esophageal CA staging Flashcards
(161 cards)
1
Q
esoph CA
Tis
depth of invasion
A
confined to epithelium
i.e. NOT invading the basement membrane
= definition of high-grade dysplasia (HGD)
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
2
Q
esoph CA
T1a
depth of invasion
A
mucosa:
lamina propria OR muscularis mucosae
into but not through
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
3
Q
esoph CA
T1b
depth of invasion
A
submucosa
into but not through
broken down into SM1/2/3 for superfic/middle/deep 1/3 of submucosa respectively
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
4
Q
esoph CA
T2
depth of invasion
A
muscularis propria
into but not through
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
5
Q
esoph CA
T3
depth of invasion
A
adventitia
i.e. has escaped the esophagus
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
6
Q
esoph CA
T4
depth of invasion
A
adjacent structures
subcategorized into T4a & T4b by resectability
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
7
Q
esoph CA
T4a
depth of invasion
A
resectable structures:
pleura
pericardium
azygos vein
diaphragm
peritoneum
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
8
Q
esoph CA
T4b
depth of invasion
A
unresectable structures
all else from T4a incl:
aorta
vertebral body
trachea
adjacent visceral organs (incl liver, pancreas, lung, spleen)
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
9
Q
esoph CA
layers of the esophageal wall
starting from internal lumen moving externally
for staging;
A
- epithelium (mucosa)
- basement membrane (mucosa)
- lamina propria (mucosa)
- muscularis mucosae (mucosa)
- submucosa
- muscularis propria (incl circular & longitudinal fiber layers)
- [adventitia]
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
10
Q
esoph CA
N0
A
self-explanatory
11
Q
esoph CA
N1
A
1-2 regional LN+
any regional LN
12
Q
esoph CA
N2
A
3-6 regional LN+
any regional LN
13
Q
esoph CA
N3
A
7+ regional LN+
any regional LN
14
Q
esoph CA
M0
A
self-explanatory
15
Q
esoph CA
M1
A
any distant met(s)
16
Q
Does adenoCA staging, SCC staging, or both incorporate location of the tumor?
A
SCC only
(L-upper/middle/lower)
17
Q
esoph CA
L-upper (for SCC)
A
cervical esophagus to lower border of azygos vein
18
Q
esoph CA
L-middle (for SCC)
A
lower border of azygos vein to lower border of IPV
IPV = inferior pulmonary vein
19
Q
esoph CA
L-lower (for SCC)
A
lower border of IPV to stomach, incl GEJ
IPV = inferior pulmonary vein
20
Q
esoph CA
How is location defined for L-category (for SCC)?
(or for Siewert classification of GEJ CA)
A
by “epicenter”
21
Q
EGD distance (from incisors) of:
UES
A
15cm
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
22
Q
EGD distance (from incisors) of:
sternal notch
A
20cm
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
23
Q
EGD distance (from incisors) of:
azygos vein
A
25cm
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
24
Q
EGD distance (from incisors) of:
IPV
A
30cm
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
25
EGD distance (from incisors) of:
LES
40cm
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
26
EGD distance (from incisors) of:
GEJ
40-42cm
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
27
Siewert I
| definition
5cm prox to GEJ
to 1cm prox to GEJ
| GEJ defined as Z-line
## Footnote
https://drive.google.com/file/d/197a9Fj0M2bSiCo0Fh4YgqYx7tK1bEgfg/view
28
Siewert II
| definition
1cm prox to GEJ
to 2cm dist to GEJ
| GEJ defined as Z-line
## Footnote
https://drive.google.com/file/d/197a9Fj0M2bSiCo0Fh4YgqYx7tK1bEgfg/view
29
Siewert III
| definition
2cm dist to GEJ
to 5cm dist to GEJ
*tx as gastric CA*
| GEJ defined as Z-line
## Footnote
https://drive.google.com/file/d/197a9Fj0M2bSiCo0Fh4YgqYx7tK1bEgfg/view
30
cervical esophagus
| distance/definition
15-20cmFI
UES : sternal notch
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
31
upper [thoracic] esophagus
| distance/definition
20-25cmFI
sternal notch : azygos vein
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
32
middle [thoracic] esophagus
| distance/definition
25-30cmFI
azygos vein : IPV
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
33
distal [thoracic] esophagus
| distance/definition
30-40cmFI
IPV : LES
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
34
# esoph CA
SCC cI
T1 N0-1
35
# esoph CA
adenoCA cI
T1 N0 *only*
36
# esoph CA
difference between SCC & adenoCA cI
both include T1 N0
*only* SCC also incl T1 N1
37
# esoph CA
SCC cII
T2 N0-1
T3 N0
38
# esoph CA
Are there substages of SCC cII?
NO
39
# esoph CA
Are there substages of adenoCA cII?
YES
40
# esoph CA
Are there substages of cIII for either adenoCA or SCC?
NO
41
# esoph CA
adenoCA cIIA
T1 N1 *only*
42
# esoph CA
adenoCA cIIB
T2 N0 *only*
| note that T2 is worse than N1
43
# esoph CA
adenoCA cIII
T3-4a N0
T2-4a N1
44
# esoph CA
adenoCA cIVA
T4b
N2
N3
45
# esoph CA
SCC cIII
T3 N1
T1-3 N2
46
# esoph CA
SCC cIVA
T4a-T4b
N3
47
# esoph CA
cIVB (either SCC or adenoCA)
M1
48
How is tumor grade used in esophageal CA p-staging?
substratifies T stage for T1a,T1b,T2 in adenoCA & for T1a,T2,T3 in SCC
49
# esoph CA
T-stage: confined to the epithelium
| i.e. NOT through the basement membrane
Tis
| = definition of *high-grade dysplasia*
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
50
# esoph CA
T-stage: invades lamina propria
| into but not through
T1a
| confined to the mucosa
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
51
# esoph CA
T-stage: invades muscularis mucosae
| into but not through
T1a
| confined to the mucosa
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
52
# esoph CA
T-stage: invades submucosa
| into but not through
T1b
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
53
# esoph CA
T-stage: invades muscularis propria
| into but not through
T2
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
54
# esoph CA
T-stage: invades adventitia
| i.e. has escaped the esophagus
T3
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
55
# esoph CA
T-stage: invades adjacent structures
T4
| subcategorized into T4a & T4b by resectability
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
56
# esoph CA
T-stage: invades pleura
T4a
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
57
# esoph CA
T-stage: invades pericardium
T4a
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
58
# esoph CA
T-stage: invades azygos vein
T4a
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
59
# esoph CA
T-stage: invades diaphragm
T4a
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
60
# esoph CA
T-stage: invades peritoneum
T4a
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
61
# esoph CA
T-stage: invades aorta
T4b
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
62
# esoph CA
T-stage: invades vertebral body
T4b
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
63
# esoph CA
T-stage: invades trachea
T4b
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
64
What layers of the esophageal wall comprise the **mucosa**?
| in order from luminal outward
layers of the esophageal wall
(starting from internal lumen moving externally)
**1. epithelium
2. basement membrane
3. lamina propria
4. muscularis mucosae**
5. submucosa
6. muscularis propria (incl circular & longitudinal fiber layers)
7. [adventitia]
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
65
What are the primary (big picture) layers of the esophageal wall?
| in order from luminal outward
**1. mucosa
2. submucosa
3. muscularis**
layers of the esophageal wall
(starting from internal lumen moving externally)
1. epithelium
2. basement membrane
3. lamina propria
4. muscularis mucosae
5. submucosa
6. muscularis propria (incl circular & longitudinal fiber layers)
7. [adventitia]
## Footnote
https://drive.google.com/file/d/1HC1jAdUxITpbG7PY_yVDqhRF47PcnnvF/view
66
# esoph CA
N-stage: 1-2 LN+
| any regional LN
N1
67
# esoph CA
N-stage: 3-6 LN+
| any regional LN
N2
68
# esoph CA
N-stage: 7+ LN+
| any regional LN
N3
69
# esoph CA
L-stage: cervical esophagus to lower border of azygos vein
L-upper (for SCC)
70
# esoph CA
L-stage: lower border of azygos vein to lower border of IPV
| IPV = inferior pulmonary vein
L-middle (for SCC)
71
# esoph CA
L-stage: lower border of IPV to stomach, incl GEJ
| IPV = inferior pulmonary vein
L-lower (for SCC)
72
Siewert class:
5cm prox to GEJ
to 1cm prox to GEJ
| GEJ defined as Z-line
## Footnote
https://drive.google.com/file/d/197a9Fj0M2bSiCo0Fh4YgqYx7tK1bEgfg/view
Siewert I
73
Siewert class:
1cm prox to GEJ
to 2cm dist to GEJ
| GEJ defined as Z-line
