Esophageal cancer is staged on a scale from 0 to 4. The cancer stage indicates how far it has spread and how large the tumor is.

Esophageal cancer is staged ranging from 0 to 4. Higher stages indicate more advanced cancer.

Stages are then assigned letters within the stages. Letters indicate progression within the stage. For instance, stage 1C is more advanced than stage 1A.

Staging is done using the American Joint Committee on Cancer TNM system. The TNM system breaks down esophageal cancer by looking at these features:

  • T: T stands for tumor and is graded on a scale between 1 and 4. T1 tumors are small tumors that have invaded the first layers of the esophagus. T4 tumors are larger and invade other structures.
  • N: N stands for node and is graded on a scale from 0 to 3. N0 cancer hasn’t spread, but N3 cancer has spread to several lymph nodes.
  • M: M stands for metastasis and is a rating of whether cancer has spread. A grade of M0 means cancer hasn’t spread, while a grade of M1 means cancer has spread to other organs.

Esophageal cancer is also given a grade. A cancer grade is how cancer cells look under a microscope. The grading scale ranges from 1 to 3. Grade 1 cells look more like healthy cells, while grade 3 cells look very abnormal.

Stage 0 esophageal cancer is also known as high-grade dysplasia. This stage can be considered precancerous.

In stage 0, the abnormal cells are only located on the outer layer of the esophagus, and no metastasis has occurred. There are generally no symptoms in this stage, and cancers in this stage aren’t graded.

Treatment options at this stage include endoscopic options, such as photodynamic therapy (PDT), endoscopic mucosal resection (EMR), or radiofrequency ablation (RFA) to remove the abnormal cells. Follow-up appointments will be needed to ensure no new precancerous or cancerous cells develop.

Some people choose to have an esophagectomy. This is a surgical procedure to remove the part of the esophagus where the precancerous tumor is growing. Esophagectomy is more invasive than endoscopic treatment, but it eliminates the need for follow-up appointments and additional procedures.

Stage 1 esophageal cancer grows into the lower layers of the esophageal tissue. Cancer in this stage hasn’t spread or been found in any lymph nodes.

Stage 1 esophageal cancer has letter-graded stub stages. The exact definition of those substages depends on the type of esophageal cancer you have.

Substages of stage 1 esophageal squamous cell carcinoma are:

  • Stage 1A: In stage 1A, cancer grows into the lamina propria or muscularis mucosa tissues under the epithelium. Stage 1A cancer can be grade 1, or it can be an undetermined grade.
  • Stage 1B: In Stage 1B, cancer grows into the lamina propria or muscularis mucosa tissues under the epithelium or the muscle layer of the esophagus. Cancer can be any grade.

Substages of stage 1 esophageal adenocarcinoma are:

  • Stage 1A: Cancer grows into the lamina propria or muscularis mucosa tissues under the epithelium in stage 1A. Cancer can be either grade 1 or an undetermined grade.
  • Stage 1B: Cancer grows into the lamina propria or muscularis mucosa tissues under the epithelium or to the submucosa in stage 1B. Cancer can be grades 1, 2, or an undetermined grade.
  • Stage 1C: Cancer grows into the lamina propria or muscularis mucosa tissues under the epithelium, the submucosa, or the muscle layer of the esophagus. Cancer can be any grade.

Symptoms

Stage 1 esophageal cancer is usually asymptomatic. If symptoms do occur, they’re often mild and easy to mistake for symptoms of minor conditions.

For instance, you might have chest pain that feels like heartburn or slight difficulty swallowing that gets worse with time.

Treatment

Treatment at this stage almost always involves surgery. Very small tumors in stage 1A might be able to be treated with an endoscopic procedure such as EMR, but nearly all stage 1 tumors require an esophagectomy to remove the tumor and affected tissue.

Sometimes, surgery is the only required treatment. However, it’s common for radiation or chemotherapy to be used before or after surgery, especially in stages 1B or 1C.

