Radiation Oncology/Esophagus/Staging

Staging
AJCC 7th Edition (2009)

T-stage:

• T1 - invades lamina propria, muscular mucosae, or submucosa
  • T1a - invades lamina propria or muscular mucosae
  • T1b - invades submucosa
• T2 - invades mucularis propria
• T3 - invades adventitia
• T4 - invades adjacent structures
  • T4a - resectable tumor invading pleura, pericardium, or diaphragm
  • T4b - unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.

N-stage:
Regional lymph nodes "extend from periesophageal cervical nodes to celiac nodes."

• N0 - no lymph node metastases
• N1 - metastasis in 1-2 regional nodes
• N2 - metastasis in 3-6 regional nodes
• N3 - metastasis in 7 or more nodes

M-stage:

• M0 - no distant metastasis
• M1 - distant metastasis

Tumor location

• Location is defined by the position of the upper/proximal edge of the tumor -- see Overview#Anatomy

Overall stage:

Squamous

Adenocarcinoma

IA - Any location: T1 N0 and Grade 1 (or Grade unknown) IB - Any location: T1 N0 and Grade 2-3 IB - Lower tumor: T2-3 N0 and Grade 1 IIA - Upper or middle tumor: T2-3 N0 and Grade 1 (or GX) IIA - Lower tumor/X: T2-3 N0 and Grade 2-3 IIB - Upper or middle tumor: T2-3 N0 and Grade 2-3 IIB - Any location: T1-2 N1 The stages below are the same for squamous + adeno: IIIA - Any location: T1-2 N2, T3 N1, T4a N0 IIIB - Any location: T3 N2 IIIC - Any location: T4a N1-2, T4b, N3 IV - M1

IA - T1 N0 and Grade 1-2 (or Grade unknown) IB - T1 N0 and Grade 3, T2 N0 and Grade 1-2 (or GX) IIA - T2 N0 and Grade 3 IIB - T3 N0, T1-2 N1 The stages below are the same for squamous + adeno: IIIA - T1-2 N2, T3 N1, T4a N0 IIIB - T3 N2 IIIC - T4a N1-2, T4b, N3 IV - M1

Changes from 6th edition

• Subdivided T1 into T1a and T1b
• Subdivided T4 into T4a and T4b
• Changed N-stage from N0-1 to N0-3 based on # of nodes
• Revised definition of regional lymph nodes
• Overall stage: I subdivided into IA/IB, III into IIIA/B/C
• Overall stage now incorporates tumor grade and tumor location (upper,middle,lower) and histology
• M1 no longer subdivided into M1a and M1b (M1a was redefined as N+ regional nodes)
• Note: This staging includes tumors of the esophagogastric junction and proximal 5 cm of the stomach (see details at Overview). This division was clarified in the 7th edition AJCC Staging Manual. There was also specification of tumor location as cervical, upper thoracic, middle thoracic, and lower.

Previous staging editions

6th edition (2002)
T-stage:

• T1 - invades lamina propria or submucosa
• T2 - invades mucularis propria
• T3 - invades adventitia
• T4 - invades adjacent structures

N-stage:

• N0 - no lymph node metastases
• N1 - lymph node metastases

M-stage:

• M0 - no distant metastasis
• M1 - distant metastasis
• Lower thoracic esophagus:
  • M1a - celiac lymph nodes
  • M1b - other distant mets
• Mid-thoracic esophagus:
  • M1a - N/A
  • M1b - nonregional lymph nodes and/or other distant mets
• Upper thoracic esophagus:
  • M1a - cervical nodes
  • M1b - other distant mets

Overall stage:

• I - T1 N0
• IIA - T2-T3 N0
• IIB - T1-2 N1
• III - T3 N1 or T4 any N
• IV - M1
• IVA - M1a
• IVB - M1b

5th edition (1997) - same as 6th
4th edition (1992)
3rd edition (1988)
2nd edition (1983) - clinical staging

I - <5 cm length, no obstruction, not circumferential

II - >5 cm length, obstruction or circumferential involvement:

III - evidence of extraesophageal spread.