1. Staging of Esophageal Cancer

2. A major change between the 2002 and the 2010 TNM staging system is the development of separate stage groupings according to histology

3. Other major differences from the 2002 classification include: 1.A simplification of tumor location 2.Redefinition of Tis as high-grade dysplasia 3.Subclassification of T4 disease 4.Subclassification of nodal (N) status 5.Reassignment of stage groupings

4. TNM TNM staging of esophageal cancer ( both squamous cell and adenocarcinoma) (SCC) Primary tumor (T)* TXPrimary tumor cannot be assessed T0No evidence of primary tumor TisHigh-grade dysplasia T1 T1a T1b Tumor invades lamina propria, muscularis mucosae, or submucosa Tumor invades lamina propria or muscularis mucosa Tumor invades submucosa T2Tumor invades muscularis propria T3Tumor invades adventitia T4 T4a T4b Tumor invades adjacent structures Resectable tumor invading pleura, pericardium, or diaphragm Unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.

5. Regional lymph nodes (N) NXRegional lymph node(s) cannot be assessed N0No regional lymph node metastasis N1Metastasis in 1-2 regional lymph nodes N2Metastasis in 3-6 regional lymph nodes N3Metastasis in seven or more regional lymph nodes

6. Distant metastasis (M) M0No distant metastasis M1Distant metastasis

7. Histologic grade (G) GXGrade cannot be assessed - stage grouping as G1 G1Well differentiated G2Moderately differentiated G3Poorly differentiated G4Undifferentiated - stage grouping as G3 squamous

8. Anatomic stage/prognostic groups Squamous cell carcinoma StageTNMGradeTumor location 0Tis (HGD) N0M01, XAny IAT1 N0M01, XAny IB T1N0M02-3Any T2-3N0M01, XLower, X IIA T2-3N0M01, X Upper, middle T2-3N0M02-3Lower, X IIB T2-3N0M02-3 Upper, middle T1-2N1M0Any

9. StageTNMGrade Tumor location IIIA T1-2N2M0Any T3N1M0Any T4aN0M0Any IIIBT3N2M0Any IIIC T4aN1-2M0Any T4bAnyM0Any N3M0Any IVAny M1Any

10. Anatomic stage/prognostic groups Adenocarcinom StageTNMGrade 0Tis (HGD)N0M01, X IAT1N0M01-2, X IB T1N0M03 T2N0M01-2, X IIAT2N0M03 IIB T3N0M0Any T1-2N1M0Any

11. Anatomic stage/prognostic groups Adenocarcinom IIIA T1-2N2M0Any T3N1M0Any T4aN0M0Any IIIBT3N2M0Any IIIC T4aN1-2M0Any T4bAnyM0Any N3M0Any IVAny M1Any