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Esophageal Cancer Stages
After someone is diagnosed with esophageal cancer, doctors will try to figure out if 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. Doctors also use a cancer's stage when talking about survival statistics.
The earliest stage esophageal cancers are called stage 0 (high grade dysplasia). It then ranges from stage 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. 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.
Most esophageal cancers start in the innermost lining of the esophagus (the epithelium) and then grow into deeper layers over time.
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 on 3 key pieces of information:
- 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? (See What Is Cancer of the Esophagus? to learn about the layers of the esophagus wall.)
- The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
- The spread (metastasis) to distant sites (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. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information see Cancer Staging.
Staging systems for esophageal cancer
Since esophageal cancer can be treated in different ways, different staging systems have been created for each situation:
- Pathological stage (also called the surgical stage): If surgery is done first, the pathological stage is determined by examining tissue removed during an operation. This is the most common system used.
- Clinical stage: If surgery might not be possible or will be done after other treatment is given, then the clinical stage is determined based on the results of a physical exam, biopsy, and imaging tests. The clinical stage will be used to help plan treatment, but it might not predict outlook as accurately as the pathologic stage. This is because sometimes the cancer has spread further than the clinical stage estimates.
- Postneoadjuvant stage: If chemotherapy or radiation is given before surgery(this is called neoadjuvant therapy), then a separate postneoadjuvant stage will be determined after surgery.
Since most cancers are staged with the pathological stage, we have included that staging system in the tables below. If your cancer has been clinically staged or if you have had neoadjuvant therapy, it is best to talk to your doctor about your specific stage for those situations.
Grade
Another factor that can affect your treatment and your outlook is the grade of your cancer. The grade describes how closely the cancer looks like normal tissue when seen through a microscope.
The scale used for grading esophagus cancers is from 1 to 3.
- GX: The grade cannot be evaluated.(The grade is unknown).
- Grade 1 (G1: well differentiated; low grade) means the cancer cells look more like normal esophagus cells.
- Grade 3 (G3: poorly differentiated, undifferentiated; high grade) means the cancer cells look very abnormal.
- Grades 2 (G2: moderately differentiated; intermediate) falls somewhere in between Grade 1 and Grade 3.
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 of the same stage.
Location
Some stages of early squamous cell carcinoma also take into account where the tumor is in the esophagus. The location is assigned as either upper, middle, or lower based on where the middle of the tumor is.
Esophageal cancer stage descriptions
The tables below are simplified versions of the TNM system, based on the most recent AJCC systems effective January 2018. They include staging systems for squamous cell carcinoma and adenocarcinoma. It’s important to know that esophageal cancer staging can be complex. If you have any questions about the stage of your cancer or what it means, please ask your doctor to explain it to you in a way you understand.
Squamous Cell Carcinoma Stages
AJCC Stage |
Stage description SQUAMOUS CELL CARCINOMA |
0 |
The cancer is only in the epithelium (the top layer of cells lining the inside of the esophagus). It has not started growing into the deeper layers. This stage is also known as high-grade dysplasia. It has not spread to any lymph nodes or distant organs. The cancer grade does not apply. The cancer can be located anywhere in the esophagus. |
IA |
The cancer is growing into the lamina propria or muscularis mucosa (the tissue under the epithelium). It has not spread to any lymph nodes or distant organs. The cancer is grade 1 or an unknown grade and located anywhere in the esophagus. |
IB |
The cancer is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), submucosa or the thick muscle layer (muscularis propria). It has not spread to nearby lymph nodes or to distant organs. The cancer can be any grade or an unknown grade and located anywhere in the esophagus. |
IIA |
The cancer is growing into the thick muscle layer (muscularis propria). It has not spread to nearby lymph nodes or to distant organs. The cancer can be grade 2 or 3 or an unknown grade and located anywhere in the esophagus. |
OR |
|
The cancer is growing into the outer layer of the esophagus (the adventitia). It has not spread to nearby lymph nodes or to distant organs. The cancer can be any of the following:
|
|
IIB
|
The cancer is growing into the outer layer of the esophagus (the adventitia). It has not spread to nearby lymph nodes or to distant organs. The cancer can be any of the following:
|
OR |
|
The cancer is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium) or into the submucosa. It has spread to 1 or 2 nearby lymph nodes. The cancer can be any grade and located anywhere in the esophagus. |
|
IIIA |
The cancer is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), submucosa or the thick muscle layer (muscularis propria). It has spread to no more than 6 nearby lymph nodes. It has not spread to distant organs. The cancer can be any grade and located anywhere in the esophagus. |
IIIB |
The cancer is growing into:
It has not spread to distant organs. The cancer can be any grade and located anywhere in the esophagus. |
IVA |
The cancer is growing into:
It has not spread to distant organs. The cancer can be any grade and located anywhere in the esophagus. |
IVB |
The cancer has spread to distant lymph nodes and/or other organs. such as the liver and lungs. The cancer can be any grade and located anywhere in the esophagus. |
Adenocarcinoma stages
The location of the cancer in the esophagus does not affect the stage of adenocarcinomas.
