Staging and Grading of Oesophageal Cancers

Question 1

How are tumours graded for oesophogeal adenocarcinoma?

Answer 1

• Gx = differentiation cannot be assessed
• G1 = well differentiated, >95% of the tumour is composed of well-formed glands
• G2 = moderately differentiated, 50-95% of tumour shows gland formation
• G3 = poorly differentiated, nesh sheets of cells <50% normal differentiation

Question 2

What are the differenced for grading in squamous cell carcinomas?

Answer 2

• Similar to Adenocarcinoma

- Poorly differentiated = basal like cells

Question 3

How are oesophageal tumours catgeorised by location?

Answer 3

• Lx = location unknown
• Upper = cervical oesophagus to lower border of azygous vein
• Middle = lower border of azygous vein to lower border of inf pulmonary vein
• Lower = border of inf pulmonary vein to stomach including the oesophago-gastric junction

Question 4

Where has a T1 oesophageal tumour invaded?

Answer 4

• T1 = tumour invades the lamina propria, muscularis mucosae or submucosa (1b)

Question 5

Where has a T2 oesophageal tumour invaded?

Answer 5

• Invaded the muscularis propria

Question 6

Where has a T3 oesophageal tumour invaded?

Answer 6

• Tumour has invaded the adventita

Question 7

Where has a T4 oesophageal tumour invaded?

Answer 7

• Invades surrounding structures
• a = pleura, pericardium, azygous vein, diaphragm or peritoneum
• b = other structures e.g vertebral body, aorta or trachea

Question 8

How is N staged?

Answer 8

• N0 = no lymph nodes
• N1 = metastasis in 1-2 regional lymph nodes
• N2 = 3-6 lymph nodes
• N3 = 7+ lymph nodes