Esophageal Cancer Staging 

Updated: Jan 04, 2017
  • Author: Terence D Rhodes, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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TNM Classification for Esophageal Cancer

The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification, grading, and staging system for esophageal and esophagogastric junction cancer are provided below. [1] Note that these are based on the AJCC Cancer Staging Manual, 7th Edition (2010). Although the 8th edition has been published, implementation of the new system has been delayed until January 1, 2018. The AJCC advises that, "All newly diagnosed cases through December 31st 2017 should be staged with the 7th edition." [2]

 

Table 1. Esophageal Squamous Cell Cancer (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis High-grade dysplasia
T1 Tumor invades lamina propria, muscularis mucosae, or submucosa
T1a Tumor invades lamina propria or muscularis mucosae
T1b Tumor invades submucosa
T2 Tumor invades muscularis propria
T3 Tumor invades adventitia
T4 Tumor invades adjacent structures
T4a Resectable tumor invading pleura, pericardium, or diaphragm
T4b Unresectable tumor invading other adjacent structures, such as the aorta, vertebral body, and trachea
Regional lymph nodes (N)
NX Regional lymph node(s) 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

Table 2. Histologic grade (Open Table in a new window)

Histologic grade (G)
GX Grade cannot be assessed—stage grouping as G1
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated—stage grouping as G3 squamous

Table 3. Anatomic stage/prognostic groups (Open Table in a new window)

Stage T N M Grade Tumor location
0 Tis (HGD) N0 M0 1, X Any
IA T1 N0 M0 1, X Any
IB T1 N0 M0 2-3 Any
  T2-3 N0 M0 1, X Lower, X
IIA T2-3 N0 M0 1, X Upper, middle
  T2-3 N0 M0 2-3 Lower, X
IIB T2-3 N0 M0 2-3 Upper, middle
  T1-2 N1 M0 Any Any
IIIA T1-2 N2 M0 Any Any
  T3 N1 M0 Any Any
  T4a N0 M0 Any Any
IIIB T3 N2 M0 Any Any
IIIC T4a N1-2 M0 Any Any
  T4b Any M0 Any Any
  Any N3 M0 Any Any
IV Any Any M1 Any Any

Table 4. Esophagogastric Junction Adenocarcinoma (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis High-grade dysplasia (HGD)
T1 Tumor invades lamina propria, muscularis mucosae, or submucosa
T1a Tumor invades lamina propria or muscularis mucosae
T1b Tumor invades submucosa
T2 Tumor invades muscularis propria
T3 Tumor invades adventitia
T4 Tumor invades adjacent structures
T4a Resectable tumor invading pleura, pericardium, or diaphragm
T4b Unresectable tumor invading other adjacent structures, such as the aorta, vertebral body, and trachea
Regional lymph nodes (N)
NX Regional lymph node(s) 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

Table 5. Histologic grade (Open Table in a new window)

Histologic grade (G)

GX

Grade cannot be assessed—stage grouping as G1

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated—stage grouping as G3 squamous

Table 6. Anatomic stage/prognostic groups (Open Table in a new window)

Stage

 6T

N

M

Grade

0 Tis (HGD) N0 M0 1, X
IA T1 N0 M0 1-2, X
IB T1 N0 M0 3
  T2 N0 M0 1-2, X
IIA T2 N0 M0 3
IIB T3 N0 M0 Any
  T1-2 N1 M0 Any
IIIA T1-2 N2 M0 Any
  T3 N1 M0 Any
  T4a N0 M0 Any
IIIB T3 N2 M0 Any
IIIC T4a N1-2 M0 Any
  T4b Any M0 Any
  Any N3 M0 Any
IV Any Any M1 Any