I. Segmentation of esophageal cancer, the new version of TNM criteria for esophageal cancer determines the primary site of esophageal cancer by the location of the esophagus where the upper edge of the mass is located, and the distance from the upper incisor to the upper edge of the mass is used to indicate the specific location.
Cervical segment esophagus: up to the hypopharynx, down to the entrance of the thorax in the plane of sternotomy, 15 cm to <20 cm from the incisors on endoscopy.
Upper thoracic esophagus: superiorly from the thoracic inlet and inferiorly to the level of the inferior border of the odd vein arch, 20 cm to <25 cm from the incisors on endoscopy.
Middle thoracic esophagus: upper from the lower edge of the odd vein arch, lower to the level of the inferior pulmonary vein, 25 cm to <30 cm from the incisor on endoscopy.
Lower thoracic esophagus: superiorly from the level of the inferior pulmonary vein, down to the level of the stomach, 30 cm to <40 cm from the incisors on endoscopy.
Esophagogastric junction (EGJ) cancer: the distal esophagus 5 cm above the EGJ and the proximal stomach 5 cm below the EGJ is a controversial site. The new version of TNM staging of esophageal cancer is harmonized with the TNM staging of gastric cancer, which clearly stipulates that any tumor located in 1) the lower esophagus; 2) invading the EGJ; all according to the TNM staging of esophageal adenocarcinoma; 3) adenocarcinoma occurring within 5 cm of the proximal stomach that does not invade the EGJ (3) adenocarcinoma occurring within 5 cm of the proximal part of the stomach without invading the EGJ can be called pancreatic cancer.
II. TNM definition of esophageal cancer in the 7th edition
1.Primary Tumor (T)
Tx: primary tumor cannot be determined
T0: no evidence of primary tumor.
Tis: severe atypical hyperplasia.
T1: tumor invading the lamina propria, myxomucosa, or submucosa of the mucosa.
T1a: tumor invading the lamina propria or myxomucosa of the mucosa.
T1b: tumor invading the submucosal layer.
T2: tumor invading the muscular layer of the esophagus.
T3: tumor invading the fibrous membrane of the esophagus.
T4: tumor invading the peri-esophageal structures.
T4a: tumor invading the pleura, pericardium or diaphragm (surgically resectable).
T4b: tumor invades other adjacent structures such as aorta, vertebral body, trachea, etc. (not surgically resectable).
2.Regional Lymph Nodes (N)
Nx: Regional lymph node metastasis cannot be determined.
N0: no regional lymph node metastasis.
N1: 1-2 regional lymph node metastases.
N2: 3-6 regional lymph node metastases.
N3: ≥7 regional lymph node metastases.
Note: The number of metastatic lymph nodes must be recorded together with the total number of cleared lymph nodes.
3.Distant Metastasis (M)
M0: no distant metastasis.
M1: with distant metastasis.
4.Tumor differentiation degree (Histologic Grade, G)
Gx: the degree of differentiation cannot be determined —- according to G1 staging.
G1: highly differentiated carcinoma.
G2: moderately differentiated carcinoma.
G3: poorly differentiated carcinoma.
G4: undifferentiated carcinoma —- staged according to G3.
Third, the 7th edition of TNM staging of esophageal cancer
1, Squamous cell carcinoma (including other non-adenocarcinoma types)
Staging
T
N
M
G
Part*
0
is (HGD)
0
0
1, X
Any
IA
1
0
0
1, X
Any
IB
1
0
0
2-3
Any
2-3
0
0
1, X
Lower segment, X
IIA
2-3
0
0
1, X
Middle and upper section
2-3
0
0
2-3
Lower segment, X
IIB
2-3
0
0
2-3
Middle and upper sections
1-2
1
0
Any
Any
IIIA
1-2
2
0
Any
Any
3
1
0
Any
Any
4a
0
0
Any
Any
IIIB
3
2
0
Any
Any
IIIC
4a
1-2
0
Any
Any
4b
Any
Any
Any
Any
Any
3
Any
Any
Any
Any
Any
Any
1
Any
Any
*: Tumor site is defined by the location of the upper edge of the tumor in the esophagus; X refers to the unrecorded tumor site.
2, 7th edition TNM staging of esophageal cancer: adenocarcinoma
Staging
T
N
M
G
0
is (HGD)
0
0
1, X
IA
1
0
0
1-2, X
IB
1
0
0
3
2
0
0
1-2, X
IIA
2
0
0
3
IIB
3
0
0
Any
1 – 2
1
0
Any
IIIA
1-2
2
0
Any
3
1
0
Any
4a
0
0
Any
IIIB
3
2
0
Any
IIIC
4a
1-2
0
Any
4b
Any
0
Any
Any
3
Any
Any
Any
Any
Any
1
Any
IV. Regional lymph node names and codes of esophageal cancer
Code
Name
Part Description
1
Supraclavicular lymph node
Located in the supraclavicular notch of the sternum and supraclavicular
2R
Right upper paratracheal lymph node
Located between the angle of intersection of the trachea and the root of the innominate artery and the tip of the lung
2L
Left upper paratracheal lymph node
Located between the apex of the aortic arch and the tip of the lung
3P
Posterior mediastinal lymph node
Located above the bifurcation of the trachea, also known as the upper paraesophageal lymph node
4R
Right lower paratracheal lymph node
Located between the angle of intersection of the trachea and the root of the innominate artery and the head of the odd vein
4L
Left lower paratracheal lymph node
Located between the apex of the aortic arch and the bulge
5
Aortopulmonary window lymph node
Located under the aortic arch, para-aortic and lateral to the ductus arteriosus
6
Anterior mediastinal lymph nodes
Located in front of the ascending aorta and the innominate artery
7
Inferior bulbar lymph nodes
Located at the root of the tracheal bifurcation
8M
Middle paraesophageal lymph node
Located between the tracheal bulge and the root of the inferior pulmonary vein
8L
Lower paraesophageal lymph node
Located between the root of the inferior pulmonary vein and the esophagogastric junction
9
Inferior pulmonary ligament lymph node
Located within the inferior pulmonary ligament
10R
Right tracheobronchial lymph node
Located between the head of the odd vein and the beginning of the right upper lobe bronchus
10L
Left tracheobronchial lymph node
Located between the bulge and the beginning of the left upper lobe bronchus
15
Diaphragmatic lymph nodes
Located between the bulging surface of the diaphragm and the foot of the diaphragm (supra-diaphragm)
16
Peripancreatic lymph nodes
Lymph nodes located around the gastroesophageal junction (subdiaphragm)
17
Left gastric lymph node
Located in the left gastric artery travel area
18
General hepatic lymph node
Located in the area of the common hepatic artery
19
Splenic lymph nodes
Located in the area of the splenic artery
20
Abdominal lymph nodes
Located around the abdominal cavernous artery
Note: 11 – interlobular lymph nodes, 12 – lobar lymph nodes; 13 – segmental lymph nodes; 14 – subsegmental lymph nodes are not part of the lymph nodes draining from esophageal cancer and are not listed in this table.