Esophageal Cancer: Stages

Approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition to stage, a cancer’s growth may also be described by its grade, which describes how much cancer cells look like healthy cells. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How deeply has the primary tumor grown into the wall of the esophagus and the surrounding tissue?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for esophageal cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the tumor, including whether the cancer has grown into the wall of the esophagus or nearby tissue, and if so, how deep. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no cancer in the esophagus.

Tis: This is called carcinoma (cancer) in situ. Carcinoma in situ is very early cancer. Cancer cells are in only one small area of the top lining of the esophagus without any spread into the lining.

T1: There is a tumor in the lamina propria and the 2 inside layers of the esophagus called the submucosa. Cancer cells have spread into the lining of the esophagus.

T2: The tumor is in the third layer of the esophagus called the muscularis propria. Cancer cells have spread into but not through the muscle wall of the esophagus.

T3: The tumor is in the outer layer of the esophagus called the adventitia. Cancer cells have spread through the entire muscle wall of the esophagus into surrounding tissue.

T4: The tumor has spread outside the esophagus into areas around it. Cancer cells have spread to structures surrounding the esophagus, including the large blood vessel coming from the heart called the aorta, the windpipe, diaphragm, and the pleural lining of the lung.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. In esophageal cancer, lymph nodes near the esophagus and in the chest are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The lymph nodes cannot be evaluated.

N0: The cancer was not found in any lymph nodes.

N1: The cancer has spread to 1 or 2 lymph nodes in the chest, near the tumor.

N2: The cancer has spread to 3 to 6 lymph nodes in the chest, near the tumor.

N3: The cancer has spread to 7 or more lymph nodes in the chest, near the tumor.

Metastasis (M)

The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.

MX: Metastasis cannot be evaluated.

M0: The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part of the body.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

G1: The tissue looks more like healthy cells, called well differentiated.

G2: The cells are somewhat different than healthy cells, called somewhat differentiated.

G3: The tumor cells barely look like healthy cells, called poorly differentiated.

G4: The cancer cells look almost alike and do not look like healthy cells, called not differentiated.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. There are separate staging systems for the two most common types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. The staging system for each is described below.

Staging of squamous cell carcinoma of the esophagus

In addition to the TNM classifications, for squamous cell carcinoma, the stages may be subdivided based on whether the tumor is located in the upper, middle, or lower section of the esophagus, as well as the grade (G) of the tumor cells.

Stage 0: This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

Stage IA: This is the same as T1 cancer, in which the cancer is located in only the 2 inside layers of the esophagus (T1, N0, M0, G1).

Stage IB: Either of these conditions:

  • The cancer is located in only the 2 inside layers of the esophagus, but the tumor cells are less differentiated (T1, N0, M0, G2 or G3).

  • The tumor is located in the lower part of the esophagus, and the cancer has spread to either of the 2 outer layers of the esophagus, but not to the lymph nodes or other parts of the body (T2 or T3, N0, M0, G1).

Stage IIA: Either of these conditions:

  • The tumor is located in the upper or middle part of the esophagus, and the cancer is in either of the 2 outer layers of the esophagus (T2 or T3, N0, M0, G1).

  • The tumor is located in the lower part of the esophagus, and the cancer is in either of the 2 outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).

Stage IIB: Either of these conditions:

  • The tumor is located in the upper or middle part of the esophagus, and cancer is in either of the 2 outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).

  • Cancer is in the inner layers of the esophagus and has spread to 1 or 2 lymph nodes near the tumor (T1 or T2, N1, M0, any G).

Stage IIIA: Any of these conditions:

  • Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor (T1 or T2, N2, M0, any G).

  • Cancer is in the outside layer of the esophagus and has spread to 1 or 2 lymph nodes (T3, N1, M0, any G).

  • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

Stage IIIB: Cancer is in the outside layer of the esophagus and in 3 to 6 lymph nodes (T3, N2, M0, any G).

Stage IIIC: Any of these conditions:

  • Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in 6 or less lymph nodes (T4a, N1 or N2, M0, any G).

  • Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).

  • Cancer has spread to 7 or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

Staging of adenocarcinoma of the esophagus

For adenocarcinoma, doctors use the T, N, and M classifications, as well as the grade (G).

Stage 0: This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

Stage IA: This is the same as T1 cancer, in which the cancer is located in either of the 2 inside layers of the esophagus only (T1, N0, M0, G1 or G2).

Stage IB: Either of these conditions:

  • The cancer is located in either of the 2 inside layers of the esophagus only, and the tumor cells are poorly differentiated (T1, N0, M0, G3).

  • The cancer has spread to an outer layer of the esophagus but not to the lymph nodes or other parts of the body (T2, N0, M0, G1 or G2).

Stage IIA: Cancer is in an outer layer of the esophagus, and the cells are poorly differentiated (T2, N0, M0, G3).

Stage IIB: Either of these conditions:

  • Cancer is in the outside layer of the esophagus but not beyond (T3, N0, M0, any G).

  • Cancer is in an inner layer or the muscularis propria of the esophagus and has spread to 1 or two lymph nodes (T1 or T2, N1, M0, any G).

Stage IIIA: Any of these conditions:

  • Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor (T1 or T2, N2, M0, any G).

  • Cancer is in the outside layer of the esophagus and has spread to 1 or 2 lymph nodes (T3, N1, M0, any G).

  • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

Stage IIIB: Cancer is in the outside layer of the esophagus and in 3 to 6 lymph nodes (T3, N2, M0, any G).

Stage IIIC: Any of these conditions:

  • Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in 6 or less lymph nodes (T4a, N1 or N2, M0, any G).

  • Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).

  • Cancer has spread to 7 or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

Recurrent: Recurrent cancer is cancer that has come back after treatment. It may come back in the esophagus or in another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org. Please note that AJCC’s Eighth Edition (2017) has been released; related changes to the information provided above are underway. Please check back soon for updated staging definitions or talk with your doctor about whether these changes affect your diagnosis.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.