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Questions and Answers
What is the term for the rigid thickened stomach that occurs in about 5% of primary gastric cancers?
What is the term for the rigid thickened stomach that occurs in about 5% of primary gastric cancers?
According to the TNM staging system, what does the 'T' in the staging classification represent?
According to the TNM staging system, what does the 'T' in the staging classification represent?
What is the most common route of spread for stomach cancer?
What is the most common route of spread for stomach cancer?
What is the prognosis for patients with linitis plastica?
What is the prognosis for patients with linitis plastica?
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What is the purpose of laboratory studies in stomach cancer patients?
What is the purpose of laboratory studies in stomach cancer patients?
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What is the percentage of patients with Stage IV stomach cancer who survive?
What is the percentage of patients with Stage IV stomach cancer who survive?
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What is the stage of a colon cancer patient with a primary tumor that invades the visceral peritoneum?
What is the stage of a colon cancer patient with a primary tumor that invades the visceral peritoneum?
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A patient is diagnosed with a primary tumor that cannot be assessed. What is the TNM staging classification for this tumor?
A patient is diagnosed with a primary tumor that cannot be assessed. What is the TNM staging classification for this tumor?
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What is the definition of N1c in the TNM staging classification?
What is the definition of N1c in the TNM staging classification?
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What is the curative modality for localized colon cancer?
What is the curative modality for localized colon cancer?
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A patient is diagnosed with ulcerative growth pattern. What is the associated prognosis?
A patient is diagnosed with ulcerative growth pattern. What is the associated prognosis?
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What is the definition of Tis in the TNM staging classification?
What is the definition of Tis in the TNM staging classification?
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What is the N suffix used to indicate in the TNM staging classification?
What is the N suffix used to indicate in the TNM staging classification?
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What is the definition of M in the TNM staging classification?
What is the definition of M in the TNM staging classification?
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A patient is diagnosed with a primary tumor that invades the muscularis propria. What is the TNM staging classification for this tumor?
A patient is diagnosed with a primary tumor that invades the muscularis propria. What is the TNM staging classification for this tumor?
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What is the prognosis associated with elevated preoperative CEA level?
What is the prognosis associated with elevated preoperative CEA level?
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What is the characteristic feature of malignant lymph nodes on EUS?
What is the characteristic feature of malignant lymph nodes on EUS?
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What is the primary indication for bronchoscopy in esophageal cancer?
What is the primary indication for bronchoscopy in esophageal cancer?
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What is the TNM staging classification for tumor invasion into the lamina propria or muscularis mucosae?
What is the TNM staging classification for tumor invasion into the lamina propria or muscularis mucosae?
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What is the purpose of laparoscopy and thoracoscopy in esophageal cancer?
What is the purpose of laparoscopy and thoracoscopy in esophageal cancer?
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What is the characteristic feature of T4 stage esophageal cancer?
What is the characteristic feature of T4 stage esophageal cancer?
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What is the primary use of barium swallow in esophageal cancer?
What is the primary use of barium swallow in esophageal cancer?
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What is the reason for the modest improvement in 5-year survival in esophageal cancer?
What is the reason for the modest improvement in 5-year survival in esophageal cancer?
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What is the characteristic feature of Tis stage esophageal cancer?
What is the characteristic feature of Tis stage esophageal cancer?
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Study Notes
TNM Staging System
- The TNM staging system uses three descriptors: T for primary tumor, N for lymph node involvement, and M for metastasis.
Primary Tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ (intraepithelial or intramucosal)
- T1: Tumor invades submucosa (through the muscularis mucosa)
- T2: Tumor invades muscularis propria
- T3: Tumor invades pericolorectal tissues
- T4: Tumor invades visceral peritoneum or adheres to adjacent organ or structure
- T4a: Tumor invades through the visceral peritoneum (including gross perforation of the bowel through tumor)
- T4b: Tumor directly invades or adheres to other organs or structures
Regional Lymph Nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in 1-3 regional lymph nodes
- N1a: Metastasis in 1 regional lymph node
- N1b: Metastasis in 2-3 regional lymph nodes
- N1c: Tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolorectal tissues without regional nodal metastasis
- N2: Metastasis in 4 or more lymph nodes
- N2a: Metastasis in 4-6 regional lymph nodes
- N2b: Metastasis in 7 or more regional lymph nodes
- N Suffix:
- (sn): Select if regional lymph node metastasis identified by sentinel lymph node biopsy only
- (f): Select if regional lymph node metastasis identified by fine needle aspiration biopsy only
Prognostic Factors
- Bowel obstruction at diagnosis is associated with worse prognosis
- Ulcerative growth pattern is associated with worse prognosis
- Perforation is associated with worse prognosis
- Elevated preoperative CEA level is associated with worse prognosis
Approach Considerations
- Surgery is the only curative modality for localized colon cancer (stage I-III)
- Linitis plastica has an extremely poor prognosis
Clinical Staging
- Stage 0: Tis, N0, M0
- Stage I: T1-2, N0, M0
- Stage IIA: T1-2, N1-3, M0
- Stage IIB: T3, N0, M0 or T4a, N0, M0
- Stage III: T3, N0, M0 or T4a, N1-3, M0
- Stage IVA: T4b, any N, M0
- Stage IVB: Any T, any N, M1
Survival Rates
- Stage IA: 94%
- Stage IB: 88%
- Stage IIA: 82%
- Stage IIB: 68%
- Stage IIIA: 54%
- Stage IIIB: 36%
- Stage IIIC: 18%
- Stage IV: 5%
Spread Patterns
- Direct extension into omenta, pancreas, diaphragm, transverse colon or mesocolon, and duodenum is common
- Peritoneal involvement is frequent if the lesion extends beyond the gastric wall to a free peritoneal surface
- The visible gross lesion frequently underestimates the true extent of the disease
- Abundant lymphatic channels within the submucosal and subserosal layers of the gastric wall allow for easy microscopic spread
Laboratory Studies
- The goal is to assist in determining optimal therapy
- Malignant or inflammatory lymph nodes detected on EUS have characteristic features:
- Enlarged in size
- Hypoechoic (dark)
- Homogeneous
- Well circumscribed and rounded
Bronchoscopy
- Indicated for cancers of the middle and upper third of the thoracic esophagus to help exclude invasion of the trachea or bronchi
- Laparoscopy and thoracoscopy have a greater than 92% accuracy in staging regional nodes
Barium Swallow
- Very sensitive for detecting strictures and intraluminal masses
- Does not allow staging and biopsy
- May be helpful for studying the distal anatomy in obstructive tumors inaccessible by endoscopy
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Description
Understand the TNM staging system used to describe the extent of cancer, including primary tumor, lymph node involvement, and metastasis.
