# Radiation Oncology/Esophagus/Staging

* Front Page: Radiation Oncology | RTOG Trials | Randomized Trials
* Esophagus: Main Page |
* Staging |
* Overview |
* Resectable |
* Unresectable |
* Randomized |
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 (PMID 7979715); see lymph node map Korst 1998(PMID 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
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.

## 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 - M1 | I - 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 - M1 | 0 (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 - M1 | I - 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.