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Thoracic Surgery > Esophageal Cancer Staging > Flashcards

Esophageal Cancer Staging Flashcards

0
Q

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

A

EUS- endoscopic ultrasonography improves the accuracy of T staging

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1
Q

Best imaging study to stage EARLY esophageal cancer?

A

CT of the chest and abdomen

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2
Q

If you suspect locoregional esophageal cancer what study is recommended?

A

PET/CT

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3
Q

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

A

Less than 15%

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4
Q

What is the gold standard therapy for localized disease?

A

Esophagectomy

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5
Q

What is the typical presentation of esophageal cancer?

A

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.

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6
Q

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

A

Barium swallow.

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7
Q

Primary tumor cannot be assessed

A

Tx

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8
Q

No evidence of primary tumor

A

T0

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9
Q

High-grade dysplasia. T?

A

Tis

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10
Q

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

A

T1

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11
Q

Tumor invades lamina propria or muscularis mucosae. T?

A

T1a

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12
Q

Tumor invades submucosa. T?

A

T1b

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13
Q

Tumor invades muscularis propria. T?

A

T2

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14
Q

Tumor invades adventitia. T?

A

T3

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15
Q

Tumor invades adjacent structures. T?

A

T4

16
Q

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

A

T4 a

17
Q

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

A

T4b

18
Q

Regional lymph nodes cannot be assessed. N?

A

Nx

19
Q

No regional lymph node metastasis. N?

A

N0

20
Q

Metastases and 1-2 regional lymph nodes. N?

A

N1

21
Q

Metastases and 3-6 regional lymph nodes. N?

A

N2

22
Q

Metastases in seven or more regional lymph nodes. N?

A

N3 - minimum stage for adeno and squamous is IIIC

23
Q

Well differentiated. G?

A

G1

24
Q

Moderately differentiated. G?

A

G2

25
Q

Poorly differentiated. G?

A

G3

26
Q

Undifferentiated. G?

A

G4

27
Q

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

A

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.

28
Q

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

A

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

29
Q

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

A

Stage 2A T2N0M0G3

30
Q

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

A

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

31
Q

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

A

IIIA T1-2N2M0Gany

32
Q

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

A

IIIA T3N1M0Gany

33
Q

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

A

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

34
Q

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

A

IIIB T3N2M0Gany. N2: three - six lymph nodes

35
Q

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

A

IIIC T4aN2M0Gany

36
Q

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

A

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.

37
Q

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

A

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

38
Q

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

A

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

Thoracic Surgery (2 decks)

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