Esophageal Cancer TNM Staging

Primary tumor (T)

TX
T0
Tis
T1
T2
T3
T4

Primary tumor cannot be assessed
No evidence of primary tumor
Carcinoma in situ
Tumor invades lamina propria or submucosa
Tumor invades muscularis propria
Tumor invades adventitia
Tumor invades adjacent structures

Refer to the
AJCC Stage Groupings
below for somewhat clearer explainations of tumor classification.

Regional lymph nodes (N)

NX
N0
N1

Regional lymph nodes cannot be assessed
No regional lymph node metastasis
Regional lymph node metastasis

Distant metastasis (M)

MX
M0
M1

Distant metastasis cannot be assessed
No distant metastasis
Distant metastasis

Lower esophagus:

Mid esophagus:

Upper esophagus:

M1a

Metastasis in celiac
lymph nodes

For tumors of mid thoracic esophagus use only M1b, since metastasis in non regional lymph nodes have an equal prognosis with other distant metastasis.

Metastasis in cervical
lymph nodes

M1b

Other distant
metastasis

Non regional lymph
nodes and/or other
distant metastasis

Other distant
metastasis

Stage 0

Tis, N0, M0

Cancer cells are only in the lining of esophagus (in the epithelium). Cancer has not invaded the outer layers or lymph nodes. May be called, "carcinoma in situ."

Stage I

T1, N0, M0

Cancer has invaded from the lining layer into outer layer of tissue, but not as far as the muscle layer. No tumor has spread to lymph nodes.

Stage IIA

T2, N0, M0
T3, N0, M0

Cancer has invaded the muscle layer and outermost covering layer or tissue, but has not spread to lymph nodes.

Stage IIB

T1, N1, M0
T2, N1, M0

Cancer has invaded the muscle layer and spread to nearby lymph nodes. It has not invaded the covering layer of the esophagus.

Stage III

T3, N1, M0
T4, Any N, M0

Cancer has spread as far as the outer layer of the esophagus, into nearby tissues such as lymph nodes next to the esophagus. No tumor has spread to lymph nodes in the neck or abdomen, or to other organs.

Stage IV

Any T, Any N, M1

Cancer has spread to lymph nodes away from the original tumor or to other parts of the body (liver, bones, brain). Refer to the TNM Definitions above for specific Stage IV M1a and M1b differentiation.

Stage IVA

Any T, Any N, M1a

Stage IVB

Any T, Any N, M1b