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TNM Staging System for Esophageal Adenocarcinoma Stage Description Primary tumor (T) T1 Tumor invades lamina propria, muscularis mucosae, or submucosa T1a Tumor invades lamina propria or muscularis mucosae T1b Tumor invades submucosa T2 Tumor invades muscularis propria T3 Tumor invades adventitia T4 Tumor invades adjacent structures T4a Resectable tumor is invading pleura, pericardium, diaphragm T4b Unresectable tumor is invading aorta, vertebral body, trachea Regional lymph nodes (N)a N0 No regional lymph node metastasis N1 Metastasis in 1 or 2 regional lymph nodes N2 Metastasis in 3-6 regional lymph nodes N3 Metastasis in 7 regional lymph nodes Distant metastasis (M) M0 No distant metastasis M1 Distant metastasis present The 2010 edition of the staging recommendations eliminated emphasis on the location of lymph nodes and replaced it with the number of lymph nodes involved (because the number of lymph nodes has been shown to be more prognostic of survival)

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The few that do, like certain peptide capsules , rely on protective coatings, permeation enhancers, or the unusual gastric stability of specific peptides like BPC-157

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