CS Mets at DX

Notes

**Note 1**: Periesophageal lymph nodes extending from the cervical/supraclavicular region to the celiac region previously considered to be distant are now classified as regional nodes. Involvement of these nodes is coded in CS Lymph Nodes. **Note 2**: Lymph node stations/groups are listed in parentheses where applicable. For a list of these nodal groups, see Part I Section 2 or Figure 10.3 from the AJCC Cancer Staging Atlas, 2nd Ed. or errata for AJCC 7th Ed. chapter 10. **Note 3**: Errata for AJCC 7th Ed. has clarified the status of the most distal node chains for the esophagus/esophagogastric junction chapter. The left gastric and celiac nodes (levels 17, 20) are regional, but the common hepatic and splenic artery nodes (levels 18, 19) are not regional. The common hepatic and splenic nodes continue to be captured in code 15.
Code Description AJCC 7 M AJCC 6 M Summary Stage 1977 M Summary Stage 2000 M
00 No distant metastasis M0 Lymph Nodes Mets at DX Table AJCC6 NONE NONE
10 Distant lymph node(s), NOS M1 M1NOS D D
11 OBSOLETE DATA RETAINED V0200
Considered regional in AJCC 7th Edition
See CS Lymph Nodes code 250

Upper thoracic esophagus only:
Cervical lymph nodes M1
Lower thoracic (abdominal) esophagus only:
Celiac lymph nodes (20) M1		 ERROR: M1a D D
12 OBSOLETE DATA REVIEWED AND CHANGED V0200
The specified lymph nodes in code 12 were considered distant in AJCC 6th Edition and are considered regional in AJCC 7th Edition EXCEPT for common hepatic and splenic lymph nodes which are still considered distant and are included in code 15.
See CS Lymph Nodes code 265

Specified distant lymph node(s), other than code 11, including:
Cervical esophagus only:
Common hepatic (18)
Diaphragmatic (15)
Pulmonary ligament (9)
Splenic (19)
Intrathoracic esophagus, upper or middle, only:
Common hepatic (18)
Diaphragmatic (15)
Splenic (19)
Lower thoracic (abdominal) esophagus only:
Aortopulmonary (5)
Pulmonary ligament (9)		 ERROR: ERROR: ERROR: ERROR:
15 Common hepatic (18)
Splenic (19)		 M1 M1b D D
40 Distant metastases except distant lymph node(s) (codes 10 or 15)
Carcinomatosis		 M1 M1b D D
50 40 + any of (10 to 15)

Distant lymph node(s) plus other distant metastases		 M1 M1b D D
60 Distant metastasis, NOS

Stated as M1 [NOS] with no other information on distant metastasis		 M1 M1NOS D D
99 Unknown; distant metastasis not stated
Distant metastasis cannot be assessed
Not documented in patient record		 M0 Lymph Nodes Mets at DX Table AJCC6 U U
- For CS Mets at DX codes 00 or 99, the N and M categories for AJCC 6 staging are assigned based on the coding of CS Lymph Nodes as shown in the Lymph Nodes Mets at DX AJCC 6 Table.