Detailed Guide: Esophagus Cancer How Is Esophagus Cancer Staged?
Staging is the process of finding out whether the cancer has spread and if so, how far. The treatment and prognosis (the outlook for chances of survival) for people with esophageal cancer depend, to a great extent, on the cancer's stage. Eophageal cancer can be staged in several ways but symptoms such as dysphagia most commonly lead to a barium swallow and/or endoscopy procedure. The size of the tumor can then be estimated. Then a CT scan is usually done, especially if the tumor is smaller than 5 centimeters (2 inches). The CT scan can show if the cancer has spread to nearby lymph nodes and/or the lungs, if the tumor extends through the esophagus into the trachea (windpipe), and if the cancer has spread to distant organs like the liver. In some medical centers, endoscopic ultrasound can be performed to give very detailed pictures of just how deeply the cancer has invaded the esophageal tissue. The depth of penetration of the cancer is very important in determining the chances for at least a 5-year survival as well as whether surgery is likely to help the patient. The most common system used to stage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The TNM system describes 3 key pieces of information. T refers to the size of the primary tumor and how far it has spread within the esophagus and to nearby organs. N refers to cancer spread to nearby lymph nodes. M indicates whether the cancer has metastasized (spread to distant organs). T Stages TX: primary tumor cannot be assessed T0: no evidence of primary tumor Tis: carcinoma in situ (the tumor has not invaded beyond the epithelium, the first or innermost layer of the esophagus) T1: tumor invades the lamina propria (second layer) or submucosa (third layer) T2: tumor invades the muscularis propria (fourth layer) T3: tumor invades the adventitia (fifth and outermost layer) T4: tumor invades nearby structures N Stages NX: nearby lymph nodes cannot be assessed N0: no spread to nearby lymph nodes N1: spread to nearby lymph nodes M Stages MX: spread to other organs cannot be assessed M0: no spread to distant organs M1: spread to distant organs Information about the tumor, lymph nodes, and metastasis is then combined to assign a stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV:
Stage 0: This is the earliest stage of esophageal cancer. This stage is also called carcinoma in situ, meaning that cancer cells are limited to the epithelium (the part of the mucosa forming the inner lining of the esophagus). The cancer does not invade the connective tissue beneath the epithelium. The cancer has not spread to lymph nodes or other organs. Stage I: Stage I means that the esophageal cancer has invaded from the epithelium into some of the other layers of the esophagus. Cancer may be present in the lamina propria, the connective tissue part of the mucosa, or the submucosa, the connective tissue underneath the mucosa. The cancer has not spread to the muscularis propria, the thick muscle layer of the esophagus that pushes food from the throat into the stomach. In this stage, the cancer has not spread to lymph nodes or to any other organs. Stage II: There are 2 substages IIA and IIB. Stage IIA: In this stage, the cancer has invaded the muscularis propria and may extend through that layer into the adventitia, the connective tissue covering the outside of the esophagus. The cancer has not spread to lymph nodes or to any other organs. Stage IIB: The cancer may invade the lamina propria, submucosa, and the muscularis propria, but not the adventitia. However, it has spread to lymph nodes near the esophagus. Other organs are not involved. Stage III: Cancers in this stage have either spread to the adventitia and to lymph nodes near the esophagus or they have spread beyond the adventitia into nearby organs, such as the trachea (windpipe), and may or may not have spread to the lymph nodes. The cancer has not spread to lymph nodes farther away from the esophagus (such as nodes in the neck or nodes in the lower abdomen). It has not spread through the bloodstream to organs farther away from the esophagus (such as the liver, bones, or brain). Stage IV: This stage indicates that the esophageal cancer has spread to distant organs. Spread through the bloodstream to organs away from the esophagus (such as the liver, bones, or brain) is always considered distant spread. Depending on the exact location of the primary cancer in the esophagus, spread to nonregional (not next to the esophagus) lymph nodes may also be considered distant spread. If the esophageal cancer is in the upper part of the chest, spread to lymph nodes in the abdomen near the stomach is considered distant spread. For cancers of the lower part of the esophagus, spread to lymph nodes near the neck is considered distant spread. Survival Rates by Stage
These survival rates are an average of outcomes of patients with the same stage. They do not take into account differences in treatment or a patient's general state of health. These are provided as estimates only and the outlook for any individual patient may differ from these average figures. . In addition, these rates are based on past cases. Recent treatment advances may offer options for people with esophageal cancer today that past patients did not have. Revised 1-1-04 
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