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Esophageal cancer

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Staging esophageal cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes how deep the tumour has grown into the wall of the esophagus and where the cancer is in the body. Staging for esophageal cancer includes cancer of the esophagus and the gastroesophageal (GE) junction, which is where the esophagus and stomach join.

TNM staging

The most common staging system for esophageal cancer is the TNM system.

  • T describes how deeply the primary tumour has grown into the wall of the esophagus and if it has grown into tissues around the esophagus.
  • N describes the number and location of any lymph nodes around the esophagus that have cancer cells in them.
  • M describes whether or not the cancer has spread, or metastasized, to other parts of the body.

Diagram of the layers of the esophagus

Primary tumour (T)

TX

Primary tumour cannot be assessed.

T0

No evidence of primary tumour.

Tis

The cancer is only in the epithelium, or inner lining, of the mucosa. It is considered carcinoma in situcarcinoma in situA very early stage of cancer in which tumour cells have not yet invaded surrounding tissues. or high-grade dysplasiadysplasiaAbnormal development, appearance and organization of cells so that they are different from normal cells in size, shape and organization within tissue. Dysplasia almost always refers to a precancerous condition. (a precancerous condition).

T1

The cancer has spread to one of the following:

  • the lamina propria in the mucosa
  • muscularis mucosa in the mucosa
  • the submucosa (a layer of connective tissue that surrounds the mucosa layer)

T1a

The cancer has spread to the lamina propria or the muscularis mucosa.

T1b

The cancer has spread to the submucosa.

T2

The cancer has spread to the muscle layer of the esophagus (called the muscularis propria).

T3

The cancer has spread to the outer layer of connective tissue that covers the esophagus (called the adventitia).

T4

The cancer has spread to nearby structures.

T4a

The cancer has spread to the pleurapleuraThe thin layer of tissue that covers the lungs and lines the chest cavity. It protects and cushions the lungs and produces a fluid that acts like a lubricant so the lungs can move smoothly in the chest cavity., pericardiumpericardiumThe double-layered sac that surrounds the heart. It protects the heart and produces a fluid that acts like a lubricant so the heart can move normally in the chest. or diaphragmdiaphragmThe thin muscle below the lungs and heart that separates the chest cavity from the abdomen..

T4b

The cancer has spread to other nearby structures, such as the aorta (the main artery in the body), vertebrae (bones in the spine) or trachea (windpipe).

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed.

N0

The cancer has not spread to any lymph nodes.

N1

The cancer has spread to 1 or 2 nearby lymph nodes.

N2

The cancer has spread to 3–6 regional lymph nodes.

N3

The cancer has spread to 7 or more regional lymph nodes.

Distance metastasis (M)

M0

There is no distant metastasis (the cancer hasn’t spread to other parts of the body).

M1

The cancer has spread to a distant part of the body.

Stage grouping for esophageal cancer

Overall stage or stage groupings are based on the TNM system. Each stage is given a number from 0 to 4, usually as a Roman numeral (I, II, III or IV). Generally, the higher the number, the further the cancer has progressed. Your healthcare team uses the stage grouping to plan treatment and estimate prognosis.

Adenocarcinoma and squamous cell carcinoma have slightly different stage groupings.

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