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About stages and grades

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 oesophageal cancers, doctors also consider whereabouts the cancer is in your oesophagus. 

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 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

Doctors sometimes use the terms well differentiated, moderately differentiated or poorly differentiated to describe the grade of your cancer. As normal cells grow and mature, they become specialised for their role and place in the body.  This is called differentiation. 

Cancer cells can look very like normal cells and are described as 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 known as undifferentiated or high grade. These cancers tend to grow and spread more quickly than low grade cancers.

Types

The 2 main types of oesophageal cancer are squamous cell cancer and adenocarcinoma. Doctors stage oesophageal squamous cell cancers in a different way to oesophageal adenocarcinomas. Treatment may also be different for the 2 types.

Where the cancer is in your oesophagus

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.

Diagram showing the parts of the oesophagus
Last reviewed: 
07 Aug 2019
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer, Springer, 2017

  • Principles and practice of oncology (11th edition)
    VT de Vita, S Hellman and SA Rosenberg
    Lippincott, Williams and Wilkins, 2019