Staging

The news we received today was not good. The cancer has spread. The official stage is now defined as T3N1cM1a, which translates to Stage IVa.

According to the National Cancer Institute, the TNM system is the most commonly used cancer staging system. The TNM staging system is based on the extent of the tumor (T), spread to the lymph nodes (N), and metastatis (spread to other parts of the body) (M).

TNM Definitions

Primary tumor (T)

TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor invades lamina propria or submucosa
T2 Tumor invades muscularis propria
T3 Tumor invades adventitia
T4 Tumor invades adjacent structures

Regional lymph nodes (N)

NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis

Distant metastasis (M)

MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M1a Metastasis in celiac lymph nodes
M1b Other distant metastasis

Stage Groupings

Stage 0

Tis, N0, M0
Cancer cells are only in the lining of esophagus (in the epithelium). Cancer has not invaded the outer layers or lymph nodes. May be called, "carcinoma in situ."

Stage I

T1, N0, M0
Cancer has invaded from the lining layer into outer layer of tissue, but not as far as the muscle layer. No tumor has spread to lymph nodes.

Stage IIA

T2, N0, M0T3, N0, M0
Cancer has invaded the muscle layer and outermost covering layer or tissue, but has not spread to lymph nodes.

Stage IIB

T1, N1, M0T2, N1, M0
Cancer has invaded the muscle layer and spread to nearby lymph nodes. It has not invaded the covering layer of the esophagus.

Stage III

T3, N1, M0T4, Any N, M0
Cancer has spread as far as the outer layer of the esophagus, into nearby tissues such as lymph nodes next to the esophagus. No tumor has spread to lymph nodes in the neck or abdomen, or to other organs.

Stage IV

Any T, Any N, M1
Cancer has spread to lymph nodes away from the original tumor or to other parts of the body (liver, bones, brain). Refer to the TNM Definitions above for specific Stage IV M1a and M1b differentiation.

Stage IVA

Any T, Any N, M1a

Stage IVB

Any T, Any N, M1b

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Edited to add: July 1, 2009 positive supraclavicular lymph node now stages E. as a Stage 4b.