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Glossary


Stages of esophageal cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. The most common staging system used in Canada for esophageal cancer is the TNM system. The American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) use the TNM system to describe the extent of many solid tumour cancers.

TNM

TNM stands for tumour, nodes, metastasis. TNM staging describes:

  • the size of the primary tumour
  • the number and location of any regional lymph nodes that have cancer cells in them
  • whether the cancer has spread or metastasized to another part of the body

 

Primary tumour (T)

TX

Primary tumour cannot be assessed

T0

No evidence of primary tumour

Tis

Tumour is confined to the inner lining (epithelium) or confined to the layer of connective tissue (lamina propria) of the mucous membrane (mucosa) of the esophagus

T1

Tumour invades connective tissue layer of the mucosa (lamina propria), muscle layer of the mucosa (muscularis mucosa) or submucosa. T1 is further divided:

T1a – Tumour invades lamina propria or muscularis mucosa

T1b – Tumour invades submucosa

T2

Tumour invades muscularis propria

T3

Tumour invades adventitia

T4

Tumour invades adjacent structures.

T4a* – tumour invades pleura, pericardium or diaphragm

T4b** – tumour invades other adjacent structures, such as aorta, vertebral body (cylindrical part of a spine bone [vertebra]), or trachea

*T4a tumours can be removed by surgery (operable; resectable).

**T4b tumours cannot be removed by surgery (inoperable; unresectable).

 

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in 1–2 regional lymph nodes

N2

Metastasis in 3–6 regional lymph nodes

N3

Metastasis in 7 or more regional lymph nodes

 

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Pathological staging

In addition to the TNM staging of esophageal cancer, doctors will also determine the pathological stage. The clinical stage is assigned based on the results of diagnostic tests. The pathological stage (pTNM) is based on examination of the tumour and other tissue after surgical removal. The pTNM is linked to the TNM categories.

  • The clinical stage is used in making treatment decisions.
  • The pathological stage, which is given after surgery, is a more accurate way to determine prognosis.

 

When tissue is removed from the mediastinum during surgery for esophageal cancer, it usually includes 6 or more lymph nodes. If less than 6 lymph nodes were removed and no cancer is found in them, the N category will be given as pN0.

Stage grouping for esophageal cancer

The AJCC and UICC further group the TNM data into the stages listed in the table below. The stage grouping is based on:

  • the type of esophageal cancer
    • squamous cell carcinoma
    • adenocarcinoma
  • the TNM stage of the cancer
  • the grade of the cancer
  • the location of cancer in the esophagus
    • only for squamous cell carcinoma of the esophagus

 

AJCC/UICC stage/prognostic grouping – squamous cell carcinoma of the esophagus

AJCC/UICC

TNM

Grade

Location in the esophagus

Explanation

stage 0

Tis

N0

M0

1

any

Carcinoma in situ

stage IA

T1

N0

M0

1

any

Cancer has spread to lamina propria, muscularis mucosa or submucosa.

stage IB

T1

N0

M0

2, 3

any

Cancer has spread to lamina propria, muscularis mucosa or submucosa.

 

T2, T3

N0

M0

1

lower thoracic esophagus

Cancer has spread to muscularis propria or adventitia.

stage IIA

T2, T3

N0

M0

1

upper or middle thoracic esophagus

Cancer has spread to muscularis propria or adventitia.

 

T2, T3

N0

M0

2, 3

lower thoracic esophagus

Cancer has spread to muscularis propria or adventitia.

stage IIB

T2, T3

N0

M0

2, 3

upper or middle thoracic esophagus

Cancer has spread to muscularis propria or adventitia.

 

T1, T2

N1

M0

any

any

Cancer has spread to lamina propria, muscularis mucosa, submucosa or muscularis propria.

Cancer has also spread to 1–2 nearby lymph nodes.

stage IIIA

T1, T2

N2

M0

any

any

Cancer has spread to lamina propria, muscularis mucosa, submucosa or muscularis propria.

Cancer has also spread to 3–6 nearby lymph nodes.

 

T3

N1

M0

any

any

Cancer has spread to adventitia and 1–2 nearby lymph nodes.

 

T4a

N0

M0

any

any

Cancer has spread to pleura, pericardium or diaphragm.

stage IIIB

T3

N2

M0

any

any

Cancer has spread to adventitia and 3–6 nearby lymph nodes.

stage IIIC

T4a

N1, N2

M0

any

any

Cancer has spread to pleura, pericardium or diaphragm.

Cancer has also spread to 1–6 nearby lymph nodes.

 

T4b

any

M0

any

any

Cancer has spread to other adjacent structures, such as aorta, vertebral body or trachea.

Cancer may or may not have spread to nearby lymph nodes.

 

any

N3

M0

any

any

Cancer has spread to any layer of the esophagus or adjacent structure.

Cancer has spread to 7 or more nearby lymph nodes.

stage IV

Cancer has spread to any layer of the esophagus or adjacent structure.

Cancer may or may not have spread to nearby lymph nodes, but has spread to a distant part of the body.

 

AJCC/UICC stage/prognostic grouping – adenocarcinoma of the esophagus

AJCC/UICC

TNM

Grade

Explanation

stage 0

Tis

N0

M0

1

Carcinoma in situ

High-grade dysplasia

stage IA

T1

N0

M0

1, 2

Cancer has spread to lamina propria, muscularis mucosa or submucosa.

stage IB

T1

N0

M0

3

Cancer has spread to lamina propria, muscularis mucosa or submucosa.

 

T2

N0

M0

1, 2

Cancer has spread to muscularis propria.

stage IIA

T2

N0

M0

3

Cancer has spread to muscularis propria.

stage IIB

T3

N0

M0

any

Cancer has spread to adventitia.

 

T1, T2

N1

M0

any

Cancer has spread to lamina propria, muscularis mucosa, submucosa or muscularis propria.

Cancer has also spread to 1–2 nearby lymph nodes.

stage IIIA

T1, T2

N2

M0

any

Cancer has spread to lamina propria, muscularis mucosa, submucosa or muscularis propria.

Cancer has also spread to 3–6 nearby lymph nodes.

 

T3

N1

M0

any

Cancer has spread to adventitia.

Cancer has also spread to 1–2 nearby lymph nodes.

 

T4a

N0

M0

any

Cancer has spread to pleura, pericardium or diaphragm.

stage IIIB

T3

N2

M0

any

Cancer has spread to adventitia.

Cancer has also spread to 3–6 nearby lymph nodes.

stage IIIC

T4a

N1, N2

M0

any

Cancer has spread to pleura, pericardium or diaphragm.

Cancer has also spread to 1–6 nearby lymph nodes.

 

T4b

any

M0

any

Cancer has spread to other adjacent structures, such as aorta, vertebral body or trachea.

Cancer may or may not have spread to nearby lymph nodes.

 

any

N3

M0

any

Cancer has spread to any layer of the esophagus or adjacent structure.

Cancer has spread to 7 or more nearby lymph nodes.

stage IV

Cancer has spread to any layer of the esophagus or adjacent structure.

Cancer may or may not have spread to nearby lymph nodes, but has spread to a distant part of the body.

Recurrent esophageal cancer

Recurrent esophageal cancer means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic esophageal cancer).

Gastroesophageal junction tumours

The Siewert, AJCC or UICC classification systems may be used to classify adenocarcinoma tumours that develop within 5 cm of the area where the stomach and the esophagus join (gastroesophageal or GE junction).

References

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