Esophageal Cancer Staging 

Updated: Feb 07, 2018
  • 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 system for esophageal and esophagogastric junction cancer is provided below, along with histologic grade and anatomic/prognostic groups for squamous cell carcinoma and adenocarcinoma. [1, 2]

Table 1. TNM Classification (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,* defined as malignant cells confined by the basement membrane
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
*High-grade dysplasia includes all noninvasive neoplastic epithelial lesions formerly called carcinoma in situ; that term is no longer used for columnar mucosae anywhere in the gastrointestinal tract.
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. 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 4. Clinical stage groups (Open Table in a new window)

Stage Group

cT

cN

cM

Squamous cell carcinoma
   0 Tis N0 M0
   I T1 N0–1 M0
  II T2 N0–1 M0
T3 N0 M0
   III T3 N1 M0
T1–3 N2 M0
   IVA T4 N0–2 M0
T1–4 N3 M0
   IVB T1–4 N0–3 M1
Adenocarcinoma
   0 Tis N0 M0
   I T1 N0 M0
   IIA T1 N1 M0
   IIB T2 N0 M0
   III T2 N1 M0
T3–4a N0–1 M0
   IVA T1–4a N2 M0
T4b N0–2 M0
T1–4 N3 M0
   IVB T1–4 N0–3 M1

 

Table 5. Pathologic stage groups (Open Table in a new window)

Stage group

pT

pN

pM

Grade

Location

Squamous cell carcinoma
   0 Tis N0 M0 N/A Any
   IA T1a N0 M0 G1, X Any
   IB T1b N0 M0 G1, X Any
T1 N0 M0 G2–3 Any
T2 N0 M0 G1 Any
   IIA T2 N0 M0 G2–3, X Any
T3 N0 M0 Any Lower
T3 N0 M0 G1 Upper/middle
   IIB T3 N0 M0 G2–3 Upper/middle
T3 N0 M0 X Any
T3 N0 M0 Any X
T1 N1 M0 Any Any
   IIIA T1 N2 M0 Any Any
T2 N1 M0 Any Any
   IIIB T4a N0–1 M0 Any Any
T3 N1 M0 Any Any
T2–3 N2 M0 Any Any
   IVA T4a N2 M0 Any Any
T4b N0–2 M0 Any Any
T1–4 N3 M0 Any Any
   IVB T1–4 N0–3 M1 Any Any
Adenocarcinoma
   0 Tis N0 M0 N/A  
   IA T1a N0 M0 G1, X  
   IB T1a N0 M0 G2  
T1b N0 M0 G1–2, X  
   IC T1 N0 M0 G3  
T2 N0 M0 G1–2  
   IIA T2 N0 M0 G3, X  
   IIB T1 N1 M0 Any  
T3 N0 M0 Any  
   IIIA T1 N2 M0 Any  
T2 N1 M0 Any  
   IIIB T4a N0–1 M0 Any  
T3 N1 M0 Any  
T2–3 N2 M0 Any  
   IVA T4a N2 M0 Any  
T4b N0–2 M0 Any  
T1–4 N3 M0 Any  
T1–4 N0–3 M1 Any  
N/A = not applicable; X = not defined