## Footnote
https://drive.google.com/file/d/197a9Fj0M2bSiCo0Fh4YgqYx7tK1bEgfg/view
Siewert II
74
Siewert class:
2cm dist to GEJ
to 5cm dist to GEJ
| GEJ defined as Z-line
## Footnote
https://drive.google.com/file/d/197a9Fj0M2bSiCo0Fh4YgqYx7tK1bEgfg/view
Siewert III
| *tx as gastric CA*
75
15-20cmFI
| region
cervical esophagus
| = UES : sternal notch
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
76
UES : sternal notch
| region
cervical esophagus
| = 15-20cmFI
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
77
20-25cmFI
| region
upper [thoracic] esophagus
| = 20-25cmFI
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
78
sternal notch : azygos vein
| region
upper [thoracic] esophagus
| = sternal notch : azygos vein
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
79
azygos vein : IPV
| region
middle [thoracic] esophagus
| = 25-30cmFI
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
80
25-30cmFI
| region
middle [thoracic] esophagus
| = azygos vein : IPV
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
81
IPV : LES
| region
distal [thoracic] esophagus
| = 30-40cmFI
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
82
30-40cmFI
| region
distal [thoracic] esophagus
| = IPV : LES
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view?usp=drive_fs
83
# esoph CA
SCC c-stage: T1 N0-1
SCC cI
84
# esoph CA
SCC c-stage: T1 N0
SCC cI
85
# esoph CA
SCC c-stage: T1 N1
SCC cI
86
# esoph CA
SCC c-stage: T2-3 N0
SCC cII
87
# esoph CA
SCC c-stage: T2 N1
SCC cII
88
# esoph CA
SCC c-stage: T2 N0
SCC cII
89
# esoph CA
SCC c-stage: T3 N0
SCC cII
90
# esoph CA
adenoCA c-stage: T1 N0
adenoCA cI
(T1 N0 is the *only* cI)
91
# esoph CA
adenoCA c-stage: T1 N1
adenoCA cIIA
(T1 N1 is the *only* cIIA)
| note that N1 is not as bad as T2
92
# esoph CA
adenoCA c-stage: T2 N0
adenoCA cIIB
(T2 N0 is the *only* cIIB)
| note that T2 is worse than N1
93
# esoph CA
adenoCA c-stage:
T3-4a N0
adenoCA cIII
94
# esoph CA
adenoCA c-stage:
T3 N0
adenoCA cIII
95
# esoph CA
adenoCA c-stage:
T4a N0
adenoCA cIII
96
# esoph CA
adenoCA c-stage:
T2-4a N1
adenoCA cIII
97
# esoph CA
adenoCA c-stage:
T2 N1
adenoCA cIII
98
# esoph CA
adenoCA c-stage:
T3 N1
adenoCA cIII
99
# esoph CA
adenoCA c-stage:
T4a N1
adenoCA cIII
100
# esoph CA
adenoCA c-stage: T3-4a N0
adenoCA cIII
101
# esoph CA
adenoCA c-stage: T3 N0
adenoCA cIII
102
# esoph CA
adenoCA c-stage: T4a N0
adenoCA cIII
103
# esoph CA
adenoCA c-stage:
T2-4a N1
adenoCA cIII
104
# esoph CA
minimum adenoCA c-stage: T4b
adenoCA cIVA
105
# esoph CA
adenoCA c-stage: N2
adenoCA cIVA
106
# esoph CA
adenoCA c-stage: N3
adenoCA cIVA
107
# esoph CA
adenoCA c-stage: M1
cIVB (either SCC or adenoCA)
108
# esoph CA
SCC c-stage: T3 N1-2
SCC cIII
109
# esoph CA
SCC c-stage: T1-2 N2
SCC cIII
110
# esoph CA
SCC c-stage: T4a-T4b N3
SCC cIVA
111
# esoph CA
SCC c-stage: M1
cIVB (either SCC or adenoCA)
112
landmark @ 15cm
| EGD distance (from incisors)
UES
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
113
landmark @ 20cm
| EGD distance (from incisors)
sternal notch
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
114
landmark @ 25cm
| EGD distance (from incisors)
azygos vein
| also probably carina
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
SEER: 23-24cm https://training.seer.cancer.gov/ugi/anatomy/esophagus.html
by EUS: 25.7cm on average https://pubmed.ncbi.nlm.nih.gov/14570085/
115
landmark @ 25cm
| EGD distance (from incisors)
carina (23-26cm)
| also azygos vein
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
SEER: 23-24cm https://training.seer.cancer.gov/ugi/anatomy/esophagus.html
by EUS: 25.7cm on average https://pubmed.ncbi.nlm.nih.gov/14570085/
116
landmark @ 30cm
| EGD distance (from incisors)
IPV
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
117
landmark @ 40cm
| EGD distance (from incisors)
LES
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
118
landmark @ 40-42cm
| EGD distance (from incisors)
GEJ
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
119
# esoph CA
minimum adenoCA c-stage: T2
