Esophageal cancer tends to be aggressive and can spread to many distant parts of your body. It most commonly spreads to the liver, lymph nodes, and lungs.

Cancer that spreads to distant body parts is called metastatic cancer, and the action of spreading to distant areas is called metastasis.

Metastatic cancer tends to have an unfavorable outlook and is the primary cause of death in more than 90% of people who die from cancer.

About half of people with esophageal cancer already have distant metastasis when they receive a diagnosis. Metastatic esophageal cancer is very difficult to treat and has a 5-year relative survival rate of about 6%.

Read on to learn more about the common and rare locations of esophageal cancer metastasis.

Fast facts about esophageal cancer

  • The American Cancer Society estimates that, in 2023, about 21,560 people in the United States will receive a diagnosis of esophageal cancer and about 16,120 people will die from it.
  • Men have about a 1 in 125 lifetime chance of developing esophageal cancer, while women have a much lower chance at 1 in 417.
  • More than 85% of people who receive a diagnosis of esophageal cancer are over the age of 55.
  • About 20% of people with esophageal cancer are alive 5 years after diagnosis.
  • The 5-year relative survival rate for esophageal cancer is 47% when doctors diagnose it early, before it spreads to other tissues.
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Esophageal cancer can spread to distant tissues before or after treatment. It tends to develop quickly. Spread to distant tissues is the major reason treatment may fail.

About half of people with esophageal cancer have metastasis at the time of diagnosis, and another third develop it after diagnosis. Metastasis most often occurs within 6 months of treatment.

In a 2020 study involving 268 people with esophageal cancer, researchers found that the following were the most common locations of metastasis:

  • liver: 56%
  • distant lymph nodes: 53%
  • lung: 50%

Other locations that the researchers reported in more than 10% of people included:

  • peritoneum (the lining of the abdominal cavity)
  • adrenal glands
  • bone
  • pleura (the membranes surrounding the lungs)
  • heart
  • kidneys

Of the 268 people with esophageal cancer in the study:

  • 54.5% had metastasis in 3 or more locations
  • 23.9% had metastasis in 2 locations
  • 21.6% had metastasis in 1 location

Esophageal cancer metastasis can affect many parts of your body and may cause unexpected symptoms. A careful examination of your skin, eyes, and muscles, as well as a full-body CT-PET scan, can help healthcare professionals find metastasis in unusual locations.

In a 2017 review, researchers analyzed the frequency of esophageal cancer metastasis to atypical locations in 164 people with esophageal cancer. They reported the following frequencies:

Number of peoplePercentage
gastrointestinal tract53%
subcutaneous (under skin)42%
lymph nodes42%
lips or gums32%
salivatory glands21%
pineal gland21%
chest wall21%

Metastatic esophageal cancer symptoms depend on where your cancer spreads to.

Symptoms of liver metastasis

If the cancer spread to your liver, it may cause symptoms such as:

Symptoms of lung metastasis

Spread to your lungs might cause:

Symptoms of lymph node metastasis

Spread to your lymph nodes can cause swelling and tenderness in those areas. If lymph nodes in your chest are affected, you might find it hard to swallow or have pain when swallowing.

The 5-year survival rate for esophageal cancer is now about 4 times greater than it was 50–60 years ago. However, it remains relatively low, largely due to the cancer’s aggressiveness and the difficulty of performing surgery or radiation therapy so close to your heart and lungs.

Based on data from 2012 to 2018, the 5-year relative survival rates for esophageal cancer in the United States are:

Stage5-year relative survival rate
distant (metastasized)6%
all stages21%

Once metastasis develops, half of people live less than 5 months. Treatment usually revolves around trying to reduce symptoms and prolong survival rather than trying to cure the cancer.

People who are younger or in better overall health tend to have a better outlook than older people or people with multiple additional health issues.

Esophageal cancer tends to be aggressive and often has a relatively unfavorable outlook. It can spread to many different parts of your body, including your liver, lymph nodes, and lungs. In about half of people with this cancer, the cancer has already spread to distant locations at the time of diagnosis.

Esophageal cancer can also spread to distant locations after treatment has started. Treatment for metastasized esophageal cancer usually aims to prolong life rather than to cure the cancer.

Researchers are continuing to examine newer treatment options for esophageal cancer that may help improve the outlook for people with this cancer in the future.