basaloid squamous cell carcinomas
    • Adenosquamous carcinoma
    • Spindle cell (squamous) carcinoma
    • Verrucous (squamous) carcinoma
    • Undifferentiated carcinoma with squamous component
  • Adenocarcinoma:
    • Adenocarcinoma
    • Adenoid cystic carcinoma
    • Mucoepidermoid carcinoma
    • Mixed adenoneuroendocrine carcinoma
    • Undifferentiated carcinoma with glandular component
  • Other:
    • Neuroendocrine tumor, G1
    • Neuroendocrine tumor, G2
    • Neuroendocrine carcinoma
    • Large cell neuroendocrine carcinoma
    • Small cell neuroendocrine carcinoma
Residual tumor
  • R0: No evidence of residual tumor
  • R1: Microscopic tumor at margins (including at inked radial margin)
  • R2: Macroscopically visible tumor at margins
Diagrams / tables

Images hosted on other servers:

Illustration of T category and N category staging

Stages of throat cancer

Various stages

Board review question #1
Which of the following variables has no impact on staging esophageal squamous cell carcinoma?

  1. Histologic grade
  2. Margin status
  3. Neoadjuvant therapy use
  4. Tumor location within esophagus
Board review answer #1
B. Margin status