95adjuvant therapy (administration of therapeutic agents such as
chemoradiation before a main treatment) whereas the post-
neoadjuvant pathological prognostic staging group (yp) is for
patients having neoadjuvant therapy to the cancer before the
esophagectomy (see Note 3).- Determine the extent of involvement of the adenocarcinoma
in the esophagus and the adjacent structures (T stage). T stage
of the tumors can be classified into T0, Tis, T1 (T1a and T1b),
T2, T3, and T4 (T4a and T4b) (see Note 4). - Count the number of regional lymph nodes involved by the
adenocarcinoma and assign the cancer to subgroups N0, N1,
N2, and N3 (see Note 5). - Determine whether there are distant metastases and grouped
the cancer into M0 or M1 (see Note 6). - For pathological staging group after esophagectomy with no
preoperative neoadjuvant therapy, obtain the histological grade
(G) of the esophageal adenocarcinoma from pathological
examination of the resected esophageal (see Note 7). - Refer to the Table in the eighth edition of the AJCC Cancer
Staging Manual (based on the T, N, M, and G) in order to get
an overall staging prognostic group. The staging prognostic
groups broadly divide the adenocarcinoma into four stage
groups: I, II, III, and IV (see Note 8). These subgroups have
different biological behaviors. - Additional factors recommended for clinical care include
tumor length, lymphovascular invasion, histoviability, surgical
margin, extranodal extension, and HER2 status of the esopha-
geal adenocarcinoma.
4 Notes
- The esophagus starts below the hypopharynx and has two por-
tions: cervical and thoracic esophagus. Clinically, the location
of the esophageal cancer is identified by endoscopic measure-
ments from the incisors. The esophagus starts at approximately
15 cm from the incisor. The lower extent of an esophageal
cancer is a controversial concept. It is difficult to define whether
the adenocarcinoma originates from esophagus or from the
stomach if both esophagus and stomach are involved. In future,
genetic signatures of the cancer may identify the features that
characterize the carcinoma from these two sites. In the current
edition of staging, a tumor of the epicenter within 2 cm of the
esophagogastric junction is classified as esophageal cancer.
Thus, any tumor with epicenter more than 2 cm from the
esophagogastric junction.
Pathological Staging and Esophageal Adenocarcinoma