TNM staging for oesophageal cancer

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.

Tumour, node and metastasis (TNM) staging is the most common way to stage oesophageal cancer.

Doctors may also use the number staging system.

Tumour (T)

Tumour describes the size of the tumour (area of cancer). This is a simplified description of the T stage.

There are 4 stages of tumour size in oesophageal cancer - T1 to T4.

T1 means the cancer has grown no further than the layer of supportive tissue (submucosa). It's split into 2 further stages, T1a and T1b:

  • T1a means the cancer is in the inner layer (mucosa) or thin muscle layer of the oesophagus wall
  • T1b means the cancer has grown into the supportive tissue (submucosa)

T2 means the cancer 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 (adventitia).

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’s divided into T4a and T4b:

  • T4a means the cancer has grown into the tissue covering the lungs (pleura), the outer covering of the heart (pericardium), the muscle at the bottom of the rib cage (diaphragm), or the tissue lining the abdomen (peritoneum)
  • 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

Node (N)

Node (N) describes whether the cancer has spread to the lymph nodes.

There are 4 possible stages describing whether the lymph nodes contain cancer - N0 to N3.

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)

Metastasis (M)

Metastasis (M) describes whether the cancer has spread to a different part of the body.

There are 2 stages of metastasis.

M0 means the cancer has not 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 stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is 
  • other health conditions that you have

The stage of the cancer and these other factors can also give an idea of your outlook (prognosis).

Treatment might include:

  • surgery - to remove part or all your oeosphagus
  • chemotherapy
  • radiotherapy
  • chemoradiotherapy (chemotherapy together with radiotherapy)
  • targeted cancer drugs
  • symptom control treatment

You may have treatment as part of a clinical trial.

Last reviewed: 
29 Nov 2019
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    LH Sobin, MK Gospodarowicz, CH Wittekind
    John Wiley and Sons, Hoboken, New Jersey, 2009

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