I. Segmentation of esophageal cancer
Unlike the previous version, 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 incisors to the upper edge of the mass is used to indicate the specific location.
Cervical segment esophagus: up to the hypopharynx and down to the entrance of the thorax in the plane of the sternotomy, 15 cm to <20< span=""> 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< span="">cm from the incisors on endoscopy.
Middle thoracic esophagus: superiorly from the inferior border of the odd vein arch, inferiorly to the level of the inferior pulmonary vein, 25 cm to <30< span="">cm from the incisors on endoscopy.
Lower thoracic esophagus: superiorly from the level of the inferior pulmonary vein, down to the level of the final stomach, 30 cm to <40< span=""> 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 content of 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 without invading 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. Definition of TNM for esophageal cancer
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.
Regional lymph node names and codes of esophageal cancer
Supraclavicular lymph node: located on the supraclavicular notch and the clavicle, 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 pulmonary apex, 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 nodes: located under the aortic arch, para-aortic and lateral to the ductus arteriosus,6
Anterior mediastinal lymph nodes: located anterior to the ascending aorta and the innominate artery,7
subaortic lymph node: located at the root of the tracheal bifurcation, 8M
Middle paraoesophageal lymph node: located between the tracheal ramus and the root of the inferior pulmonary vein, 8L
Lower paraoesophageal lymph node: located between the root of the lower 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 ramus 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
peri-pancreatic lymph nodes: lymph nodes located around the gastroesophageal junction (subdiaphragm),17
Left gastric lymph node: located in the area of the left gastric artery,18
Common hepatic lymph nodes: located in the region of the common hepatic artery,19
Splenic lymph nodes: located in the region 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 were not part of the lymph nodes draining from esophageal cancer and were not listed in this table.