Staging

Once a diagnosis of oesophageal carcinoma is established, staging of the condition is important in order to make an individualised treatment decision (1,2).

Staging of the diseases is carried out according to the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system.

• staging should include:
  • history and physical examination
  • upper-gastrointestinal endoscopy
  • CT of the chest, abdomen (useful to assess local spread of disease and metastases)
  • PET
  • endoscopic ultrasonography
  • bronchoscopy (for midoesophageal or upper-oesophageal lesions)
• TNM7 categories:
  • primary tumour (T)
    • TX Primary tumour cannot be assessed
    • T0 No evidence of primary tumour
    • Tis Carcinoma in situ/high-grade dysplasia
    • T1 Tumour invades lamina propria or submucosa
    • T1a Tumour invades mucosa or lamina propria or muscularis mucosae
    • T1b Tumour invades submucosa
    • T2 Tumour invades muscularis propria
    • T3 Tumour invades adventitia
    • T4 Tumour invades adjacent structures
    • T4a Tumour invades pleura, pericardium, diaphragm or adjacent peritoneum
    • T4b Tumour invades other adjacent structures such as aorta, vertebral body or trachea
  • regional lymph nodes (N)
    • NX Regional lymph nodes cannot be assessed
    • N0 No regional lymph node metastasis
    • N1 Metastasis in 1–2 regional lymph nodes
    • N2 Metastasis in 3–6 regional lymph nodes
    • N3 Metastasis in 7 or more regional lymph nodes
  • distant metastasis (M)
    • MX Distant metastasis cannot be assessed
    • M0 No distant metastasis
    • M1 Distant metastasis (1,2)

Reference:

• (1) Lordick F et al. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v50-v57.
• (2) Pennathur A et al. Oesophageal carcinoma. Lancet. 2013;381(9864):400-12.