adenoCA cIIB
120
# esoph CA
minimum adenoCA c-stage: T3
adenoCA cIII
121
# esoph CA
minimum adenoCA c-stage: N1
adenoCA cIIA
122
# esoph CA
minimum adenoCA c-stage: N2
adenoCA cIVA
123
# esoph CA
minimum adenoCA c-stage: T4b
adenoCA cIVA
124
# esoph CA
adenoCA I v II
| differentiating stage criteria
T2 OR N1
| T2 (N0) = IIB; (T1) N1 = IIA
125
# esoph CA
adenoCA IIA v IIB
| differentiating stage criteria
N1 (IIA) v T2 (IIB)
| (T1) N1 = IIA; T2 (N0) = IIB
126
# esoph CA
adenoCA IVA v IVB
| differentiating stage criteria
M1 = IVB
| same in SCC
127
# esoph CA
SCC IVA v IVB
| differentiating stage criteria
M1 = IVB
| same in adenoCA
128
# esoph CA
adenoCA II v III
| differentiating stage criteria
T2 N0 OR T1 N1 v
T3 (N0) OR (T2-4a) N1
129
# esoph CA
adenoCA III v IVA
| differentiating stage criteria
T4b OR N2+
130
# esoph CA
SCC III v IVA
| differentiating stage criteria
T4a+ OR N3
131
# esoph CA
SCC I v II
| differentiating stage criteria
T2-3 OR N1
| T2-3 N0 & T2 N1
132
# esoph CA
SCC c-stage: T1 N1
cI
| ***only* N+ stage I**
133
# esoph CA
SCC IIA v IIB
| differentiating stage criteria
trick Q: NO substages
| for SCC II; only SCC substages are for IV: IVA/IVB
134
# esoph CA
SCC II v III
| differentiating stage criteria
T3 N1 OR \
135
# esoph CA
minimum adenoCA c-stage: T4a
adenoCA cIII
136
# esoph CA
minimum SCC c-stage: T4a
SCC cIVA
137
# esoph CA
minimum SCC c-stage: T2
SCC cII
138
# esoph CA
minimum SCC c-stage: T3
SCC cII
139
# esoph CA
minimum SCC c-stage: N1
SCC cI
140
# esoph CA
minimum SCC c-stage: N2
SCC cIII
141
# esoph CA
minimum SCC c-stage: N3
SCC cIVA
142
# esoph CA
minimum adenoCA c-stage: N3
adenoCA cIVA
143
# esoph CA
adenoCA c-stage: Tis
adenoCA c0
144
# esoph CA
SCC c-stage: Tis
SCC c0
145
# esoph CA
risk of +N with T1a
<3%
146
# esoph CA
risk of +N with T1b
25%
147
# esoph CA
risk of +N with T2
25-50%
148
# esoph CA
risk of +N with T3
75-80%
149
# esoph CA
indication for bronchoscopy as part of staging w/u (at time of esophagectomy)
+resp sx
upper & mid-esophageal (@ or above carina)
esp SCC
150
EGD distance (from incisors) of:
carina
25cm (~23-26cm)
## Footnote
https://drive.google.com/file/d/1HM9tm22JDxHLW5iGeVQm7r9SXZa_wyuT/view
SEER: 23-24cm https://training.seer.cancer.gov/ugi/anatomy/esophagus.html
by EUS: 25.7cm on average https://pubmed.ncbi.nlm.nih.gov/14570085/
151
NCCN recommended w/u for esophageal CA
EGD + bx
CT C/A/P with PO+IV contrast
PET-CT
Siewert classification
EUS ± EMR for staging T1a/T1b
± bronch if tumor @ or above carina
± lap staging/peritoneal washing for Siewert II
152
NCCN recommended pathologic testing during w/u of esophageal CA
MSI testing by NGS or MMR IHC
PD-L1 testing for advanced
Her2 for metastatic adenoCA
153
Do celiac axis nodes count as regional (i.e. non-metastatic) dz for esophageal CA?
YES
154
What are the regional (versus distant=metastatic) LN for esophageal CA?
all para/periesophageal LN from neck to celiac axis, incl:
paratracheal (cervical & thoracic)
level 7
9R/9L
L gastric
prox common hepatic artery
prox splenic artery
celiac artery down to base
(but *NOT incl supraclav LN*, which are not considered peri/para)
155
EUS appearance of LN suspicious for esophageal CA involvement
enlarged, hypoechoic (dark), homogeneous, well-circumscribed, rounded structures
(confirm with FNA)
156
indication(s) to consider laparoscopic staging incl peritoneal washing/cytology
cT3 or cN+
157
How is ⊕peritoneal washing/cytology considered for esophageal CA staging?
M1
158
minimum # LN required for adequate oncologic resxn/staging of esophageal CA if NO induction chemoRT/neoadjuvant
15 LNs
159
minimum # LN required for adequate oncologic resxn/staging of esophageal CA AFTER induction chemoRT/neoadjuvant
15 LNs
(actually unknown, but recommendation the same)
160
procedure of peritoneal washing during staging laparoscopy for esophageal/GEJ CA without e/o macroscopic peritoneal dz
200mL saline @ RUQ, LUQ, pelvis (each), collected in Lukens trap
(UpToDate)
161
