Oesophageal and oesophagogastric junction squamous cell carcinoma (staging)

Oesophageal and oesophagogastric junction squamous cell carcinoma staging refers to TNM staging of squamous cell carcinoma 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 squamous intraepithelial neoplasia (dysplasia), basaloid squamous cell carcinoma, adenosquamous carcinoma, spindle cell (squamous) carcinoma, verrucous (squamous) carcinoma, and undifferentiated carcinoma with a squamous component. While the individual TNM category definitions are identical to that of other histologies of the oesophagus and oesophagogastric junction cancers, the prognostic stage groups are different. The following article reflects the 8^th 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 adenocarcinoma (staging)
• oesophageal and oesophagogastric junction neuroendocrine tumour (staging)

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

Other prognostic factors

The prognostic stage group also depends on histologic grade and location.

Histologic grade (G)

• GX: grade cannot be assessed
• G1: well-differentiated: prominent keratinisation with pearl formation and a minor component of nonkeratinizing basal-like cells; tumour cells arranged in sheets, and low mitotic counts
• G2: moderately differentiated; variable histologic features, ranging from parakeratotic to poorly keratinising lesions; generally, pearl formation absent
• G3: poorly differentiated or undifferentiated; predominantly of basal-like cells forming large and small nests with frequent central necrosis; nests consist of sheets or pavement-like arrangements of tumour cells, and occasionally punctuated by small numbers of parakeratotic or keratinising cells

Location (L)

Location is defined by the centre of the tumour within the oesophagus.

• X: location unknown
• upper: cervical oesophagus to lower border of azygos vein
• middle: lower border of azygos vein to lower border of inferior pulmonary vein
• lower: lower border of inferior pulmonary vein to stomach, including gastrooesophageal junction

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, N1], M0
• stage II
  • ​T2, [N0, N1], M0
  • T3, N0, M0
• stage III
  • ​T3, N1, M0
  • [T1, T2, T3], N2, M0
• stage IVA
  • ​T4, [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], [Any L]
• stage IA
  • T1a, N0, M0, [GX, G1], [Any L]
• stage IB
  • T1a, N0, M0, [G2, G3], [Any L]
  • T1b, N0, M0, [Any G], [Any L]
  • T2, N0, M0, G1, [Any L]
• stage IIA
  • T2, N0, M0, [GX, G2, G3], [Any L]
  • T3, N0, M0, G1, [upper, middle]
  • T3, N0, M0, [G1, G2, G3], [lower]
• stage IIB
  • T1, N1, M0, [Any G], [Any L]
  • ​T3, N0, M0, [G2, G3], [upper, middle]
  • T3, N0, M0, GX, [upper, middle, lower]
  • T3, N0, M0, [Any G], [Location X]
• stage IIIA
  • T1, N2, M0, [Any G], [Any L]
  • T2, N1, M0, [Any G], [Any L]
• stage IIIB
  • ​T2, N2, M0, [Any G], [Any L]
  • T3, [N1, N2], M0, [Any G], [Any L]
  • T4a, [N0, N1], M0, [Any G], [Any L]
• stage IVA
  • ​T4a, N2, M0, [Any G], [Any L]
  • T4b, [N0, N1, N2], M0, [Any G], [Any L]
  • [Any T], N3, M0, [Any G], [Any L]
• 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