Staging
Staging requires a few tests to see how far the cancer has grown and whether it has spread outside of the esophagus. When the tests are completed a "stage", ranging from 0-4, will be assigned to the tumor. For the most part, the stage of an esophageal cancer depends on how deeply the tumor cells have grown into the wall of the esophagus and whether it has spread to lymph nodes or other parts of the body.
Staging of Esophageal Cancer
Stage 0
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Description
- Cancer cells have formed on the surface of the esophagus but have not actually penetrated into the wall. This is called high grade dysplasia, and it is thought of as a pre-cancer.
Treatment
- Stage 0 esophageal cancer may be treated with endoscopic procedures such as ablation or endoscopic mucosal resection (EMR). In rare, very tough cases, stage 0 is treated with surgery.
Stage I
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Description
- Cancer is found only in the shallow layers of the esophagus.
Treatment
- Stage I esophageal cancer may be treated with endoscopic mucosal resection (EMR) or surgery.
Stage II
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Description
- Cancer has grown into the deeper layers of the esophagus or may have spread to nearby lymph nodes.
Treatment
- Stage II esophageal cancer is typically treated with surgery, although at times chemotherapy with or without radiation will be recommended before or after surgery.
Stage III
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Description
- Cancer has spread into or through the deepest layers of the esophagus. Nearby lymph nodes will be involved in most cases.
Treatment
- Stage III esophageal cancer is most often treated with perioperative chemotherapy. This involves a few rounds of chemotherapy upfront, followed by surgery, followed by a few more rounds of chemotherapy after surgery. Patients in this stage should be evaluated by a surgeon and a medical oncologist. For some patients, there are too many health risks to undergo surgery so instead of preoperative chemotherapy, they will undergo definitive chemoradiation.
Stage IV
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Description
- Cancer has spread to distant organs or other parts of the body.
Treatment
- Stage IV esophageal cancer is usually treated with systemic therapies (chemotherapy, immunotherapy, targeted therapy) alone.
