This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on May 19, 2022.
Making an educated esophageal cancer treatment decision begins with determining the stage, or progression, of the disease. The stage of esophageal cancer is one of the most important factors in evaluating treatment options.
The patient’s care team will use a variety of diagnostic tests to evaluate esophageal cancer and develop an individualized treatment plan. After the patient is diagnosed, the care team will review his or her pathology to confirm the diagnosis and staging information and develop a personalized treatment plan. If the patient is diagnosed with a recurrence, the care team will perform comprehensive testing and identify a treatment approach tailored to the patient’s needs.
It’s also important to understand that the stage of a patient’s cancer may change. The patient’s care team will evaluate whether the staging information is affected by the progression, or regression, of the disease.
The stages of esophageal cancer are assigned based on the American Joint Committee on Cancer’s (AJCC’s) TNM system, a commonly accepted method based on three key components:
T (tumor): This describes the size of the original tumor.
N (node): This indicates whether the cancer is present in the body’s lymph nodes.
M (metastasis): This refers to whether cancer has spread to other parts of the body.
A number (0-4) or the letter X is assigned to each factor. In esophageal cancer staging, as in all cancer staging, a higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed.
Once the T, N and M scores have been assigned, an overall stage is assigned.
This overview will cover the basic facts about esophageal cancer stages, including:
In addition to the T, N and M staging system, health care providers also assess grade (G) to describe the appearance of cancer cells. Tumor grades for esophageal cancer (X, 1, 2 or 3) are assigned based on how normal or abnormal cancer cells appear under a microscope.
Nearly normal cancer cells are considered low grade and described as well-differentiated. Other esophageal cancer cells may be intermediate grade or high grade, and they’re sometimes described as moderately differentiated or undifferentiated/poorly differentiated, respectively. Grades range from X for cells that can’t be assessed to 3 for undifferentiated, high-grade cells.
Adenocarcinoma and squamous cell carcinoma are the two most common types of esophageal cancer. They have their own separate staging guidelines that are based on where the tumor is located in the esophagus.
Below is an overview of the staging of these types of cancer:
Stage 0
The cancer is detected only in the top lining of the esophagus. Cancer grade doesn’t apply at this stage.
Stage 1A
Cancer cells are detected in the lining of any part of the esophagus and may be in the layers underneath. The grade is unknown or low grade.
Stage 1B
Either of the following conditions apply:
Stage 1C
Either of the following conditions apply:
Stage 2A
Cancer has reached the muscularis propria. The grade is high or unknown.
Stage 2B
Either of the following conditions apply:
Stage 3A
The cancer is in the inner or third layer of the esophagus and has spread to three to six lymph nodes close to the tumor.
Stage 3B
Any of the following conditions apply:
Stage 4A
Either of the following conditions apply:
Stage 4B
The cancer has spread to another part of the body.
Stage 0
The cancer is only detected in the top layer of cells that line the inside of the esophagus. This stage is also referred to as high-grade dysplasia or Barrett’s esophagus.
Stage 1A
The cancer was found in the connective tissue or thin layer of muscle just under the epithelium, or the top, most inner layer of the esophagus. The grade is low or unknown, and the cancer may be located anywhere in the esophagus.
Stage 1B
Either of the following conditions apply:
Stage 2A
Any of the following conditions apply:
Stage 2B
Any of the following conditions apply:
Stage 3A
Any of the following conditions apply:
Stage 3B
Any of the following conditions apply:
Stage 4A: Either of the following conditions apply:
Stage 4B
The cancer has spread to distant lymph nodes and/or organs throughout the body. It can be any grade and located in any part of the esophagus.
The American Cancer Society refers to data collected in the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) database to determine cancer survival rates.
In the SEER database, survival rates for esophageal cancer are not based on the stages listed above. Instead, they’re classified based on how far the cancer has spread.
According to the most recent SEER data, the relative five-year survival rate for patients diagnosed with esophageal cancer is 21.7 percent. Survival rates change when broken down by cancer location at the time of diagnosis.
The five-year relative survival rates based on cancer location are listed below.
Recurrent cancer is cancer that returns after treatment. In some cases, treatment doesn’t fully remove or destroy all cancer cells. That doesn’t necessarily mean the patient had the “wrong” treatment. It means that a small number of cancer cells survived treatment and were able to go undetected in follow-up tests. In time, those remaining cells grew into cancer or tumors that became detectable.
Cancer experts conduct a series of lab and imaging tests to determine the type of recurrence the patient is experiencing. These tests assess the location of the cancer, as well as whether and where it may have spread. This process is sometimes referred to as restaging.
The same staging criteria apply, but an “r” is added at the beginning of the new stage to indicate the cancer is recurrent. (The staging for the original cancer diagnosis remains the same.)
Next topic: How is esophageal cancer diagnosed?