Esophageal and esophagogastric junction adenocarcinoma (staging)

Esophageal and esophagogastric junction adenocarcinoma staging refers to TNM staging of adenocarcinoma originating in the esophagus or esophagogastric junction (including tumors whose center 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 esophagus and esophagogastric 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 January 1, 2018 1,2.

  • Tx: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: high grade dysplasia (malignant cells confined to the epithelium by the basement membrame)
  • T1: tumor invades lamina propria, muscularis mucosae or submucosa
    • T1a: invades lamina propria or muscularis mucosae
    • T1b: invades submucosa
  • T2: tumor invades muscularis propria
  • T3: tumor invades adventitia
  • T4: tumor invades adjacent structures
  • 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: esophageal lymph node stations.

  • cM0: no distant metastasis
  • cM1: distant metastasis clinically present
  • pM1: distant metastases pathologically (microscopically) confirmed

NB: The MX category is no longer used, it was removed in the 6th edition of the TNM system, if presence of metastases is not known the cancer is assigned M0 5.

The prognostic stage group also depends on histologic grade.

  • Gx: differentiation cannot be assessed
  • G1: well differentiated. >95% of tumor is composed of well-formed glands
  • G2: moderately differentiated. 50% to 95% of tumor showing gland formation
  • G3: poorly differentiated or undifferentiated; composed of nest and sheets of cells with <50% of tumor demonstrating glandular formation

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.

  • 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
  • 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]
  • 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
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Article information

rID: 69164
Section: Staging
Tag: cases
Synonyms or Alternate Spellings:
  • Esophageal cancer staging - adenocarcinoma
  • Oesophagogastric junction adenocarcinoma staging
  • Esophagogastric junction adenocarcinoma staging
  • Gastroesophageal junction adenocarcinoma staging
  • Esophageal adenocarcinoma staging

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