Stage Information
TNM Definitions
AJCC Stage Groupings
The stage determines whether the intent of the therapeutic approach will be
curative or palliative. The American Joint Committee on Cancer (AJCC) has
designated staging by TNM classification.[1]
TNM Definitions
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ
- T1: Tumor invades lamina propria or submucosa
- T2: Tumor invades muscularis propria
- T3: Tumor invades adventitia
- T4: Tumor invades adjacent structures
Regional lymph nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Regional lymph node metastasis
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis
- Tumors of the lower thoracic esophagus:
- M1a: Metastasis in celiac lymph nodes
- M1b: Other distant metastasis
- Tumors of the midthoracic esophagus:
- M1a: Not applicable
- M1b: Nonregional lymph nodes and/or other distant metastasis
- Tumors of the upper thoracic esophagus:
- M1a: Metastasis in cervical nodes
- M1b: Other distant metastasis
For tumors of the midthoracic esophagus, use only M1b because these tumors with
metastases in nonregional lymph nodes have equally poor prognoses as do those
with metastases in other distant sites.
AJCC Stage Groupings
Stage 0
Stage I
Stage IIA
Stage IIB
Stage III
Stage IV
Stage IVA
Stage IVB
The current staging system for esophageal cancer is based largely on
retrospective data from the Japanese Committee for Registration of Esophageal
Carcinoma. It is most applicable to patients with squamous cell carcinomas of
the upper third and middle third of the esophagus, as opposed to the increasingly
common distal esophageal and gastroesophageal junction adenocarcinomas.[2] In
particular, the classification of involved abdominal lymph nodes as M1 disease
has been criticized. The presence of positive abdominal lymph nodes does not
appear to carry as grave a prognosis as metastases to distant organs.[3]
Patients with regional and/or celiac axis lymphadenopathy should not
necessarily be considered to have unresectable disease caused by metastases.
Complete resection of the primary tumor and appropriate lymphadenectomy should
be attempted when possible.
References
-
Esophagus. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 91-8.
-
Iizuka T, Isono K, Kakegawa T, et al.: Parameters linked to ten-year survival in Japan of resected esophageal carcinoma. Japanese Committee for Registration of Esophageal Carcinoma Cases. Chest 96 (5): 1005-11, 1989.
[PUBMED Abstract]
-
Korst RJ, Rusch VW, Venkatraman E, et al.: Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 115 (3): 660-69; discussion 669-70, 1998.
[PUBMED Abstract]
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