TNM staging of esophageal squamous cell cancer (SCC)

Primary tumor (T)^*
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	High-grade dysplasia^¶
T1	Tumor invades lamina propria, muscularis mucosae, or submucosa
T1a	Tumor invades lamina propria or muscularis mucosae
T1b	Tumor invades submucosa
T2	Tumor invades muscularis propria
T3	Tumor invades adventitia
T4	Tumor invades adjacent structures
T4a	Resectable tumor invading pleura, pericardium, or diaphragm
T4b	Unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.
Regional lymph nodes (N)^Δ
NX	Regional lymph node(s) cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in 1 to 2 regional lymph nodes
N2	Metastasis in 3 to 6 regional lymph nodes
N3	Metastasis in seven or more regional lymph nodes
Distant metastasis (M)
M0	No distant metastasis
M1	Distant metastasis
Histologic grade (G)
GX	Grade cannot be assessed - stage grouping as G1
G1	Well differentiated
G2	Moderately differentiated
G3	Poorly differentiated
G4	Undifferentiated - stage grouping as G3 squamous
Anatomic stage/prognostic groups
Squamous cell carcinoma^◊
Stage	T	N	M	Grade	Tumor location^§
0	Tis (HGD)	N0	M0	1, X	Any
IA	T1	N0	M0	1, X	Any
IB	T1	N0	M0	2 to 3	Any
IB	T2-3	N0	M0	1, X	Lower, X
IIA	T2-3	N0	M0	1, X	Upper, middle
IIA	T2-3	N0	M0	2 to 3	Lower, X
IIB	T2-3	N0	M0	2 to 3	Upper, middle
IIB	T1-2	N1	M0	Any	Any
IIIA	T1-2	N2	M0	Any	Any
	T3	N1	M0	Any	Any
	T4a	N0	M0	Any	Any
IIIB	T3	N2	M0	Any	Any
IIIC	T4a	N1-2	M0	Any	Any
	T4b	Any	M0	Any	Any
	Any	N3	M0	Any	Any
IV	Any	Any	M1	Any	Any

Note: cTNM is the clinical classification, pTNM is the pathologic classification.

* At least maximal dimension of the tumor must be recorded and multiple tumors require the T(m) suffix.
¶ High-grade dysplasia (HGD) includes all noninvasive neoplastic epithelia that were formerly called carcinoma in situ, a diagnosis that is no longer used for columnar mucosae anywhere in the gastrointestinal tract.
Δ Number must be recorded for total number of regional nodes sampled and total number of reported nodes with metastasis.
◊ Or mixed histology including a squamous component or not otherwise specified (NOS).
§ Location of the primary cancer site is defined by the position of the upper (proximal) edge of the tumor in the esophagus.

Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer New York, Inc.

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