About the stages, types and grades of oesophageal cancer

The stage of a cancer tells you how big it is and whether it has spread. The grade means how abnormal the cells look under the microscope. The stage and grade help your doctor decide which treatment you need.

Staging oesophageal cancer

Staging is very complicated. It depends on:

• what type of oesophageal cancer you have (squamous cell or adenocarcinoma)
• the grade of your cancer (how abnormal the cells look)
• whether doctors stage your cancer using tests and scans (clinical staging) or after surgery (pathological staging) 

For some stage 2 squamous cell oesophageal cancers, the doctor also considers where the cancer is in your oesophagus.

Your oesophagus has 3 parts – the upper, middle and lower part.

Staging systems

There are different ways of staging oesophageal cancer. There is a TNM system and a number staging system.

TNM staging

The TNM staging system is the most common way that doctors stage oesophageal cancer. TNM stands for tumour, node, metastasis. It describes:

• the size of the primary tumour (T)
• whether the cancer has spread to the lymph nodes (N)
• whether the cancer has spread to another part of the body (M)

Number staging

Doctors may also use a number staging system. There are 5 main stages - stage 0 (high grade dysplasia) to stage 4. 

How do doctors find out your stage?

There are different ways to find out your stage. Your doctor might use:

• clinical staging before treatment and if you don't have surgery
• pathological staging if you do have surgery
• post neoadjuvant staging if you have chemotherapy or radiotherapy before surgery

Clinical staging means the doctor stages you after examining you and looking at test and scan results. Doctors use clinical staging to plan your treatment. It’s also the best way to stage people who aren’t having surgery. You might see your clinical stage written as cTNM.

Pathological staging means the doctor stages you after examining the tissue that the surgeon removes during an operation. This is also called surgical staging. The doctors combine your clinical stage results with the surgical results. Pathological staging is generally a more precise way to find out how far your cancer has spread. Your pathological stage might be different to your clinical stage. You might see your pathological stage written as pTNM.

Post neoadjuvant staging means you have had chemotherapy or radiotherapy before surgery (neoadjuvant treatment) and the doctor stages you again after surgery. You might see your post neoadjuvant stage written as ypTNM. 

For oesophageal cancer, the clinical, pathological, and post neoadjuvant staging are all different. In this section we describe the pathological and clinical stages.

Grades

The grade of a cancer tells you how much the cancer cells look like normal cells.

The grade gives your doctor an idea of how the cancer might behave and what treatment you need.

The grades of cancer cells are from 1 to 3:

• grade 1 (low grade) look most like normal cells
• grade 2 look a bit like normal cells
• grade 3 (high grade) look very abnormal and not like normal cells

Differentiation

As normal cells grow and mature, they become specialised for their role and place in the body. This is called differentiation. 

Your doctor might describe your grade of cancer as:

• well differentiated
• moderately differentiated
• poorly differentiated

Cancer cells can look like normal cells and so they are well differentiated or low grade. These cancers are more likely to grow slowly.

If the cancer cells look underdeveloped and nothing like a normal cell, they are poorly differentiated or high grade. These cancers tend to grow and spread more quickly than low grade cancers.

Types

Oesophageal cancer can start anywhere in the oesophagus. Your type of oesophageal cancer depends on the type of cell that it starts in. The 2 main types are squamous cell cancer and adenocarcinoma.

Adenocarcinoma

Adenocarcinomas are cancers that develop in gland cells. These cells make mucus in the lining of the oesophagus.

This is the most common type of oesophageal cancer in the UK. It is more common in men than women. It's linked to smoking, being overweight and having a long history of acid reflux.

Oesophageal adenocarcinomas mainly affect the lower part of the oesophagus.

Squamous cell cancer

These cancers develop from squamous cells that make up the inner lining of your oesophagus.

This is the second most common type of oesophageal cancer in the UK. It's linked to smoking and drinking alcohol.

Squamous cell cancers tend to develop in the upper and middle part of the oesophagus.

Undifferentiated cancers

Your specialist doctor might not be able to tell which type of oesophageal cancer you have. This happens because the cancer cells can look very undeveloped under the microscope.

Undeveloped cancer cells are called undifferentiated cancers. So your doctor might say you have undifferentiated oesophageal cancer.

Other types of oesophageal cancer

Other types of cancer can start in the food pipe. Treatment can be different, depending on the type of cell the cancer starts in. 

Gastro oesophageal junction cancers

The lower part of the oesophagus joins the stomach. This is called the gastro oesophageal junction. Cancers that start here are called gastro oesophageal junction (GOJ) cancers.

Melanoma

Melanoma is a type of skin cancer. Rarely, it can begin in the oesophagus.

Lymphoma

Lymphomas are cancers of the lymphatic system. The treatment is different to other oesophageal cancers. 

Sarcoma

Soft tissue sarcomas are cancers of the supporting cells of the body, such as bone or muscle. Rarely, a type of sarcoma called a gastrointestinal stromal tumour (GIST) can develop in the oesophagus.