Radiation can help shrink tumors and kill cancer tumors, and chemotherapy can help cancer cells. When used before surgery, radiation can make surgery easier. When used after surgery, radiation can make sure all the cancer cells are gone.

Outlook

Your exact outlook depends on individual factors, such as your response to treatment and your overall health. However, esophageal cancer is aggressive cancer associated with low survival rates.

The 5-year survival rate for people with stage 1 cancer is 46%. It’s important to note that these numbers are based on people who received a diagnosis and were treated between 2011 and 2017.

Treatments for esophageal cancer are continuously improving, and it’s likely that current survival rates are significantly higher.

Stage 2 esophageal cancer grows into the outer layers of the esophagus. It hasn’t spread to any organs. Minor spread to lymph nodes can occur in this stage.

Like stage 1, stage 2 also has letter-graded stages that depend on the type of esophageal cancer you have.

Substages of stage 2 esophageal squamous cell carcinoma are:

  • Stage 2A: In stage 2A, cancer grows into the muscle layer of the esophagus or the outer layer of the esophagus, but there’s no spread to lymph nodes or organs. Cancer can be either grade 2, grade 3, or an undetermined grade. Cancer that’s in both the outer layer and in the middle of the esophagus can be grade 1 or an undetermined grade.
  • Stage 2B: In stage 2B, cancer grows into the outer layer of the esophagus. Cancer growing in the middle or upper part of the esophagus can be grade 2 or 3, and cancers of undetermined grade can be located anywhere in the esophagus.
  • Stage 2B (alternate): Cancer that grows into the lamina propria or muscularis mucosa tissues under the epithelium and has spread to 1–2 lymph nodes but no organs, is also classed as stage 2B. This cancer can be any grade.

Substages of stage 2 esophageal adenocarcinoma are:

  • Stage 2A: Cancer grows into the muscle layer of the esophagus or the outer layer of the esophagus. There’s no spread to lymph nodes or organs in stage 2A. Cancer can be either a grade 3 or an undetermined grade.
  • Stage 2B: Cancer grows into the outer layer of the esophagus in stage 2B. Cancer can be any grade.
  • Stage 2B (alternate): Stage 2B is also the classification for cancer that grows into the lamina propria or muscularis mucosa tissues under the epithelium and has spread to 1–2 lymph nodes but no organs. Cancer can be any grade.

Symptoms

Symptoms might begin to show at stage 2. Symptoms can vary in severity. Not everyone will experience every symptom.

Common stage 2 symptoms include:

Treatment

The most common treatment plan for stage 2 esophageal cancer is combined chemotherapy and radiation treatments followed by surgery to remove the tumor.

Chemotherapy and radiation are used to kill cancer cells and shrink the tumor. Surgery is normally an esophagectomy procedure. After surgery, more chemotherapy or radiation might be needed.

Sometimes, surgery isn’t used. This might be because of tumor location, tumor size, or because the person with esophageal cancer isn’t a good candidate for surgery. In this case, chemotherapy and radiation will be the primary treatment. Newer treatments, such as immunotherapy, to help the body fight cancer might also be used.

Outlook

The outlook depends on individual factors, the success of surgery, and your response to treatment. Cancer survival statistics group cancer as localized, regional, or distant and don’t follow the staging model.

The 5-year survival rate for cancer that hasn’t spread beyond the esophagus is 46%. Most stage 2 cancer falls under this grouping.

Newer cancer treatments, such as immunotherapy, have likely increased these survival rates since data was last calculated.

Stage 3 esophageal cancer grows into the outer layers of the esophagus. Cancer at this stage has spread to the lymph nodes, but it hasn’t spread to organs.

This stage includes lettered substages. Unlike earlier stages, the lettered substages of esophageal squamous cell carcinoma and esophageal adenocarcinoma are the same.

