Esophageal Cancer: Staging

The overall stage of esophageal cancer is determined by three key factors- how deeply the tumor has penetrated into the wall of the esophagus, whether lymph nodes are involved and how many and lastly but most importantly whether the tumor has spread to farther parts of the body, such as the lungs, liver and bones being common places for what is called metastatic spread. 

• Stage 0 esophageal cancer (also called cancer in situ) represents a stage when the cancer cells have not broken through the most superficial protective layer of the esophagus. These tumors can many times be managed well through endoscopic measures. 

• Stage I esophageal cancers tend to be small and superficial tumors that have not yet penetrated deeply into the wall of the esophagus and usually can be managed successfully with primary surgery

• Stage II and III esophageal cancer (also called locally advanced) are larger, more deeply penetrating tumors commonly with lymph node involvement as well. These cases usually call for multimodality treatment approaches calling for expertise from gastroenterology, thoracic surgery, radiation oncology and medical oncology for best management. Many times chemotherapy and/or radiation therapy is given prior to surgery in such cases (so-called neoadjuvant therapy) and such treatment can increase the success rate of surgery and improve long-term cure rates. In cases where the tumor is too advanced to be removed by surgery, a combination of chemotherapy and radiation (so-called combined modality therapy) can sometimes still cure the cancer.

• Stage IV esophageal cancer (also called metastatic disease) involves cancer spread to farther organs in the body in which case local therapy, such as surgery or radiation has less utility and usual management involves medical therapy, such as chemotherapy and in some cases targeted therapy.