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Staging means finding out how far esophageal cancer has spread in your body. Physicians group esophageal cancer into stages I (1) through IV (4), with stage I being the least advanced and stage IV being the most advanced. This staging system is used for both types of esophageal cancer: adenocarcinoma and squamous cell carcinoma.
When your Fred Hutch Cancer Center team designs your treatment plan, they will consider the stage of your cancer along with many other factors. The stage is an important part of choosing which treatments are right for you.
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Esophageal Cancer Stages
The stage depends on:
- Which type of esophageal cancer you have
- How far the cancer has spread through the wall of your esophagus
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to other parts of your body
We also compare the cancer cells to normal cells to tell the cancer grade. The grade helps your physicians predict how your esophageal cancer will behave (how aggressive it is).
Adenocarcinoma Stages
Stage 0
Also known as high-grade dysplasia, in stage 0, cancer has formed in the inner lining of the esophagus wall, but hasn’t spread further.
Stage I (1)
In stage I, the cancer has spread to the mucosa layer (the thin muscle layer of the esophagus wall), the submucosa layer, or the thick muscle layer of the esophagus wall. Your stage may be IA, IB or IC based on the location of the cancer cells.
Stage II (2)
Similar to stage I, stage II can be either IIA or IIB, depending on where the cancer has spread.
- Stage IIA: Cancer has spread to the thick muscle layer of the esophagus wall, with grade 3 or unknown grade cancer cells.
- Stage IIB: Cancer has spread into the mucosa layer, thin muscle layer or submucosa layer, along with one or two lymph nodes nearby.
Stage III (3)
- Stage IIIA: cancer has spread to the mucosa layer, thin muscle layer or submucosa layer, along with three to six nearby lymph nodes. Or, the cancer has spread into the thick muscle layer of the esophagus wall and one to two nearby lymph nodes.
- Stage IIIB: Cancer has spread into the thick muscle layer, connective tissue layer or nearby structures like the diaphragm, azygos vein, pleura, sac around the heart, or peritoneum. Spread to lymph nodes is also considered.
Stage IV (4)
- Stage IVA: Includes cancer that has spread to surrounding structures and multiple lymph nodes near the tumor.
- Stage IVB: Cancer has spread to other parts of the body, such as the lung or the liver.
Squamous Cell Carcinoma Stages
Stage 0
Also known as high-grade dysplasia, in stage 0, cancer has formed in the inner lining of the esophagus wall, but hasn’t spread further.
Stage I (1)
In stage I, the cancer has spread to the mucosa layer (the thin muscle layer of the esophagus wall), the submucosa layer, or the thick muscle layer of the esophagus wall. Your stage may be IA, IB or IC based on the location of the cancer cells.
Stage II (2)
Similar to stage I, stage II can be either IIA or IIB, depending on where the cancer has spread.
- Stage IIA: Cancer has spread to the thick muscle layer of the esophagus wall, with grade 2, grade 3, or unknown grade cancer cells; into the connective tissue of the lower esophagus; or into the connective tissue of the upper or middle esophagus with grade 1 cancer cells.
- Stage IIB: Cancer has spread into the connective tissue layer of the upper or middle esophagus with grade 2 or 3 cancer cells; into the connective tissue layer with unknown tumor placement and cell grade; or into the mucosa layer, thin muscle layer or submucosa layer, as well as one or two nearby lymph nodes.
Stage III (3)
- Stage IIIA: Cancer has spread to the mucosa layer, thin muscle layer or submucosa layer, along with three to six nearby lymph nodes. Or, the cancer has spread into the thick muscle layer of the esophagus wall and one to two nearby lymph nodes.
- Stage IIIB: Cancer has spread into the thick muscle layer, connective tissue layer or nearby structures like the diaphragm, azygos vein, pleura, sac around the heart, or peritoneum. Spread to lymph nodes is also considered.
Stage IV (4)
- Stage IVA: Cancer that has spread to surrounding structures and multiple lymph nodes near the tumor.
- Stage IVB: Cancer has spread to other parts of the body, such as the lung or the liver.
How to Know Your Esophageal Cancer Stage
As part of your diagnosis with esophageal cancer, you will have imaging scans and other tests, like biopsies and flexible endoscopies, to tell if the cancer has spread and where. In a biopsy, a tissue sample is removed with a needle and a pathologist checks to see if it contains cancer cells.
If you have had staging tests and you already know the stage of your cancer before you come to Fred Hutch, we will look at the test results before your first appointment. If you have not had these tests, we will talk with you about which tests you need, why, how to get them and when you can expect results.
Esophageal Cancer Survival Rates
In cancer care, “survival rate” usually means the percentage of people expected to survive their cancer for at least five years from the time it was diagnosed. Data experts estimate this rate based on information about large groups of people with the same type of cancer. The rate doesn’t include the risk of dying during those five years for some other reason.
But the chance of surviving cancer for five years or more can be quite different from person to person. One important reason is the stage of the disease at the time of diagnosis. The earlier you are diagnosed, the better your outlook may be. Survival rates also vary based on factors like your age, your overall health, the type of esophageal cancer you have and the location of your tumor.
Even within a subset of people, like those with localized disease, there will be differences. Patients may have different treatments and respond to treatments in different ways.
This means it’s impossible to predict the likely lifespan of any one person based on survival rates. If you would like to know more about the outlook for your disease, talk with your Fred Hutch care team. They can tell you more based on your unique situation.
Treatment for esophageal cancer can be very different from person to person. However, the first treatment for early-stage esophageal cancer that hasn’t spread is usually an outpatient procedure to remove the tumor, using a procedure called an endoscopic mucosal resection. You may also have chemotherapy or radiation to shrink your tumor or destroy any remaining cancer cells.
If your esophageal cancer has spread through the layers of your esophagus, you may have surgery to remove part or all of your esophagus.
For metastatic cancer, the most common first treatment is chemotherapy. Other treatments, like immunotherapy, targeted therapy and other therapies, may help control the disease symptoms, shrink the tumor on imaging, slow down cancer growth, help you live longer and give you the best possible quality of life.
At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support as needed. These include integrative medicine, nutrition counseling, physical and occupational therapy, emotional support, genetic counseling to help you and your family with cancer prevention and care to reduce symptoms caused by the cancer or the treatments you receive.
Researchers at Fred Hutch and beyond are always looking for better ways to treat advanced or metastatic esophageal cancer. Clinical trials are going on to test new drugs or new combinations of drugs. In recent years, patients have benefited from newer targeted therapies, immunotherapies and proton therapy.