Substages of stage 3 esophageal cancer are:

  • Stage 3A: In stage 3A,cancer grows into the lamina propria or muscularis mucosa tissues under the epithelium, the submucosa, or to the muscle layer of the esophagus. Cancer has spread to no more than 6 lymph nodes and can be any grade.
  • Stage 3B: In stage 3B, cancer grows into the muscle layer of the esophagus or the outer layer of the esophagus and has spread to no more than six lymph nodes. Cancer that’s spread to the outer tissue surrounding the lungs, heart, or diaphragm, and has spread to no more than 2 lymph nodes, can also be classified as stage 3B.

Symptoms

You might experience increased symptoms during this stage. It’s common for symptoms to become more severe as cancer spreads.

Stage 3 symptoms might include:

Treatment

Stage 3 esophageal cancer has the same general treatment options as stage 2 esophageal cancer. A combination of radiation, chemotherapy, and surgery is almost always the primary treatment plan.

Chemotherapy can be especially powerful for helping to treat stage 3 cancer that has spread to lymph nodes.

Surgery isn’t always an option. In this case, the treatment focus will be chemotherapy and radiation. Treatments such as immunotherapy might also be used.

Outlook

Stage 3 cancer has spread beyond the esophagus and to lymph nodes. It can be difficult to treat cancer at this stage.

Many stage 3 cancers fall under the regional survival rate grouping. Regional esophageal cancer had a 5-year survival rate of 26% between 2011 and 2017.

Treatment for esophageal cancer has improved since then, and it’s important to remember that current survival rates might be higher. Individual outlook is affected by factors, such as age, overall health, and response to treatment.

Stage 4 esophageal cancer grows beyond the esophagus or spreads to distant lymph nodes or organs. Cancer in this stage is difficult to treat.

Like stage 3, the letter-graded stages of esophageal squamous cell carcinoma and esophageal adenocarcinoma are the same.

Substages of stage 4 esophageal cancer are:

  • Stage 4A: In stage 4A, cancer has spread to the outer tissue surrounding the lungs, heart, or diaphragm, or to the trachea, aorta, spine, or other nearby structures, and has spread to no more than six lymph nodes. Cancer can also be staged 4A if it has spread to the many layers of the esophagus and seven or more nearby lymph nodes. Cancer has not spread to distant organs.
  • Stage 4B: In stage 4B, cancer has spread to distant lymph nodes or organs, such as the liver. Cancer can be any grade.

Symptoms

Symptoms might be severe by stage 4. The spread of cancer by this stage might cause symptoms that go beyond the esophagus.

Symptoms of stage 4 might include:

  • chest pain
  • difficulty swallowing, including liquids
  • difficulty eating and drinking
  • unintentional weight loss
  • hoarseness
  • a chronic cough
  • coughing up blood
  • vomiting
  • anemia
  • bone pain

Treatment

Stage 4 esophageal cancer is hard to treat because of how far it has spread. At this stage, surgery generally isn’t recommended.

Often, curing esophageal cancer isn’t the goal of treatment at this stage. Instead, treatments will focus on prolonging life and relieving symptoms.

You might have treatments, such as chemotherapy and radiation therapy. Newer treatments, such as immunotherapy and targeted therapy, are also used at this stage. These treatments can help your body fight cancer.

Outlook

Stage 4 esophageal cancer can be grouped as a distant esophageal cancer in survival statistics. Between 2011 and 2017, distant esophageal cancer had a 5-year-survival rate of 5%.

However, newer treatment options introduced in the past several years have likely improved this survival rate. Additionally, individual survival outcomes are highly influenced by factors like age, overall health, and response to treatment.

Esophageal cancer is aggressive cancer that has historically been difficult to treat. Newer treatments, such as immunotherapy and targeted therapy, are helping to improve outcomes. Staging esophageal cancer is one of the ways doctors plan treatments.

Staging is based on the tumor size and cancer spread at the time of diagnosis. Esophageal cancer is staged from 0 to 4. Lower stages indicate small tumors that haven’t spread, while higher stages indicate that cancer has spread farther and is more difficult to treat.