Esophageal Cancer: Stages

Approved by the Cancer.Net Editorial Board, 03/2018

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.

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 spread 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 (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Doctors also describe this type of cancer by its grade (G). The grade 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.” If the cancerous tissue looks very different from healthy tissue, it is called “poorly 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 2 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

For squamous cell carcinoma, the stages may be divided based on whether the tumor is in the upper, middle, or lower part of the esophagus, as well as the grade (G) of the tumor cells.

Stage 0: The cancer is found in only the top lining of the esophagus.

Stage IA: The cancer is in only the top layers of the esophagus.

Stage IB: Either of these conditions:

  • The cancer is in the top layers of the esophagus, but the tumor cells are less differentiated.

  • The tumor is in the third layer of the esophagus, but it has not spread to the lymph nodes or other parts of the body.

Stage IIA: Any of these conditions:

  • The tumor is in the third layer of the esophagus. Cancer cells have spread into but not through the muscle wall of the esophagus.

  • The tumor is in the outer layer of the upper or middle part of the esophagus.

  • The tumor is in the outer layer of the lower part of the esophagus.

Stage IIB: Any of these conditions:

  • The tumor is in the outer layer of the upper or middle part of the esophagus. The tumor cells are less differentiated.

  • The tumor is in the outer layer of any part of the esophagus.

  • The tumor is in any part of the esophagus, and cancer cells have spread into the lining of the esophagus and underneath layers. Cancer has also spread to 1 or 2 lymph nodes near the tumor.

Stage IIIA: Any of these conditions:

  • The tumor is in any part of the esophagus, and cancer cells have spread into the lining of the esophagus and underneath layers. Cancer cells have also spread to 3 to 6 lymph nodes near the tumor.

  • The tumor is in any in any part of the esophagus and has grown into the third layer of the esophagus. Cancer cells have spread to 1 or 2 lymph nodes.

  • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body.

Stage IIIB: Any of these conditions:

  • The tumor is in any part of the esophagus and has grown into the third layer of the esophagus. It has also spread to 3 to 6 lymph nodes.

  • The tumor is in any part of the esophagus, has grown into the outer layer of the esophagus and to either 1 to 2 or 3 to 6 lymph nodes.

  • The tumor is in any part of the esophagus and has spread to structures surrounding the esophagus. It has either spread to no lymph nodes or only 1 to 2 lymph nodes.

Stage IVA: Either of these conditions:

  • The tumor is in any part of the esophagus and has spread to nearby structures. It may also have spread to up to 3 to 6 lymph nodes.

  • The cancer has spread to 7 or more regional lymph nodes.

Stage IVB: The cancer has spread to other parts of the body.

Staging of adenocarcinoma of the esophagus

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

Stage 0: The cancer is found in only the top lining of the esophagus.

Stage IA: Cancer cells have spread into the lining of the esophagus and the layers underneath.

Stage IB: Either of these conditions:

  • The cancer has spread to the layers underneath the lining of the esophagus. The tumor cells are moderately differentiated.

  • The cancer has grown into a layer of the esophagus called the submucosa.

Stage IC: Either of these conditions:

  • The cancer has grown into the layers underneath the lining of the esophagus or the submucosa. The cancer cells are poorly differentiated.

  • The cancer has grown into the third layer of the esophagus. The cancer cells are well or moderately differentiated.

Stage IIA: Cancer is in the third layer of the esophagus. The grade cannot be evaluated or the cells are poorly differentiated.

Stage IIB: Either of these conditions:

  • Cancer is in the outer layer of the esophagus.

  • Cancer is in an inner layer of the esophagus and has spread to 1 or 2 lymph nodes.

Stage IIIA: Either of these conditions:

  • Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor.

  • Cancer is in the third layer of the esophagus and has spread to 1 or 2 lymph nodes.

Stage IIIB: Any of these conditions:

  • Cancer is in the third layer of the esophagus and in 3 to 6 lymph nodes.

  • Cancer is in the outer layer of the esophagus and has spread to 1 to 2 or 3 to 6 lymph nodes.

  • The tumor has spread to structures near the esophagus and either no lymph nodes or 1 to 2 lymph nodes.

Stage IVA: Any of these conditions:

  • The tumor has spread to structures near the esophagus and either no lymph nodes or up to 3 to 6 lymph nodes.

  • The tumor has spread to 7 or more lymph nodes.

Stage IVB: Cancer has spread to another part of the body.

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 American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.