‘Table 1, N, and M status and histologie grade definitions for, esophagus and esophayogastrc junction cancer in the 7*etition of the American Joint Committee on Cancer (AJC) Cancer Sting Manual Tstatus Ths High-grade dysplasia 1" Invasion into the lamina propria, muscularis mucosae, Of: ‘submucosa 2 Invasion into muscularis propria 13 Invasion into adventitia Téa Invades resectable adjacent structures (pleura, pericardium, diaphragm) Téb Invades unresectable adjacent structures (aorta, vertebral body, trachea) Nstatus NO No regional lymph node metastases NM 1 to 2 positive regional Iymoh nodes N2 3106 positive regional lymph nodes NB Tor more positive regional lymph nodes Mstatus MO No distant metastases, MH Distant metastases Histologic grade Gi Well differentiated @2 Moderately differentiated @ Poorly differentiated @ Undifferentiated Table New WECC / AJCC Staging System for Esophageal Cancer ‘TN Classifications Grade x T stage M stage wm ‘Stago Classifications Stage 0 Stage tA ‘Stage 1B Stage wa Stage 18 Stage WA Stage me Stage IC Stage 'V Grade cannot be assessed Wel ateremiates Moceratayaierentates Pool diferontitod Undierentiated Primary tumor cannot be assessed No evidence of primary tumor High grace dysplasia Tumor invading lina propia or muscular mucosae Tumor invading submucosa Tumor invading muscularis props Tumor invading adventia Tumor invading pleura, peicarcum, or daptragm “Tumor invading other ajaoent structures Regional lymph nodes cannot be assessed No regional lymph node metastasis Regional lymph noge metastasis involving 1-2 nodes* Regional mph node metastasis involving 26 nodes! Regina ymph node metastasis inoWing 7 of more nodes Distant metastass eannot be assossod No stant meastasie 'Noneogional mph node metastasis or distant metastasis TONOMO, any grade Tis NO MO, any grade T1NOMO, grade 1-2 T1NOMO, grade a T2NOMO, grade 1-2 T2NOMO, grade 3 T3NOMO T0.2N1 NO, any grade T0-2N2NO, ary grade T3N1MO, any grade Téa NO MO, any rade T3NZMO, any grade Tia N1-2 MO, any grade Téb any NIMO, any grade ‘Any TNO MO, any grado ‘Any, any N, Mi any grade Tedcseand om orsophageal oval calc rode “Region WCC = Voed Esophageal Care: Conenum, AJCC = Amaran Jot Carmite on Cancer, T= Tumor Ne Node: M MotaSymptoms concerning for esophageal cancer Y Upper endescopy Y If suspicious lesion(s) present Study results normal perform biopsies or brushing Follow-up as ‘ ' No evidence Adenocarcinoma or of malignancy ‘squamous cell carcinoma ‘ t Follow-up as Integrated positron emission necessary tomography/computed tomography; laboratory toste rr 7? _ rest No distant metastasor Distant metastases —_— | once 3 Endoscopic Evaluate tor 4- sitraconography palliative therapy ‘with brachytherapy Or storing No lymphovascular invasion ymphovascular invasion I.©6h fine-needle aspiration during endoscopic Lesion < 2.cm and Lesion 22cm tubtraconiedeaese limited to mucosa fr submucosal nae oF lamina propria invasion (T1b, Tis, Tta lesions) 12.73 lesions) ndoscoph: Evaluate therapeutic options Table 3. Treatment Options and Survival Rates for Esophageal Cancer by Stage Fve-year SEERstage _AICCstag0 Treatment surat Localized Stage |(T1, ND, MO) through stage IIB Endoscopic mucosal resection AN% (13, NO, MQ) Esophagectomy if invasion beyond the submucosa without Iymph node imohernent eqional stage HE (T1-2, NI, Mo) ough stage Esophagectomy) with lymotadenectomy 23% INC (ary eassfeation 2, MO) ecadjaer/ajuvant chemotherapy or chemoradotherapy Ditant Stage IV arachythorapy 5% Esophageal bypass surgery Jelunostomy or gastrostomy tubes Palliative chemotherapy Self-expanding mucosal stents Trastuzumab (Herceptin) therapy A smeriean Joint Committee an Cancor: SEER urvailnce, Epidemiology, and End Recut Informetion irom references 3, 22,26, and 3)