98
on the grade and T stage of the cancer [ 10 – 13 ]. Rizk and col-
leagues proposed that in T1 approximately 10 lymph nodes
must be sampled; in T2, 20 lymph nodes; and in T3 or T4, 30
lymph nodes or more [ 10 ]. Other studies have suggested that
12–23 nodes should be sampled [ 11 , 12 ].- The current edition of prognostic stage grouping labeled ade-
nocarcinoma with separate focus on adenocarcinoma in distant
organ(s) being as M1. M1 also includes non-regional lymph
nodes involved by adenocarcinoma. The absence of distant
metastasis is M0. The presence of distant metastases could be
determined by the radiological examination as well as observa-
tion plus or minus biopsy examination during the operation. - In esophageal adenocarcinoma, the grade of the tumor is a new
criterion in addition to the TNM staging in the seventh edition of
the Staging Manual. The grade (differentiation) of adenocarcinoma
is important in the subgrouping of the early stages (stage I or II)
Fig. 3 T3: esophageal adenocarcinoma involves the adventitia of the esophagus. Note the carcinoma pass
through the muscularis propria into fibrous tissue of the adventitia (arrow)
Fig. 4 The definition of regional lymph node (N) stage in AJCC. The right side of the figure reveals a peri-
esophageal lymph node infiltrated by esophageal adenocarcinoma (arrows). The left side shows how the dif-
ferent N stage are classified by the number of lymph nodes with metastases
Alfred K. Lam