Staging of Oesophageal cancer ( TNM)

Staging of Oesophageal cancer

The most common system used to stage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The TNM system describes 3 key pieces of information. T refers to the size of the primary tumor and how far it has spread within the esophagus and to nearby organs. N refers to cancer spread to nearby lymph nodes. M indicates whether the cancer has metastasized (spread to distant organs). Stages

T

Stages

Stages

Information about the tumor, lymph nodes, and metastasis is then combined to assign a stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV: This is the earliest stage of esophageal cancer. This stage is also called carcinoma in situ, meaning that cancer cells are limited to the epithelium (the part of the mucosa forming the inner lining of the esophagus). The cancer does not invade the connective tissue beneath the epithelium. The cancer has not spread to lymph nodes or other organs. Stage I means that the esophageal cancer has invaded from the epithelium into the lamina propria or the submucosa. The cancer has not grown any deeper and has not spread to lymph nodes or to distant sites. There are 2 substages, IIA and IIB. In this stage, the cancer has invaded the muscularis propria and may extend through that layer into the adventitia, the connective tissue covering the outside of the esophagus. The cancer has not spread to lymph nodes or distant sites. The cancer may invade the lamina propria, submucosa, and the muscularis propria, but not the adventitia. However, it has spread to lymph nodes near the esophagus, but not to distant sites. Cancers in this stage have spread to the adventitia and to lymph nodes near the esophagus, or they have spread beyond the adventitia into nearby organs, such as the trachea (windpipe), and may or may not have spread to the lymph nodes. The cancer has not spread to lymph nodes farther away from the esophagus or to distant sites.

Stage 0 (Tis, N0, M0):

Stage I (T1, N0, M0):

Stage II:

Stage IIA (T2 or 3, N0, M0):

Stage IIB (T1 or 2, N1, M0):

Stage III (T3, N1, M0; OR T4, N0 or 1, M0):

There are 2 substages, IVA and IVB. This stage indicates that the esophageal cancer has spread to distant lymph nodes. If the esophageal cancer is in the upper part of the chest, it has spread to lymph nodes in the neck. For cancer of the lower part of the esophagus, it has spread to lymph nodes in the abdomen. This stage indicates that the esophageal cancer has spread to more distant lymph nodes or other distant sites, such as the liver, bones, or brain.

Stage IV:

Stage IVA (any T, any N, M1a):

Stage IVB (any T, any N, M1b):

Survival Rates by Stage

These numbers, from the National Cancer Data Base, describe the outcomes in 11,154 patients diagnosed in 1998:

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Five-year rates are used to produce a standard way of discussing prognosis. Of course, many people live much longer than 5 years. In addition, people diagnosed and treated in 2005 are likely to have improved survival rates than from 1998, due to improvements in treatment and care since that time. The 5-year relative survival rate incorporates the assumption that people will die of other causes and compares the observed survival with that expected for people without esophageal cancer. That means that relative survival only talks about deaths from esophageal cancer.