Σταδιοποίηση σε Ca Οισοφάγου

Ca Οισοφάγου

AJCC Stages – Πλακώδους επιθηλίου¹

Stages

T

N

M

G

Location²

0

Tis

N0

M0

G1, GX

Any location

IA

T1

N0

M0

G1, GX

Any location

IB

T1

N0

M0

G2-3

Any location

T2-3

N0

M0

G1, GX

Lower, X

IIA

T2-3

N0

M0

G1, GX

Upper, middle

T2-3

N0

M0

G2-3

Lower, X

IIB

T2-3

N0

M0

G2-3

Upper, middle

T1-2

N1

M0

Any G

Any location

IIIA

T1-2

N2

M0

Any G

Any location

T3

N1

M0

Any G

Any location

T4a

N0

M0

Any G

Any location

IIIB

T3

N2

M0

Any G

Any location

IIIC

T4a

N1-2

M0

Any G

Any location

T4b

Any N

M0

Any G

Any location

Any T

N3

M0

Any G

Any location

IV

Any T

Any N

M1

Any G

Any location

¹Or mixed histology including a squamous component or NOS. 
²Location of the primary cancer site is defined by the position of the upper (proximal) edge of the tumor in the esophagus.

AJCC Stages – Αδενοκαρκίνωμα

Stages

T

N

M

G

0

Tis

N0

M0

G1, GX

IA

T1

N0

M0

G1-2, GX

IB

T1

N0

M0

G3

T2

N0

M0

G1-2, GX

IIA

T2

N0

M0

G3

IIB

T3

N0

M0

Any G

T1-2

N1

M0

Any G

IIIA

T1-2

N2

M0

Any G

T3

N1

M0

Any G

T4a

N0

M0

Any G

IIIB

T3

N2

M0

Any G

IIIC

T4a

N1-2

M0

Any G

T4b

Any N

M0

Any G

Any T

N3

M0

Any G

IV

Any T

Any N

M1

Any G

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

High-grade dysplasia*

T1

Tumor invades lamina propria, muscularis mucosae, or submucosa

T1a

Tumor invades lamina propria or muscularis mucosae

T1b

Tumor invades submucosa

T2

Tumor invades muscularis propria

T3

Tumor invades adventitia

T4

Tumor invades adjacent structures

T4a

Resectable tumor invading pleura, pericardium, or diaphragm

T4b

Unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

At least maximal dimension of the tumor must be recorded; multiple tumors require the T(m) suffix.
Number must be recorded for total number of regional nodes sampled and total number of reported nodes with metastasis. 
*High-grade dysplasia includes all noninvasive neoplastic epithelia that was formerly called carcinoma in situ, a diagnosis that is no longer used for columnar mucosae anywhere in the gastrointestinal tract.

(N) Regional Lymph Nodes

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 regional lymph nodes

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

Χαρακτηριστικά Επέκτασης

Direct spread

• No anatomic barrier to prevent rapid local extension of tumor into mediastinum
  • Esophageal wall lacks serosa and is attached to neighboring structures by only loose connective adventitia
• Esophageal cancer can easily spread to adjacent structures in neck or thorax, including
  • Upper esophagus → trachea, thyroid gland, larynx
  • Middle esophagus → trachea, bronchi, aorta, lung, pericardium
  • Lower esophagus → aorta, lung, pericardium, diaphragm

Lymphatic spread

• Extensive lymphatic drainage system that consists of 2 lymphatic plexuses
  • First arises in mucosa
    • Pierces muscular layer and drains to regional lymph nodes
  • Second arises in muscular layer
• Flow of lymph in upper 2/3 of esophagus tends to be upward, whereas that in distal 1/3 tends to be downward
  • Tumors in upper esophagus are more likely to metastasize to cervical or mediastinal nodes
  • Tumors in distal esophagus are more likely to metastasize to abdominal lymph nodes
• All lymphatic channels intercommunicate, and there is bidirectional flow in tracheal bifurcation
  • Lymphatic fluid from any portion of esophagus may move to any other portion and may spread to any region of thorax or draining nodal bed
• Nodal stations as described by AJCC
  • 1: Supraclavicular nodes
    • Above suprasternal notch & clavicles
  • 2R: Right upper paratracheal nodes
    • Between intersection of caudal margin of innominate artery with trachea and lung apex
  • 2L: Left upper paratracheal nodes
    • Between top of aortic arch -lung apex
  • 3P: Posterior mediastinal nodes
    • Upper paraesophageal nodes, above tracheal bifurcation
  • 4R: Right lower paratracheal nodes
    • Between intersection of caudal margin of innominate artery with trachea and cephalic border of azygous vein
• 4L: Left lower paratracheal nodes
  • Between top of aortic arch and carina

• 5: Aortopulmonary nodes
  • Subaortic and paraaortic nodes lateral to ligamentum arteriosum
• 6: Anterior mediastinal nodes
  • Anterior to ascending aorta or innominate artery
• 7: Subcarinal nodes
  • Caudal to tracheal carina
• 8M: Middle paraesophageal nodes
  • From tracheal bifurcation to caudal margin of inferior pulmonary vein
• 8L: Lower paraesophageal nodes
  • From caudal margin of inferior pulmonary vein to esophagogastric junction
• 9: Pulmonary ligament nodes
  • Within inferior pulmonary ligament
• 10R: Right tracheobronchial nodes
  • From cephalic border of azygous vein to origin of right upper lung bronchus
• 10L: Left tracheobronchial nodes
  • Between carina and left upper lung bronchus
• 15: Diaphragmatic nodes
  • Lying on dome of diaphragm and adjacent to or behind its crura
• 16: Paracardial nodes
  • Immediately adjacent to gastroesophageal junction (GEJ)
• 17: Left gastric nodes
  • Along course of left gastric artery
• 18: Common hepatic nodes
  • Along course of common hepatic artery
• 19: Splenic nodes
  • Along course of splenic artery
• 20: Celiac nodes
  • At base of celiac artery

Hematogenous spread

• Most common sites, in descending order of frequency of occurrence
  • Liver
  • Lungs
  • Bones
  • Adrenal glands
  • Kidneys
  • Brain

Pleural or peritoneal seeding

• Pleural seeding follows tumor extension to parietal pleura
  • Peritoneal seeding is usually secondary to abdominal or retroperitoneal lymph node metastases

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Adenocarcinoma (AC) ≈ 50%
• Squamous cell carcinoma (SCC) ≈ 50%
  • SCC variants
    • Basaloid carcinoma
    • Spindle cell carcinoma
    • Verrucous carcinoma
    • Lymphoepithelioma-like Ca

• Other esophageal cancers
  • Melanoma
  • Malignant stromal tumors
  • Carcinoid
  • Lymphoma
  • Other rare carcinomas