For SCC, the Location (Upper vs. Middle vs. Lower) and Histological Grade (G1-G3) are part of the overall staging group, reflecting the worse prognosis of proximal SCC.
Section 3
Pearls/Pitfalls
The CROSS Protocol Rule
Clinically-staged tumours ≥ T2 or N+ (Stage II/III) typically receive neoadjuvant chemoradiotherapy (CROSS trial: Carboplatin/Paclitaxel + 41.4Gy) prior to an Ivor-Lewis or McKeown oesophagectomy.
Early Cancer (T1a vs. T1b)
T1a (mucosal) carries a < 1% risk of lymph node metastasis and can be managed with EMR/ESD. T1b (submucosal) carries a ~20% risk of hidden lymph node metastasis, often requiring surgery even if the primary is removed endoscopically.
Clinical Pearls
EUS is the most accurate modality for T-staging; PET-CT is the gold standard for M-staging
Siewert II (Cardia) cancers often present a diagnostic dilemma in choosing between a total gastrectomy and an oesophagectomy
Presence of positive coeliac lymph nodes is considered M1 (Stage IV) in most cases
Section 4
Next Steps
Management Decisions
01
T1a N0: Endoscopic Mucosal Resection (EMR) or ESD.
02
T2+ / N+: Neoadjuvantotherapy followed by surgical resection.
03
Stage IV: Palliative chemotherapy ± stenting for dysphagia.
Complementary Scoring
Siewert Classification (OGJ Location)
Gastric Cancer TNM Staging
Prague C&M Criteria (Barrett's)
Section 5
Evidence Appraisal
The Staging Authority
AJCC Cancer Staging Manual, 8th Edition.
Amin MB et al. • Springer. 2017;Chapter 16: Oesophagus and Oesophagogastric Junction.
