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The stages of oesophageal cancer

Men and women discussing non oesophageal cancer

This page is about the stages of cancer of the food pipe (oesophagus). You can find the following information

 

A quick guide to what's on this page

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.

The TNM stages of oesophageal cancer

TNM stands for Tumour, Node, Metastasis. The system can describe 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. There is more detailed information about the TNM stages of oesophageal cancer further down this page.

The number stages of oesophageal cancer

There are 4 main stages in this system – stage 1 to 4. Some doctors also refer to stage 0, which means there are severely abnormal cells in the inner lining of the oesophagus. If left untreated some of these cells may change into an invasive cancer.

Stage 1 means that cancer is found within the wall of the oesophagus. Stage 2 means the cancer has grown into the membrane covering the outside of the oesophagus or has spread to 1 or 2 nearby lymph nodes. Stage 3 means the cancer has grown no further than the outer covering of the oesophageal wall but has spread to several lymph nodes. Or the cancer has grown into nearby tissues or structures and may have spread to the lymph nodes. Stage 4 means the cancer is advanced and has spread to other parts of the body, such as the liver or lungs.

What grading is

As well as the type and stage of a cancer, doctors may also look at the grade when deciding on treatment. Specialists grade cancer cells according to how similar they look to normal cells when looked at under a microscope. The grades are from 1 to 3. Grade 1 cancer cells (low grade) look most like normal cells and grade 3 cancer cells (high grade) look the most abnormal. The grade gives your doctor an idea of how the cancer might behave.
 

CR PDF Icon View a summary of treating oesophageal cancer.

 

 

Why cancers are staged

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. 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 2 main ways are the TNM system and number systems. There is more about staging in the about cancer section. 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.

 

The TNM stages of oesophageal cancer

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

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

The wall of the oesophagus has 4 layers

  • Inner layer (mucosa)
  • Layer of supportive tissue (submucosa)
  • Muscle layer (muscularis)
  • Outer layer

Diagram showing the layers of the oesophagus

There are 4 stages of tumour size in oesophageal cancer

  • T1 means the tumour has grown no further than the layer of supportive tissue
  • T2 means the tumour has grown into the muscle layer of the wall of the oesophagus
  • T3 means the tumour has grown into the membrane covering the outside of the oesophagus

Diagram showing T1,T2 and T3 stages of oesophageal cancer

  • 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).

Diagram showing stage T4 oesophageal cancer

In cancer of the oesophagus, the N stages refer to lymph nodes that surround the food pipe (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

Diagram showing oesophageal cancer in the lymph nodes (N staging)

There are 2 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

Diagram showing oesophageal cancer that has spread (M staging)

 

The number stages of oesophageal cancer

There are 4 main stages in this system - stage 1 to 4. 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 inner 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 the cancer is found within the oesophageal wall. 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 layer of supportive tissue (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 oesophageal wall (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 the cancer has grown into the membrane covering the outside of the oesophagus, but has not spread to nearby lymph nodes (T3, N0, M0). Stage 2B means the cancer has grown no further than the layer of muscle, but is in 1 or 2 lymph nodes (T1 or T2, N1, M0). 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 grown into the membrane covering the oesophagus and is in 1 or 2 nearby lymph nodes (T3, N1, M0), OR
  • Has grown no further than the layer of muscle but has spread to 3 to 6 nearby lymph nodes (T1 or 2, N2, M0)

Stage 3B means the cancer has grown into 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 other parts of the body, such as the liver or lungs (Any T, Any N, M1). 

 

What grading is

As well as the type and stage of a cancer, doctors may also look at the grade when deciding on treatment. Cancer cells are graded according to how similar they look to normal cells when looked at under a microscope. Specialists look at the size and appearance of the control centre of the cell - the nucleus. There are 3 groups, called grades 1 to 3. Grade 1 cancer cells look most like normal cells and are called low grade or well differentiated. Grade 3 cancer cells look the most abnormal and are called high grade or poorly differentiated.

The grade gives your doctor an idea of how the cancer might behave. Generally speaking, high grade cancers are fast growing and have a greater risk of coming back after treatment. But individual cancers can behave differently.

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Updated: 13 April 2014