Esophageal Cancer Staging

Question 0

In the absence of metastatic disease on CT, what other study improve the accuracy of clinical staging?

Answer 0

EUS- endoscopic ultrasonography improves the accuracy of T staging

Question 1

Best imaging study to stage EARLY esophageal cancer?

Answer 1

CT of the chest and abdomen

Question 2

If you suspect locoregional esophageal cancer what study is recommended?

Answer 2

PET/CT

Question 3

What is the overall five-year survival rate of esophageal cancer?

Answer 3

Less than 15%

Question 4

What is the gold standard therapy for localized disease?

Answer 4

Esophagectomy

Question 5

What is the typical presentation of esophageal cancer?

Answer 5

Advanced stage with dysphagia being the most common symptom. Dysphasia is progressive from solids to liquids. Any dysphagia in a patient over 40 years of age should increase the suspicion esophageal cancer and prompt endoscopic examination. Odynophagia, regurgitation, and weight loss can also be seen in advanced cases.

Question 6

If you suspect tracheoesophageal fistula, which study should be obtained?

Answer 6

Barium swallow.

Question 7

Primary tumor cannot be assessed

Answer 7

Tx

Question 8

No evidence of primary tumor

Answer 8

T0

Question 9

High-grade dysplasia. T?

Answer 9

Tis

Question 10

Tumor invades lamina propria, muscularis mucosae, or submucosa. T?

Answer 10

T1

Question 11

Tumor invades lamina propria or muscularis mucosae. T?

Answer 11

T1a

Question 12

Tumor invades submucosa. T?

Answer 12

T1b

Question 13

Tumor invades muscularis propria. T?

Answer 13

T2

Question 14

Tumor invades adventitia. T?

Answer 14

T3

Question 15

Tumor invades adjacent structures. T?

Answer 15

T4

Question 16

Resectable tumor invading pleura, pericardium, or diaphragm. T?

Answer 16

T4 a

Question 17

Unresectable killer invading other adjacent structures, such as aorta, vertebral body, trachea, etc. T?

Answer 17

T4b

Question 18

Regional lymph nodes cannot be assessed. N?

Answer 18

Nx

Question 19

No regional lymph node metastasis. N?

Answer 19

N0

Question 20

Metastases and 1-2 regional lymph nodes. N?

Answer 20

N1

Question 21

Metastases and 3-6 regional lymph nodes. N?

Answer 21

N2

Question 22

Metastases in seven or more regional lymph nodes. N?

Answer 22

N3 - minimum stage for adeno and squamous is IIIC

Question 23

Well differentiated. G?

Answer 23

G1

Question 24

Moderately differentiated. G?

Answer 24

G2

Question 25

Poorly differentiated. G?

Answer 25

G3

Question 26

Undifferentiated. G?

Answer 26

G4

Question 27

Stage with TNMG: adenocarcinoma invading submucosa with no regional lymph node metastasis, histologic grade well differentiated (or moderately differentiated)

Answer 27

Stage 1A. T1N0M0G1-2 T1 indicates that the tumor invades the lamina propria, muscularis mucosa, or submucosa. Limited invasion to the lamina propria or muscularis mucosa is T1a, and invasion into the suBmucosa indicates T1B. And zero indicates no regional lymph node metastasis.

Question 28

Stage with TNMG: adenocarcinoma invading submucosa with no regional lymph node metastasis, histologic grade poorly differentiated

Answer 28

Stage 1B. T1N0M0G3 T1 indicates that the tumor invades the lamina propria, muscularis mucosa, or submucosa. Limited invasion to the lamina propria or muscularis mucosa is T1a, and invasion into the suBmucosa indicates T1B. And zero indicates no regional lymph node metastasis. Note that the only difference between this and 1A is the grade. Other 1B cancers include T2N0M0G1-2

Question 29

Stage with TNMG: adenocarcinoma invading muscularis propria with no regional lymph node metastasis, histologic grade poorly differentiated

Answer 29

Stage 2A T2N0M0G3

Question 30

Stage with TNMG: adenocarcinoma invading adventitia with no regional lymph node metastasis, Moderately well differentiated.

Answer 30

IIB T3N0M0G2 although once you have T3, Grade no longer affects stage. IIB can also include T1-2N1M0.

Question 31

Stage with TNMG: adenocarcinoma invading the muscularis propria with five regional lymph nodes, poorly differentiated

Answer 31

IIIA T1-2N2M0Gany

Question 32

Stage with TNMG: adenocarcinoma invading the adventitia with 2 regional lymph nodes, moderately differentiated

Answer 32

IIIA T3N1M0Gany

Question 33

Stage with TNMG: adenocarcinoma invading the pericardium with no lymph node mets, poorly differentiated

Answer 33

IIIA T4aN0M0Gany. T4a indicates a resectable tumor invading the pleura, pericardium, or diaphragm.

Question 34

Stage with TNMG: adenocarcinoma invading the adventitia with 6 lymph nodes, poorly differentiated

Answer 34

IIIB T3N2M0Gany. N2: three - six lymph nodes

Question 35

Stage with TNMG: adenocarcinoma invading the diaphragm and pericardium with 3 lymph nodes, poorly differentiated

Answer 35

IIIC T4aN2M0Gany

Question 36

Stage with TNMG: adenocarcinoma invading the carina, no lymph nodes, poorly differentiated

Answer 36

IIIC T4bN0M0G3. T4b indicates unresectable tumor invading adjacent structures such as the aorta, vertebral body, trachea, etc. IIIC is all T4b tumors regardless of lymph node status without distant mets.

Question 37

Stage with TNMG: adenocarcinoma invading the muscularis propria with 7 lymph nodes, moderately differentiated

Answer 37

IIIC T2N3M0Gany this stage is indicated by and three disease without distant metastasis regardless of tumor invasion.

Question 38

Stage with TNMG: adenocarcinoma invading the adventitia with 3 lymph nodes, poorly differentiated, with a vertebral metastasis

Answer 38

IV T3N2M1Gany. Stage IV disease indicates any adenocarcinoma with distant metastasis.