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." Includes: levels 1 (low cervical, supraclavicular), 2 (upper paratracheal), 3P (retrotracheal), 4 (lower paratracheal), 5 (subaortic), 6 (ascending aorta), 7 (subcarinal), 8 (paraesophageal), 9 (pulm ligament), 10 (hilar), 15 (diaphragmatic), 16 (paracardial), 17 (L gastric), 20 (celiac).* [levels according to Lymph node mapping system for Esophageal Cancer. From Casson (7979715); see lymph node map Korst 1998(9535455)] *See erratum in 7th reprint of AJCC Staging Manual 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 AdenocarcinomaIA - 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 - M1IA - 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. 8th Edition AJCC 8th edition (2017) -- To be used for staging beginning Jan 1, 2018. T-stage: Tis - high grade dysplasia, defined as malignant cells confined to the epithelium by the basement membrane T1 - invades lamina propria, muscularis mucosae, or submucosa T1a - invades lamina propria or muscularis mucosae T1b - invades submucosa T2 - invades mucularis propria T3 - invades adventitia T4 - invades adjacent structures T4a - invades pleura, pericardium, azygos vein, diaphragm, or peritoneum T4b - invades other adjacent structures, such as aorta, vertebral body, or airway 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 Overall stage: Squamous Clinical Stage (cTNM) Pathological Stage (pTNM) Postneoadjuvant Therapy Stage (ypTNM)0 - Tis N0 I - T1 N0-1 II - T2 N0-1 or T3 N0 III - T3 N1 or T1-3 N2 IVA - T4 N0-2 or N3 IVB - M1 0 (Tis) IA -T1a N0 G1 or GX IB - T1a N0 G2-3 T1b N0 G any T2 N0 G1 IIA - T2 N0 G2-3 or GX T3 N0 Lower tumor T3 N0 G1 Upper/Middle tumor IIB - T3 N0 G2-3 Upper/Middle tumor T3 N0 GX T3 N0 Location X T1 N1 IIIA -T1 N2 T2 N1 IIIB -T2 N2 T3 N1-2 T4a N0-1 IVA -T4a N2 T4b N3 IVB -M1I - T0-2 N0 II - T3 N0 IIIA - T0-2 N1 IIIB - T3 N1 or T0-3 N2 or T4a N0 IVA - T4a N1-2 or NX, or T4b, or N3 IVB - M1 Adenocarcinoma Clinical Stage (cTNM) Pathological Stage (pTNM) Postneoadjuvant Therapy Stage (ypTNM) 0 - Tis I - T1 N0 IIA - T1 N1 IIB - T2 N0 III - T2 N1 or T3 N0-1 or T4a N0-1 IVA - T4b or N2 or N3 IVB - M10 (Tis) IA -T1a N0 G1 or GX IB - T1a N0 G2 T1b N0 G1-2 or GX IC - T1 N0 G3 T2 N0 G1-2 IIA - T2 N0 G3 or GX IIB - T1 N1 T3 N0 IIIA - T1 N2 T2 N1 IIIB - T2 N2 T3 N1-2 T4a N0-1 IVA - T4a N2 T4b N3 IVB - M1I - T0-2 N0 II - T3 N0 IIIA - T0-2 N1 IIIB - T3 N1 or T0-3 N2 or T4a N0 IVA - T4a NX-2 or T4b N0-2 or N3 IVB - M1 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.