Esophageal Adenocarcinoma Methods and Protocols

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Alfred K. Lam (ed.), Esophageal Adenocarcinoma: Methods and Protocols, Methods in Molecular Biology, vol. 1756,
https://doi.org/10.1007/978-1-4939-7734-5_9, © Springer Science+Business Media, LLC 2018

Chapter 9

Application of Pathological Staging in Esophageal

Adenocarcinoma

Alfred K. Lam

Abstract

Staging is one of the most important factors that determine the prognosis of the patients with esophageal
adenocarcinoma. The current staging protocol includes parameters—extent of tumor (T), lymph node
status (N), presence of distant metastasis (M), and grade of the adenocarcinoma (G). In addition, different
criteria are used in patients with and without neoadjuvant therapy. The silent aspects of the use of new
staging protocol are discussed.

Key words Esophageal adenocarcinoma, Staging, Pathological, Neoadjuvant therapy, Grade

1 Introduction

Cancer staging is the most important factor in the management of

the patients with esophageal adenocarcinoma. It is actually a

description of the extent of a cancer in a human body. Clinically,

staging is essential for planning the treatment and predicting the

prognosis of the patients with the cancer. Many translational stud-

ies in esophageal adenocarcinoma as well as clinical trials need to

incorporate the staging information of the cancer. However, the

staging of cancer has changed in the recent years in order to cater

for a more personalized approach for the patients with the cancer.

Clinicians and researchers working on the esophageal adenocarci-

noma need to have update information on staging the cancer.

The globally accepted basic principle of the staging depends on

anatomical factors—tumor extent (T), lymph node status (N), and

distant metastases (M) on cancer. Pierre Denoix of the Cancer

Institute Gustave-Roussy from France developed this concept in

1940 [ 1 ]. Union for International Cancer Control (UICC) pub-

lished the first TNM staging manual in 1968 and the manual

includes esophageal cancer [ 2 ]. On the other hand, American Joint

Committee on Cancer (AJCC) published the first edition of Cancer

Staging Manual in 1977 [ 3 ]. It was until 1988, UICC and AJCC