Carcinoma of the Esophagus

Patients with esophageal carcinoma should be stratified to determine whether palliative treatment or attemptive curative therapy is appropriate. The importance of the staging of esophageal cancer (Table 5-1) lies in judging the resectability of the tumor and evaluating the prognosis of the patient. The stage of the disease has a direct effect on survival.8-11

Lymph node metastases are seldom present with a T1 mucosal (T1m) tumor, whereas the incidence with a T1 submucosal (T1sm) tumor is approximately 33%12 to 45%.13,14 Submucosal invasion by esophageal carcinoma is a decidedly advanced lesion, compared, for example, to a similar depth of penetration in gastric carcinoma. For patients with mucosal-type cancers, endoscopic resection or laser ablation is being used in many centers, particularly in Japan. In the United States and Europe, esophageal carcinomas are generally far advanced at the time of presentation.

Table 5-1. TNM Clinical Classification System for Staging Esophageal Cancers

Primary tumor (T)

Regional lymph nodes (N)

Distant metastasis (M)

Tumors of the lower thoracic esophagus:

Tumors of the midthoracic esophagus:

Tumors of the upper thoracic esophagus:

Primary tumor cannot be assessed No evidence of primary tumor Carcinoma in situ

Tumor invades lamina propria or submucosa Tumor invades muscularis propria Tumor invades adventitia Tumor invades adjacent structures

Regional lymph nodes cannot be assessed No regional lymph node metastasis Regional lymph node metastasis

Distant metastasis cannot be assessed No distant metastasis Distant metastasis

Metastasis in celiac lymph nodes Other distant metastasis

Not applicable

Nonregional lymph nodes and/or other distant metastasis

Metastasis in cervical nodes Other distant metastasis

Stage grouping

Stage 0

Tis

NO

MO

Stage I

TI

NO

MO

Stage IIA

T2

NO

MO

T3

NO

MO

Stage IIB

TI

N1

MO

T2

N1

MO

Stage III

T3

N1

MO

T4

Any N

MO

Stage IV

Any T

Any N

Ml

Stage IVA

Any T

Any N

Mia

Stage IVB

Any T

Any N

Mlb

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