Stage 4

The stage of your cancer tells the doctor how far it has grown and if it has spread.

What is stage 4 oesophageal cancer?

Stage 4 oesophageal cancer means your cancer is advanced.

Your cancer might have spread into other organs or body structures next to the oesophagus. Or it might have spread to 7 or more lymph nodes. 

Some stage 4 cancers have spread to other parts of your body, such as the lungs or liver.

This is a simplified description. We have much more detailed information below on this page.

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) 

When you read the information on this page, it's helpful to know what type of oesophageal cancer you have and whether the doctor is using pathological or clinical staging. Talk to your specialist doctor or nurse if you are unsure. They can help you understand more about your cancer stage.

You can call the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.

Staging systems

Doctors use different systems to stage oesophageal cancer. This page is about stage 4 cancer, which is part of the number staging system. This system has 5 stages, stage 0 to stage 4.

This page also tells you what stage 4 means in the TNM system. This system 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)

Squamous cell

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

Clinical staging means your doctor uses test and scan results to stage your cancer. This is different to pathological staging, which doctors use after surgery. 

Your doctor might tell you your clinical stage to begin with. And if you go on to have surgery, your stage might change when the doctor finds out your pathological stage. 

Stage 4 squamous cell cancer (clinical stage) can be any grade.

It’s split into 2 stages - stage 4A and stage 4B. 

Stage 4A means the cancer has grown into other organs or body structures next to the oesophagus - such as the windpipe (trachea) or the outer covering of the heart (pericardium). And it is in up to 6 lymph nodes.

Or it means the cancer is any size and has spread into 7 or more nearby lymph nodes.

In TNM staging, stage 4A includes:

  • T4, N0 - N2, M0
Diagram showing stage 4A squamous cell cancer (clinical stage)
  • Any T, N3, M0
Diagram showing stage 4A oesophageal cancer 1 of 3

Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes. 

In the TNM system, stage 4B is:

  • any T, any N, M1
Diagram showing stage 4B oesophageal cancer

Stage 4 squamous cell cancer (pathological stage) can be any grade.

It’s split into 2 stages - stage 4A and stage 4B. 

Stage 4A means the cancer has grown into nearby tissue or structures. It has spread to up to 6 nearby lymph nodes.

Or, the cancer is any size but has spread to 7 or more nearby lymph nodes.

In the TNM system, stage 4A includes:

  • T4a, N2, M0
Diagram showing stage 4A oesophageal cancer 2 of 3
  • T4b, N0 - N2, M0
Diagram showing stage 4A oesophageal cancer 3 of 3
  • Any T, N3, M0
Diagram showing stage 4A oesophageal cancer 1 of 3

Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes. 

In TNM staging, stage 4B is the same as:

  • any T, any N, M1
Diagram showing stage 4B oesophageal cancer

Adenocarcinoma

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

Clinical staging means your doctor uses test and scan results to stage your cancer. This is different to pathological staging, which doctors use after surgery. 

Your doctor might tell you your clinical stage to begin with. And if you go on to have surgery, your stage might change when the doctor finds out your pathological stage.  

Stage 4 adenocarcinoma (clinical stage) can be any grade.

It’s split into 2 stages - stage 4A and stage 4B. 

Stage 4A means your cancer might be any size or has grown as far as nearby tissues or structures. And it has spread into up to 6 nearby lymph nodes.

Or, the cancer is any size but has spread to 7 or more nearby lymph nodes.

In TNM staging, stage 4A includes:

  • T1 – T4a, N2, M0
Diagram showing stage 4A oesophageal cancer 2 of 3
  • T4b, N0-2, M0
Diagram showing stage 4A oesophageal cancer 3 of 3
  • Any T, N3, M0
Diagram showing stage 4A oesophageal cancer 1 of 3

Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes. 

In TNM staging, stage 4B is the same as:

  • any T, any N, M1
Diagram showing stage 4B oesophageal cancer

Stage 4 adenocarcinoma (pathological stage) can be any grade.

It’s split into 2 stages - stage 4A and stage 4B. 

Stage 4A means your cancer has grown into nearby tissues or structures. It might have spread to up to 6 nearby lymph nodes.

Or, the cancer is any size but has spread to 7 or more nearby lymph nodes

In TNM staging, stage 4A includes:

  • T4a, N2, M0
Diagram showing stage 4A oesophageal cancer 2 of 3
  • T4b, N0 - N2, M0
Diagram showing stage 4A oesophageal cancer 3 of 3
  • Any T, N3, M0
Diagram showing stage 4A oesophageal cancer 1 of 3

Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes. 

In TNM staging, stage 4B is the same as:

  • any T, any N, M1
Diagram showing stage 4B oesophageal cancer

Treatment

Treatment aims to control the cancer and maintain a good quality of life. You might have:

  • chemotherapy
  • radiotherapy
  • symptom control eg. treatment to help you swallow food
  • trastuzumab (Herceptin) biological therapy for cancers in the gastro oesophageal junction area and the cells have HER2 protein

Other stages

Last reviewed: 
11 Dec 2019
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer, Springer, 2017

  • Oesophago-gastric cancer: assessment and management in adults  [NG83]
    National Institute for Health and Clinical Excellence (NICE)
    Published January 2018

  • Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    F. Lordick and others
    Ann Oncol. 2016 27 Suppl 6: v50-v57

  • Current management of oesophageal cancer
    N Rashid and others
    British Journal of Medical practitioners 2015 Volume 8, Issue 1, page 804

  • Oesophageal cancer
    E.C.Smith and others
    Nature Reviews Disease Primers Volume 3: 17048 (2018)

  • Oesophageal cancer
    J Lagergren and others
    The Lancet Vol 390, November 25th 2017

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