Understanding Your Stage of Esophageal Cancer

Your doctor recommends tests and does exams to help determine the stage of cancer. Stage is the word doctors use to describe the size of a cancerous tumor and where and how far it has spread. The first place cancer is found in the body is called the primary site or primary tumor. When a cancer spreads, it's said to have metastasized.

The most commonly used system to stage cancer is called the TNM classification.

In the TNM system, each letter stands for some aspect of the cancer:

• T shows how much a tumor has spread inside the esophagus and nearby areas.

• N indicates whether the lymph nodes in the area of the original tumor are cancerous.

• M indicates whether the cancer has spread (metastasized) to other, distant organs in the body, such as the lungs, bones, or brain.

Once your T, N, and M stages have been determined, this information is put together in what is called stage grouping. Stage grouping is used to determine your overall disease stage. Stage grouping is shown in Roman numerals from 0 (the earliest stage) to IV (the most advanced stage). These are the stages of esophageal cancer and their definitions:

Stage 0 or carcinoma in situ. Cancer is found only in the inner layer of cells in the esophagus. It has not spread outside the esophagus.

Stage I. Cancer has spread from the inner layer of cells to the next layer in the wall of the esophagus. It has not spread outside the esophagus.

Stage II. Cancer has spread beyond the esophagus. If it has spread to the muscle or outer wall of the esophagus, it is called stage IIA. If it has spread to any of the first three layers of the esophagus and to the nearby lymph nodes, it is called stage IIB.

Stage III. Cancer has advanced through the whole esophageal wall and may have spread to nearby lymph nodes or other nearby tissues.

Stage IV. Cancer has spread to other parts of the body. If you have lower esophageal cancer and it has spread to the lymph nodes near your stomach, it is called stage IVA. If you have upper esophageal cancer and it has spread to the lymph nodes around your neck, it is also called stage IVA. If it has spread to lymph nodes beyond the region of the tumor, or if it has spread to other organs, or both, it is called stage IVB.