OESOPHAGUS (ICD‐O‐3 C15)INCLUDING OESOPHAGOGASTRIC JUNCTION (ICD‐0‐3 C16.0)

The classification applies only to carcinomas and includes adenocarcinomas of the oesophagogastric/gastroesophageal junction. There should be histological confirmation of the disease and division of cases by topographic localization and histological type. A tumour the epicentre of which is within 2 cm of the oesophagogastric junction and also extends into the oesophagus is classified and staged using the oesophageal scheme. Cancers involving the oesophagogastric junction whose epicentre is within the proximal 2 cm of the cardia (Siewert types I/II) are to be staged as oesophageal cancers.

Anatomical Subsites (Figs. 132, 133)

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.
Intrathoracic oesophagus
1. 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
2. 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
3. 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
Oesophagogastric junction (C16.0). Cancers involving the oesophagogastric junction whose epicentre is within the proximal 2 cm of the cardia (Siewert types I/II) are to be staged as oesophageal cancers. Cancers whose epicentre is more than 2 cm distal from the oesophagogastric junction will be staged using the Stomach Cancer TNM and Stage, even if the oesophagogastric junction is involved.

Regional Lymph Nodes

The regional lymph nodes, irrespective of the site of the primary tumour, are those in the oesophageal drainage area, including coeliac axis nodes and paraesophageal nodes in the neck, but not the supraclavicular nodes.

TNM Clinical Classification

Schematic illustration of Anatomical Subsites. — **Fig. 132**

Schematic illustration of Regional Lymph Nodes. — **Fig. 133**

Regional Lymph Nodes (Fig. 133)

TNM Clinical Classification

T – Primary Tumour

TX	Primary tumour cannot be assessed
T0	No evidence of primary tumour
Tis	Carcinoma in situ/high‐grade dysplasia
T1	Tumour invades lamina propria, muscularis mucosae or submucosa (Fig. 134)
	T1aTumour invades lamina propria or muscularis mucosae
	T1b Tumour invades submucosa
T2	Tumour invades muscularis propria (Fig. 134)
T3	Tumour invades adventitia (Fig. 135)
T4	Tumour invades adjacent structures (Fig. 136)
	T4a Tumour invades pleura, pericardium, azygos vein, diaphragm or peritoneum
	T4b Tumour invades other adjacent structures such as aorta, vertebral body or trachea (Fig. 137)

Photo depicts a Tumour invades muscularis propria. — **Fig. 134**

Photo depicts a Tumour invades adventitia. — **Fig. 135**

Photo depicts a Tumour invades adjacent structures. — **Fig. 136**

Schematic illustration of tumour invades other adjacent structures such as aorta, vertebral body or trachea. — **Fig. 137**

N – Regional Lymph Nodes

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in 1 to 2 regional lymph nodes (Fig. 138)
N2	Metastasis in 3 to 6 regional lymph nodes (Fig. 139)
N3	Metastasis in 7 or more regional lymph nodes (Fig. 140)

M – Distant Metastasis

M0	No distant metastasis
M1	Distant metastasis (Fig. 141)

Schematic illustration of Metastasis in 1 to 2 regional lymph nodes. — **Fig. 138**

Schematic illustration of Metastasis in 3 to 6 regional lymph nodes. — **Fig. 139**

Schematic illustration of Metastasis in 7 or more regional lymph nodes. — **Fig. 140**

Schematic illustration of Distant metastasis. — **Fig. 141**

pTNM Pathological Classification

The pT and pN categories correspond to the T and N categories.

pM1	Distant metastasis microscopically confirmed

Note

pM0 and pMX are not valid categories.

pN0

Histological examination of a regional 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.