AJCC Stage |
Stage description ADENOCARCINOMA |
0 |
The cancer is only in the epithelium (the top layer of cells lining the inside of the esophagus). It has not started growing into the deeper layers. This stage is also known as high-grade dysplasia. It has not spread to any lymph nodes or distant organs. The cancer grade does not apply. |
IA |
The cancer is growing into the lamina propria or muscularis mucosa (the tissue under the epithelium). It has not spread to any lymph nodes or distant organs. The cancer is grade 1 or an unknown grade. |
IB |
The cancer is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), or the submucosa. It has not spread to nearby lymph nodes or to distant organs. The cancer can be grade 1 or 2 or an unknown grade. |
IC |
The cancer is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), submucosa or the thick muscle layer (muscularis propria). It has not spread to nearby lymph nodes or to distant organs. The cancer can be grade 1, 2 or 3. |
IIA |
The cancer is growing into the thick muscle layer (muscularis propria). It has not spread to nearby lymph nodes or to distant organs. The cancer can be grade 3 or an unknown grade. |
IIB
|
The cancer is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), or the submucosa. It has spread to 1 or 2 nearby lymph nodes. It has not spread to distant organs. The cancer can be any grade. |
OR |
|
The cancer is growing into the outer layer of the esophagus (the adventitia). It has not spread nearby lymph nodes. The cancer can be any grade. |
|
IIIA |
The cancer is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), the submucosa, or the thick muscle layer (muscularis propria). It has spread to no more than 6 nearby lymph nodes. It has not spread to distant organs. The cancer can be any grade. |
IIIB |
The cancer is growing into:
It has not spread to distant organs. The cancer can be any grade. |
IVA |
The cancer is growing into:
It has not spread to distant organs. The cancer can be any grade. |
IVB |
The cancer has spread to distant lymph nodes and/or other organs. such as the liver and lungs. The cancer can be any grade. |
Resectable versus unresectable cancer
The AJCC staging system provides a detailed summary of how far an esophagus cancer has spread. But for treatment purposes, doctors are often more concerned about whether the cancer can be removed completely with surgery (resected). If, based on where the cancer is located and how far it has spread, it 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.
As a general rule, stage 0, I, and II esophageal cancers are potentially resectable. Most stage III cancers are potentially resectable also, even when they have spread to nearby lymph nodes, as long as the cancer has not grown into the trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine, or other nearby important structures. Unfortunately, many people whose cancer is potentially resectable might not be able to have surgery to remove their cancers because they aren’t healthy enough.
If you have localized esophageal cancer, it is often recommended that your case be discussed at a multidisciplinary meeting. In this meeting, your medical information is reviewed at one time with doctors from different specialties (for example, medical oncology, pathology, surgery, radiation oncology) who, as a group, recommend a treatment plan for you.
Cancers that have grown into nearby structures or that have spread to distant lymph nodes or to other organs are considered unresectable, so treatments other than surgery are usually the best option.
- Written by
- References
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.
American Joint Committee on Cancer. Esophagus and Esophagogastric Junction. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:185.
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National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. V.4.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf on Jan 23, 2020.
PDQ® Adult Treatment Editorial Board. PDQ Esophageal Cancer Treatment (Adult). Bethesda, MD: National Cancer Institute. Updated 01/22/2020. Available at: https://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq. Accessed 01/29/2020. [PMID: 26389338].
Posner MC, Goodman KA, and Ilson DH. Ch 52 - Cancer of the Esophagus. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams & Wilkins; 2019.
Last Revised: March 20, 2020
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