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united to publish staging manual (fourth edition for UICC and
third edition for AJCC). There are many subsequent editions for
UICC and AJCC refining the criteria for staging [ 4 , 5 ].
For esophageal cancer, the criteria for staging started to have
major modifications in the seventh edition published in 2009 and
have more enhancement in the current edition (eighth edition)
published in 2016 [ 6 , 7 ]. One of the major changes is the inclusion
of additional prognostic factors to the anatomical factors (TNM).
Thus, AJCC adopts the term prognostic stage group. In addition,
the enhancement of staging criteria in the current versions has
input of the survival data of large number of patients from
Worldwide Esophageal Cancer Collaboration (WECC) which was
founded in 2006 [ 8 ]. WECC collected data from multiple institu-
tions in different countries in different continents of the world.
This chapter will describe and highlight the principle and
changes in the most recent staging information concerning esoph-
ageal adenocarcinoma.2 Materials
- Have the surgical specimens dissected and with the hematoxy-
lin and eosin slides reviewed by pathologists collected. - The pathological report.
- Clinical information as obtained by multidisciplinary team
meeting for management of cancer. - The most recent edition of American Joint Committee on
Cancer (AJCC) Cancer Staging Manual.
3 Methods
- Define the cancer whether it is from the esophagus or from the
stomach by determining the anatomical location (see Note 1). - Look for staging information specific for esophageal adenocar-
cinoma (see Note 2). - Select the section for the type of staging specific for the status
of the patients.
In the eighth edition of the AJCC Cancer Staging Manual,
this is the first time that there are three prognostic staging
groups for esophageal adenocarcinoma. The first one is clinical
staging based on clinical, radiological, and endoscopic finding
before operation. The other two prognostic staging groups are
for patients after esophagectomy. The pathological staging
prognostic group is for patients without any preoperative neo-
Alfred K. Lam