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Staging Esophageal Cancer

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Once diagnosed, your team will evaluate whether the esophageal cancer has spread beyond its original site. Understanding how far the cancer has spread is crucial, as it influences the treatment approach. Remember, if esophageal cancer spreads to other parts of the body, it will still be treated as esophageal cancer, regardless of what other organs are involved.

If you were recently diagnosed with esophageal cancer, talk with your GI oncologist about your treatment options.

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Determining the Esophageal Cancer Stage

The American Joint Committee on Cancer (AJCC) TNM system is the staging system most often used for esophageal cancer, where TNM refers to:

  • Tumor size and extent of tumors (T)
  • Lymph node involvement (N)
  • Presence or absence of distant metastasis or spread to other areas of the body (M)

Staging can be done in a few different ways:

  • Clinical stage: If surgery isn’t the initial treatment or will follow another therapy, the clinical stage is determined based on physical exams, biopsy results, and imaging tests. While this information helps shape your treatment plan, it may not always accurately reflect the cancer’s spread.
  • Pathological staging (also known as surgical stage): When surgery is the first line of treatment, your oncologist will determine the pathological stage by examining tissue removed during surgery. This method is the most commonly used.
  • Postneoadjuvant stage: If you receive radiation or chemotherapy before surgery (neoadjuvant therapy), a postneoadjuvant stage will be determined after surgery.

Tumor Grade

In addition to the TNM staging system, a grade is assigned to each tumor. The grade indicates how closely the cancer resembles normal tissue under a microscope.

Tumor grades for esophageal cancer are as follows:

  • GX: The grade is unknown because it cannot be evaluated.
  • Grade 1 (G1): The cancer cells appear more similar to normal esophageal cells and are categorized as well-differentiated or low-grade.
  • Grades 2 (G2): The cells are moderately differentiated, falling between Grade 1 and Grade 3.
  • Grade 3 (G3): The cancer cells look very abnormal and are classified as poorly differentiated or high-grade.

Typically, low-grade cancers grow and spread more slowly than high-grade cancers, leading to a more favorable prognosis for low-grade cancers compared to high-grade cancers at the same stage.

Esophageal Cancer Stages

Esophageal cancer can be stage 0, I, II, III, or IV. A lower stage number indicates less spread of cancer, while a higher stage number, like IV, means a more advanced and serious condition. Below are the details of each class for the two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma.

Staging for Esophageal Squamous Cell Carcinoma

Abnormal cells are found only in the inner lining of the esophagus and have not spread to nearby tissue. This stage is also called high-grade dysplasia.

Cancer is present but has not spread to lymph nodes or distant organs.

  • Stage IA: Cancer has grown into the mucosa or thin muscle layer. Grade 1 or unknown.
  • Stage IB: Cancer has grown deeper into the mucosa, thin muscle, or submucosa. Grade GX, G1, or G2.

Cancer has not spread to distant organs.

  • Stage IIA: Cancer has grown into the thick muscle layer or the outer esophageal layer but not lymph nodes.
  • Stage IIB: Cancer has spread to 1 or 2 nearby lymph nodes or has reached the outer layer of the esophagus.

Cancer has grown deeper into the esophagus and may involve nearby lymph nodes (up to six), but has not spread to distant organs. It may also spread to nearby tissues such as the pleura, pericardium, or diaphragm.

Cancer has grown deeper into the esophagus and may involve nearby lymph nodes (up to six), but has not spread to distant organs. It may also spread to nearby tissues such as the pleura, pericardium, or diaphragm.

  • Stage IVA: Cancer has spread to nearby structures or many nearby lymph nodes but not distant organs.

  • Stage IVB: Cancer has spread to distant lymph nodes or organs such as the liver or lungs.

Staging for Esophageal Adenocarcinoma

Abnormal cells are limited to the inner lining of the esophagus. They have not spread to nearby tissue, lymph nodes, or distant organs. This stage is also called high-grade dysplasia.

Cancer is present but has not spread to lymph nodes or distant organs.

  • Stage IA: Cancer has grown into the first layers of the esophagus. Grade GX or G1.
  • Stage IB: Cancer has grown deeper into the mucosa, thin muscle, or submucosa. Grade GX, G1, or G2.
  • Stage IC: Cancer has grown into deeper layers of the esophageal wall, possibly including the thick muscle. Grade GX to G3.

Cancer has not spread to distant organs.

  • Stage IIA: Cancer has grown into the thick muscle layer but not lymph nodes. Grade GX or G3.
  • Stage IIB: Cancer has spread to 1 or 2 nearby lymph nodes, or into the outer esophageal layer.

Cancer has grown deeper into the esophagus and may involve nearby lymph nodes (up to six), but has not spread to distant organs. It may also reach nearby structures such as the pleura, pericardium, or diaphragm.

  • Stage IVA: Cancer has spread to nearby structures or many nearby lymph nodes but not distant organs.
  • Stage IVB: Cancer has spread to distant lymph nodes or organs such as the liver or lungs.

Resectable vs. Unresectable Esophageal Cancer and Its Impact on Treatment Options

Understanding the stage of your esophageal cancer helps the oncologist develop your personalized treatment plan. One of the key factors we consider is whether the cancer can be completely removed through surgery (resected). Generally, esophageal cancers classified as Stage 0, I, and II are considered potentially resectable, meaning there’s a strong possibility that surgery can be performed to remove all of the cancer. Cancers that have spread too far to be fully removed are classified as unresectable. When surgery is not recommended, a different set of treatments for metastatic cancer will be explored.

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