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Esophageal Cancer- Stage Dictates Prognosis
Esophageal cancer- stage dictates prognosis, meaning that your therapy plan depends largely on both your stage at diagnosis as well as your personal goals.
i am a long-term survivor of an incurable blood cancer. For the past 25 or so years, my life has been dominated by therapy-induced long-term and late-stage side effects. When I talk about your stage and your life goals, I’m talking about balancing the length of life with the quality of life.
For example, a diagnosis of Barrett’s Esophagus (BE) is a diagnosis of pre-esophageal cancer. While BE raises the risk of an EC diagnosis, it is not a diagnosis of cancer. Treatments should only be treatments that come with little risk of side effects.
Keep in mind that it is totally normal to freak out when you think you have cancer that can kill you. However, many diagnoses are of cancer at a stage that will NOT kill you. My point is that it is important to get an accurate stage before even thinking about a diagnosis or treatment of esophageal cancer.
I linked the video below because it is an excellent overview of EC diagnosis and staging.
Esophageal Cancer Diagnosis and Staging
As a long-term cancer survivor, I’ve learned that evidence-based, non-conventional therapies are usually not discussed by your oncologist, but 2) helpful in managing a cancer at any stage.
If you’d like to learn more about evidence-based complementary EC therapies, scroll down the page, post a question or comment, and I will reply to you ASAP.
Good luck,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Stages of Esophageal Cancer
If you are diagnosed with esophageal (esophagus) cancer, doctors will try to figure out whether it has spread, and if so, how far. This process is called staging.
The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
How is the stage determined?
The staging system most often used for esophageal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based mainly on:
- The extent (size) of the tumor (T): How far has the cancer grown into the wall of the esophagus? Has the cancer reached nearby structures or organs? (Most esophageal cancers start in the innermost lining of the esophagus, the epithelium, and then grow into deeper layers over time).
- Spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many?
- Spread (metastasis) to distant parts of the body (M): Has the cancer spread to distant lymph nodes or distant organs such as the lungs or liver?
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.
Other factors that can affect the stage of esophageal cancer
Two other factors might also affect the stage of esophageal cancer.
Grade
The grade describes how closely the cancer looks like normal esophagus tissue when seen through a microscope.
The scale used for grading esophageal cancers is from 1 to 3.
- GX: The grade cannot be evaluated (the grade is unknown).
- G1 (well differentiated; low grade): The cancer cells still look somewhat like normal esophagus cells.
- G2 (moderately differentiated; intermediate grade): Falls somewhere between G1 and G3.
- G3 (poorly differentiated; undifferentiated; high grade): The cancer cells look very abnormal.
Low-grade cancers tend to grow and spread more slowly than high-grade cancers. Most of the time, the outlook is better for low-grade cancers than it is for high-grade cancers.
Location of the tumor
For some stages of early squamous cell carcinoma, where the tumor is in the esophagus is also important. The location is assigned as either upper, middle, or lower based on where the middle of the tumor is.
Stage grouping
Once a person’s T, N, and M categories and the grade and location of the tumor have been determined, this information is combined in a process called stage grouping to assign an overall stage.
The earliest stage esophageal cancers are called stage 0 (high-grade dysplasia). Stages then range from I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage (IIA is lower than IIB).
For more general information about cancer stages, see Cancer Staging.
Esophageal cancer staging
The tables below are simplified versions of the most recent AJCC TNM pathological stages for esophageal cancers. They include separate staging systems for squamous cell carcinoma and adenocarcinoma, the two most common types of esophageal cancer.
Esophageal cancer staging can be complex. If you have any questions about the stage of your cancer or what it means, be sure to ask your doctor to explain it to you in a way you understand.
Squamous cell carcinoma stages
Adenocarcinoma stages
The location of the cancer in the esophagus does not affect the stage of adenocarcinomas.
Resectable versus unresectable esophageal cancer
The AJCC staging system provides a detailed summary of how far an esophageal cancer has spread. But for treatment purposes, doctors are often more concerned about whether the cancer can be removed (resected) completely with surgery.
- If the cancer could be removed completely by surgery, it is considered potentially resectable.
- If the cancer has spread too far to be removed completely, it is considered unresectable.
In general, stage 0, I, and II esophageal cancers are potentially resectable. Most stage III cancers are potentially resectable as well, even when they’ve spread to nearby lymph nodes, as long as the cancer hasn’t grown into important nearby structures such as the trachea (windpipe), the aorta (the large blood vessel coming from the heart), or the spine.
Surgery to remove esophageal cancer is a major operation, and unfortunately some people whose cancer is potentially resectable still might not be able to have the surgery if they aren’t healthy enough.
If you have localized esophageal cancer, it is often recommended that your case be discussed at a multidisciplinary meeting (often referred to as a tumor board). In this meeting, your medical information is reviewed by doctors from different specialties (for example, medical oncology, pathology, surgery, and radiation oncology) who, as a group, recommend a treatment plan for you.
Cancers that have grown into nearby vital structures or that have spread to distant lymph nodes or to other organs are generally considered unresectable, so treatments other than surgery are usually the best option.
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