TNM 7 Classification





TNM 6 Classification



1. Rules for Classification


The classification applies only to carcinomas. There should be histological confirmation of the disease and division of cases by histological type.



The following are the procedures for assessing T, N, and M categories.



T categories. Physical examination, imaging, endoscopy (including bronchoscopy), and/or surgical exploration

N categories. Physical examination, imaging, and/or surgical exploration

M categories. Physical examination, imaging, and/or surgical exploration



2. Anatomical Subsites



  1. Cervical oesophagus (C15.0): This commences at the lower border of the cricoid cartilage and ends at the thoracic inlet (suprasternal notch), approximately 18 cm from the upper incisor teeth.

  2. Intrathoracic oesophagus


    • The upper thoracic portion (C15.3) extending from the thoracic inlet to the level of the tracheal bifurcation, approximately 24 cm from the upper incisor teeth.

    • The mid-thoracic portion (C15.4) is the proximal half of the oesophagus between the tracheal bifurcation and the oesophagogastric junction. The lower level is approximately 32 cm from the upper incisor teeth.

    • The lower thoracic portion (C15.5), approximately 8 cm in length (includes abdominal oesophagus), is the distal half of the oesophagus between the tracheal bifurcation and the oesophagogastric junction. The lower level is approximately 40 cm from the upper incisor teeth.



3. Regional Lymph Nodes




The regional lymph nodes are as follows:


Cervical oesophagus:


  • Scalene

  • Internal jugular

  • Upper and lower cervical

  • Perioesophageal

  • Supraclavicular



Intrathoracic oesophagus-upper, middle, and lower


  • Upper perioesophageal (above the azygous vein)

  • Subcarinal

  • Lower perioesophageal (below the azygous vein)

  • Mediastinal

  • Perigastric, except coeliac


4. TNM Clinical Classification


4.1. T - Primary Tumour



TX. Primary tumour cannot be assessed

T0. No evidence of primary tumour

Tis. Carcinoma in situ

T1. Tumour invades lamina propria or submucosa

T2. Tumour invades muscularis propria

T3. Tumour invades adventitia

T4. Tumour invades adjacent structures



4.2. N - Regional Lymph Nodes



NX. Regional lymph nodes cannot be assessed

N0. No regional lymph node metastasis

N1. Regional lymph node metastasis



4.3. M - Distant Metastasis



MX. Distant metastasis cannot be assessed

M0. No distant metastasis

M1. Distant metastasis


For tumours of lower thoracic oesophagus

  M1a. Metastasis in coeliac lymph nodes

  M1b. Other distant metastasis


For tumours of upper thoracic oesophagus

  M1a. Metastasis in cervical lymph nodes

  M1b. Other distant metastasis


For tumours of mid-thoracic oesphagus

  M1a. Not applicable

  M1b. Non-regional lymph node or other distant metastasis

5. pTNM Pathological Classification




The pT, pN, and pM categories correspond to the T, N, and M categories.



pN0. Histological examination of a mediastinal lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.



6. G Histopathological Grading




See definitions on .



7. Stage Grouping
































































Stage 0
 Tis
 N0
 M0
Stage I
 T1
 N0
 M0
Stage IIA
 T2. T3
 N0
 M0
Stage IIB
 T1. T2
 N1
 M0
Stage III
 T3
 N1
 M0
T4
 Any N
 M0
Stage IV
 Any T
 Any N
 M1
Stage IVA
 Any T
 Any N
 M1a
Stage IVB
 Any T
 Any N
 M1b







8. Summary




































































Oesophagus
T1
 Lamina propria, submucosa
T2
 Muscularis propria
T3
 Adventitia
T4
 Adjacent structures
N1
 Regional
M1
 Distant metastasis

Tumour of lower thoracic oesophagus
M1a
 Coeliac nodes
M1b
 Other distant metastasis

Tumour of upper thoracic oesophagus
M1a
 Cervical nodes
M1b
 Other distant metastasis

Tumour of mid-thoracic oesophagus
M1b
 Distant metastasis including non-regional lymph nodes