Oesophageal and oesophagogastric junction adenocarcinoma staging refers to TNM staging of adenocarcinoma originating in the oesophagus or oesophagogastric junction (including tumours whose centre is within the proximal 2 cm of the gastric cardia).
Related histologies included in this system are high-grade glandular dysplasia (intraepithelial neoplasia), adenoid cystic carcinoma, mucoepidermoid carcinoma, mixed adenoneuroendocrine carcinoma, and undifferentiated carcinoma with glandular component but without squamous component. While the individual TNM category definitions are identical to that of other histologies of oesophagus and oesophagogastric junction cancers, the prognostic stage groups are different. The following article reflects the 8th edition published by the American Joint Committee on Cancer, which is used for staging starting 1 January 2018 1,2.
For the other histological types, please refer to their dedicated staging articles:
- oesophageal and oesophagogastric junction squamous cell carcinoma (staging)
- oesophageal and oesophagogastric junction neuroendocrine tumour (staging)
On this page:
Primary tumour (T)
- Tx: primary tumour cannot be assessed
- T0: no evidence of primary tumour
- Tis: high-grade dysplasia (malignant cells confined to the epithelium by the basement membrane)
-
T1: tumour invades lamina propria, muscularis mucosae or submucosa
- T1a: invades lamina propria or muscularis mucosae
- T1b: invades submucosa
- T2: tumour invades muscularis propria
- T3: tumour invades adventitia
-
T4: tumour invades adjacent structures
- T4a: tumour invades pleura, pericardium, azygos vein, diaphragm, or peritoneum
- T4b: tumour invades other adjacent structures, e.g. aorta, vertebra, or trachea
Regional lymph node (N)
- Nx: regional nodes cannot be assessed
- N0: no regional lymph node metastasis
- N1: metastasis in 1-2 regional nodes
- N2: metastasis in 3-6 regional nodes
- N3: metastasis in ≥7 regional nodes
The regional lymph node stations are defined separately: oesophageal lymph node stations.
Distant metastasis (M)
- cM0: no distant metastasis
- cM1: distant metastasis clinically present
- pM1: distant metastasis pathologically (microscopically) confirmed
NB: The MX category is no longer used, it was removed in the 6th edition of the TNM system, if the presence of metastases is not known the cancer is assigned M0 5.
Other prognostic factors
The prognostic stage group also depends on the histologic grade.
Histologic grade (G)
- Gx: differentiation cannot be assessed
- G1: well-differentiated. >95% of the tumour is composed of well-formed glands
- G2: moderately differentiated. 50% to 95% of the tumour showing gland formation
- G3: poorly differentiated or undifferentiated; composed of nest and sheets of cells with <50% of tumour demonstrating glandular formation
Stage groups
Staging criteria are separated by treatment strategy: clinical (cTNM) classification prior to any treatment, pathologic (pTNM) classification after surgery alone, and posttherapy pathologic (ypTNM) classification after both neoadjuvant (systemic or radiation therapy) treatment and then surgery.
Clinical (cTNM)
-
stage 0
- Tis, N0, M0
-
stage I
- T1, N0, M0
-
stage IIA
- T1, N1, M0
-
stage IIB
- T2, N0, M0
-
stage III
- T2, N1, M0
- T3, [N0, N1], M0
- T4a, [N0, N1], M0
-
stage IVA
- [T1, T2, T3, T4a], N2, M0
- T4b, [N0, N1, N2], M0
- [Any T], N3, M0
-
stage IVB
- [Any T], [Any N], M1
Pathological (pTNM)
-
stage 0
- Tis, N0, M0, [G N/A]
-
stage IA
- T1a, N0, M0, [GX, G1]
-
stage IB
- T1a, N0, M0, G2
- T1b, N0, M0, [GX, G1, G2]
-
stage IC
- T1, N0, M0, G3
- T2, N0, M0, [G1, G2]
-
stage IIA
- T2, N0, M0, [GX, G3]
-
stage IIB
- T1, N1, M0, [Any G]
- T3, N0, M0, [Any G]
-
stage IIIA
- T1, N2, M0, [Any G]
- T2, N1, M0, [Any G]
-
stage IIIB
- T2, N2, M0, [Any G]
- T3, [N1, N2], M0, [Any G]
- T4a, [N0, N1], M0, [Any G]
-
stage IVA
- T4a, N2, M0, [Any G]
- T4b, [N0, N1, N2], M0, [Any G]
- [Any T], N3, M0, [Any G]
-
stage IVB
- [Any T], [Any N], M1, [Any G], [Any L]
Posttherapy pathological (ypTNM)
-
stage I
- [T0, T1, T2], N0, M0
-
stage II
- T3, N0, M0
-
stage IIIA
- [T0, T1, T2], N1, M0
-
stage IIIB
- T3, N1, M0
- [T0, T1, T2, T3], N2, M0
- T4a, N0, M0
-
stage IVA
- T4a, [NX, N1, N2], M0
- T4b, [N0, N1, N2], M0
- [Any T], N3, M0
-
stage IVB
- [Any T], [Any N], M1