Classificatie oesofaguscarcinomen

Histologische classificatie van epitheliale oesofaguscarcinomen

(WHO classification of tumours, Pathology & Genetics, Tumours of the digestive system, Hamilton & Aaltonen (2000) 61

Benigne

Papilloma

Intrepitheliale neoplasie

Squameus

Glandulair (adenoom)

Maligne

Plaveiselcelcarcinoom

Verrukeus (plaveiselcel)carcinoom

Basaloïd plaveiselcelcarcinoom

Spoelcellig (plaveiselcel)carcinoom

Adenocarcinoom

Adenosquameus carcinoom

Muco-epidermoïd carcinoom

Adenoïd cystisch carcinoom

Kleincellig carcinoom

Ongedifferentieerd carcinoom

 

Histologische classificatie van epitheliale maagtumoren

Benigne

Adenoma

Tubulair adenoom

Villeus adenoom

Tubulovilleus adenoom

Intra-epitheliale neoplasie

Intra-epitheliale neoplasie - Adenoom

Maligne

Carcinoom

Adenocarcinoom

Intestinaal type

Diffuus type

Papillair adenocarcinoom

Tubulair adenocarcinoom

Mucineus adenocarcinoom

Zegelringcelcarcinoom

Adenosquameus carcinoom

Plaveiselcelcarcinoom

Kleincellig carcinoom

Ongedifferentieerd carcinoom

Anders

Carcinoïd

 

Stadiëring

Volgens de richtlijnen van de Union Internationale Contre le Cancer (UICC 2009, 7de editie) worden

het oesofagus- en de gastro-oesofageale overgang als volgt gestadieerd:

 

Oesophagus including oesophagogastric junction (ICD-O C15)

Including oesophagogastic junction (C16.0)

 

Rules for classification

The classification applies only to carcinomas and includes adenocarcinomas of the oeophagogastric 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 5 cm of the oesophagogastric junction and also extends into the oesophagus is classified and staged using the oesophageal scheme. Tumours with an epicentre in the stomach greater than 5 cm from the oesophagogastric junction or those within 5 cm of the oesophagogastric junction without extension in the oesophagus are classified and staged using the gastric carcinoma scheme.

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

 

Anatomical subsites

 

Regional lymph nodes

The regional lymph nodes, irrespective of the site of the primary tumour, are those in the

oesophageal drainage areas including coeliac axis nodes and paraoesophageal nodes in the neck, but not supraclavicular nodes.

 

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

T1a Tumour invades lamina propria or muscularis mucosae

T1b Tumour invades submucosa

T2 Tumour invades muscularis propria

T3 Tumour invades adventitia

T4 Tumour invades adjacent structures

T4a Tumour invades pleura, pericardium, or diaphragm

T4b Tumour invades other adjacent structures such as aorta, vertebral body, or

trachea

N - Regional lymph nodes

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastases in 1-2 regional lymph nodes

N2 Metastases in 3-6 regional lymph nodes

N3 Metastases in 7 or more regional lymph nodes

M - Distant metastasis

M0 No distant metastasis

M1 Distant metastasis

If the pathologist does not have knowledge of the clinical M, MX should NOT be recorded. It has been deleted from TNM.

pMX: does not exist; pM0: does not exist (except at autopsy)

pM1= distant metastasis proven microscopically, e.g., needle biopsy

 

 

pTNM Pathological classification

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

 

G Histopathological grading

GX Grade of differentiation cannot be assessed

G1 Well differentiated

G2 Moderately differentiated

G3 Poorly differentiated

G4 Undifferentiated

 

Stage grouping

Stage 0            Tis        N0        M0

Stage IA           T1        N0        M0

Stage 1B          T2        N0        M0

Stage IIA          T3        N0        M0

Stage IIB          T1, T2   N1        M0

Stage IIIA          T4a       N0        M0

T3        N1        M0

T1,T2    N2        M0

Stage IIIB          T3        N2        M0

Stage IIIC          T4a       N1, N2 M0

                        T4b       Any N   M0

                        Ant T    N3        M0

Stage IV           Any T   Any N   M1

 

Summary

Oesophagus (includes oesophagogastric junction)

T1 Lamina propria (pT1a), submucosa (pT1b)

T2 Muscularis propria

T3 Adventitia

T4a Pleura, pericardium, diaphragm

T4b Aorta, vertebral body, trachea

N1 1-2 regional

N2 3-6 regional

N3 7 or more regional

M1 Distant metastasis

 

In 1996, Siewert et al proposed a classification of gastro-oesophageal junction adenocarcinomas based upon their location relative to the gastro-oesophageal junction identified by the proximal margin of the gastric folds. Gastro-oesophageal junction cancers were considered to be those whose centre lay between 5 cm proximal to and 5 cm distal to the gastro-oesophageal junction. Siewert et al subdivided these gastro-oesophageal junction cancers into type I if the tumour centre lay 1-5 cm proximal to the gastro-oesophageal junction, type II if between 1 cm proximal and 1 cm distal to the junction and type III if 1-5 cm distal to the junction. This classification has been internationally recognised and is used by surgeons to plan management of the tumour.