After a diagnosis has been made, your doctor will determine the stage of your esophageal cancer. Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Knowing the stage will help your doctor decide what the best form of treatment will be.
The American Joint Committee on Cancer (AJCC) TNM system is the staging system most often used for esophageal cancer. In regards to staging, TNM refers to:
- Tumor size and extent of tumors
- Lymph node involvement
- Presence or absence of distant metastasis (whether or not the cancer has spread to other areas of the body)
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread from where it started. Below are the details of each class:
- Stage 0: Abnormal cells are present but have not spread to nearby tissue.
- Stage I, II, III: Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.
- Stage IV: The cancer has spread to distant parts of the body.
Staging for squamous cell carcinoma of the esophagus
Stages for squamous cell carcinoma may be divided based on whether the tumor is in the upper, middle, or lower part of the esophagus, as well as the grade (G) of the tumor cells.
Stage 0: The cancer is found in only the top lining of the esophagus.
Stage IA: The cancer is in only the top layers of the esophagus.
Stage IB: Either of these conditions:
- The cancer is in the top layers of the esophagus, but the tumor cells are less differentiated.
- The tumor is in the third layer of the esophagus, but it has not spread to the lymph nodes or other parts of the body.
Stage IIA: Any of these conditions:
- The tumor is in the third layer of the esophagus. Cancer cells have spread into but not through the muscle wall of the esophagus.
- The tumor is in the outer layer of the upper or middle part of the esophagus.
- The tumor is in the outer layer of the lower part of the esophagus.
Stage IIB: Any of these conditions:
- The tumor is in the outer layer of the upper or middle part of the esophagus. The tumor cells are less differentiated.
- The tumor is in the outer layer of any part of the esophagus.
- The tumor is in any part of the esophagus, and cancer cells have spread into the lining of the esophagus and underneath layers. Cancer has also spread to 1 or 2 lymph nodes near the tumor.
Stage IIIA: Any of these conditions:
- The tumor is in any part of the esophagus, and cancer cells have spread into the lining of the esophagus and underneath layers. Cancer cells have also spread to 3 to 6 lymph nodes near the tumor.
- The tumor is in any part of the esophagus and has grown into the third layer of the esophagus. Cancer cells have spread to 1 or 2 lymph nodes.
- Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body.
Stage IIIB: Any of these conditions:
- The tumor is in any part of the esophagus and has grown into the third layer of the esophagus. It has also spread to 3 to 6 lymph nodes.
- The tumor is in any part of the esophagus, has grown into the outer layer of the esophagus and to either 1 to 2 or 3 to 6 lymph nodes.
- The tumor is in any part of the esophagus and has spread to structures surrounding the esophagus. It has either spread to no lymph nodes or only 1 or 2 lymph nodes.
Stage IVA: Either of these conditions:
- The tumor is in any part of the esophagus and has spread to nearby structures. It may also have spread to up to 3 to 6 lymph nodes.
- The cancer has spread to 7 or more regional lymph nodes.
Stage IVB: The cancer has spread to other parts of the body.
Staging of adenocarcinoma of the esophagus
T, N, and M classifications, as well as the grade (G) are used for adenocarcinoma.
Stage 0: The cancer is found in only the top lining of the esophagus.
Stage IA: Cancer cells have spread into the lining of the esophagus and the layers underneath.
Stage IB: Either of these conditions:
- The cancer has spread to the layers underneath the lining of the esophagus. The tumor cells are moderately differentiated.
- The cancer has grown into a layer of the esophagus called the submucosa.
Stage IC: Either of these conditions:
- The cancer has grown into the layers underneath the lining of the esophagus or the submucosa. The cancer cells are poorly differentiated.
- The cancer has grown into the third layer of the esophagus. The cancer cells are well or moderately differentiated.
Stage IIA: Cancer is in the third layer of the esophagus. The grade cannot be evaluated or the cells are poorly differentiated.
Stage IIB: Either of these conditions:
- Cancer is in the outer layer of the esophagus.
- Cancer is in an inner layer of the esophagus and has spread to 1 or 2 lymph nodes.
Stage IIIA: Either of these conditions:
- Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor.
- Cancer is in the third layer of the esophagus and has spread to 1 or 2 lymph nodes.
Stage IIIB: Any of these conditions:
- Cancer is in the third layer of the esophagus and in 3 to 6 lymph nodes.
- Cancer is in the outer layer of the esophagus and has spread to 1 to 2 or 3 to 6 lymph nodes.
- The tumor has spread to structures near the esophagus and either no lymph nodes or 1 or 2 lymph nodes.
Stage IVA: Any of these conditions:
- The tumor has spread to structures near the esophagus and either no lymph nodes or up to 3 to 6 lymph nodes.
- The tumor has spread to 7 or more lymph nodes.
Stage IVB: Cancer has spread to another part of the body.
When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed.