A cancer staging primer: Esophagus and esophagogastric junction

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Presentation transcript:

A cancer staging primer: Esophagus and esophagogastric junction Thomas W. Rice, MD, Eugene H. Blackstone, MD, Valerie W. Rusch, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 3, Pages 527-529 (March 2010) DOI: 10.1016/j.jtcvs.2009.11.002 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Seventh edition TNM classifications. T is classified as Tis: high-grade dysplasia; T1: cancer invades lamina propria, muscularis mucosae, or submucosa; T2: cancer invades muscularis propria; T3: cancer invades adventitia; T4a: resectable cancer invades adjacent structures such as pleura, pericardium, or diaphragm; and T4b; unresectable cancer invades other adjacent structures, such as aorta, vertebral body, or trachea. N is classified as N0: no regional lymph node metastasis; N1: regional lymph node metastases involving 1 to 2 nodes; N2: regional lymph node metastases involving 3 to 6 nodes; and N3: regional lymph node metastases involving 7 or more nodes. M is classified as M0: no distant metastasis; and M1: distant metastasis. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 527-529DOI: (10.1016/j.jtcvs.2009.11.002) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Cancer location. Cervical esophagus, bounded superiorly by the cricopharyngeus and inferiorly by the sternal notch, is typically 15 to 20 cm from the incisors at esophagoscopy. Upper thoracic esophagus, bounded superiorly by the sternal notch and inferiorly by the azygos arch, is typically more than 20 to 25 cm from the incisors at esophagoscopy. Middle thoracic esophagus, bounded superiorly by the azygos arch and inferiorly by the inferior pulmonary vein, is typically more than 25 to 30 cm from the incisors at esophagoscopy. Lower thoracic esophagus, bounded superiorly by the inferior pulmonary vein and inferiorly by the lower esophageal sphincter, is typically more than 30 to 40 cm from the incisors at esophagoscopy; it includes cancers whose epicenter is within the proximal 5 cm of the stomach that extend into the esophagogastric junction or lower thoracic esophagus. UES, Upper esophageal sphincter; EGJ, esophagogastric junction. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 527-529DOI: (10.1016/j.jtcvs.2009.11.002) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Stage groupings for M0 adenocarcinoma by T and N classification and histologic grade (G). The Journal of Thoracic and Cardiovascular Surgery 2010 139, 527-529DOI: (10.1016/j.jtcvs.2009.11.002) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Stage groupings for M0 squamous cell carcinoma. A, Stage groupings for T1N0M0 and T2-3N0M0 squamous cell carcinomas by histologic grade (G) and cancer location. B, Stage groupings for all other M0 squamous cell carcinomas. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 527-529DOI: (10.1016/j.jtcvs.2009.11.002) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions