The stages of oesophageal cancer

The stage of a cancer tells the doctor how far it has spread. It is important because treatment is often decided according to the stage of a cancer. Your scans will give some information about the stage of your cancer. But your doctor may not be able to tell you the exact stage until you have surgery.

There are different ways of staging cancers. The two main ways are the TNM system and number systems. There is more about staging in the about cancer section of CancerHelp UK. When staging oesophageal cancer, your doctor may also include the grade of the cancer (what the cells look like under the microscope) and for squamous cell carcinoma, exactly where in the oesophagus the cancer is.

‘TNM’ stands for Tumour, Node, Metastasis. The system describes the size of a primary tumour, whether there are lymph nodes with cancer cells in them and whether the cancer has spread to a different part of the body.

The staging system for oesophageal cancer changed in 2010 and now includes cancers of the gastro oesophageal junction (where the oesophagus joins the stomach).

There are 4 stages of tumour size in oesophageal cancer

• T1 means the tumour has grown no further than the inner layer of the oesophagus (the submucosa)
• T2 means the tumour has grown into the muscle layer of the wall of the oesophagus (the muscularis)
• T3 means the tumour has broken through the membrane covering the outside of the oesophagus
• T4 means the tumour has grown into other organs or body structures next to the food pipe.  It is divided into T4a and T4b. T4a means that the cancer has grown into the tissue covering the lungs (pleura), the outer covering of the heart (pericardium), or the muscle at the bottom of the rib cage (diaphragm). T4b means that the cancer has spread into other nearby structures such as the windpipe (trachea), a spinal bone (vertebra) or a major blood vessel (the aorta).

In cancer of the oesophagus, the N stages refer to lymph nodes that surround the gullet (the regional lymph nodes). There are 4 possible stages

• N0 means there are no lymph nodes containing cancer cells
• N1 means there are cancer cells in 1 or 2 nearby lymph nodes 
• N2 means there are cancer cells in 3 to 6 nearby lymph nodes
• N3 means there are cancer cells in 7 or more nearby lymph nodes

There are two stages of metastasis

• M0 means there is no cancer spread to other organs
• M1 means the cancer has spread to other parts of the body

There are four main stages in this system - stage one to four. Some doctors also refer to stage 0.

Stage 0 or high grade dysplasia (severely abnormal cell changes)

Doctors sometimes call high grade dysplasia (HGD) carcinoma in situ (CIS). This means that there are severely abnormal cells in the lining of the oesophagus. If left untreated some of these cells may change into an invasive cancer. People with Barrett's oesophagus are at risk of developing these abnormal cells, and so may have regular endoscopies as part of their follow up care.

Stage 1

This means that cancer is found in the top layers of the lining of the oesophagus. It has not spread to nearby tissues, lymph nodes or other organs.

It is divided into stage 1A and 1B. Stage 1A means the cancer has grown no further than the inner layer of the oesophagus (the submucosa). This is the same as T1, N0, M0 in the TNM staging system. Stage 1B means the cancer has grown into the muscle layer of the wall of the oesophagus (the muscularis) but has not spread elsewhere. This may be written as T2, N0, M0.

Stage 2

This is divided into stage 2A and 2B. Stage 2A means that cancer has broken through the membrane covering the oesophagus but has not spread to the nearby lymph nodes (T3, N0, M0). Stage 2B means the cancer is in the top layers lining the oesophagus and is in 1 or 2 lymph nodes (T1 or T2, N1, M0). In stage 2, the cancer has not spread to any other organs.

Stage 3

Stage 3 is divided into 3A, 3B and 3C.

Stage 3A means the cancer

• Has grown into the tissue covering the lungs (pleura), the outer covering of the heart (pericardium) or the muscle at the bottom of the rib cage (diaphragm) but has not spread anywhere else (T4a, N0, M0), OR
• Has broken through the membrane covering the oesophagus and is in 1 or 2 nearby lymph nodes (T3, N1, M0), OR
• Is in the top layers of the oesophageal lining and has spread to 3 to 6 nearby lymph nodes (T1 or 2, N2, M0)

Stage 3B means the cancer has broken through the membrane covering the oesophagus and has spread to 3 to 6 lymph nodes but nowhere else (T3, N2, M0).

Stage 3C means the cancer

• Has grown into the tissue covering the lungs (pleura), the outer covering of the heart (pericardium) or the muscle at the bottom of the rib cage (diaphragm) and is in up to 6 lymph nodes (T4a, N1 or 2, M0), OR
• Has grown into nearby structures such as the windpipe (trachea), a spinal bone (vertebra) or a major blood vessel (the aorta) and has spread to any number of local lymph nodes (T4b, Any N, M0), OR
• Is any size and has spread to 7 or more nearby lymph nodes. But has not spread to another part of the body (Any T, N3, M0)

Stage 4

This means that the cancer is advanced and has spread to lymph nodes and other parts of the body, such as the liver or lungs (Any T, Any N, M1).