Esophageal Cancer (Cancer of the Esophagus)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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How do physicians determine esophageal cancer staging?

Staging describes a system used to show how deep the cancer has extended into the esophageal tissue, whether it has spread to lymph nodes, and what other organs in the body might be involved.

There is a common system agreed upon by the Union for International Cancer Control and the American Joint Committee on Cancer that uses TNM staging.

  • T refers to the size and reach of the primary tumor.
  • N refers to the spread to lymph nodes.
  • M refers to the presence of metastases.

With the endoscope, the gastroenterologist can use ultrasound to determine how deep into the layers of the esophagus the tumor has grown. The doctor can also tell whether lymph nodes that line the esophagus have been invaded.

Either CT scan of the chest and abdomen or PET scan is then used to determine the extent of tumor spread.

Depending on the type of cancer and the extent the tumor has spread, there are certain circumstances where more invasive procedures are warranted to help with staging: laparoscopy (an operation where a surgeon inserts a camera into the abdominal cavity), thoracoscopy (the camera is inserted into the chest cavity), and bronchoscopy (a camera is inserted into the lung airways).

What are the stages of esophageal cancer?

The stages of esophageal cancer can be complicated and are related to the following:

  • T1 to T4: This depends on total tumor depth and what layers of the esophagus have been invaded by the cancer.
  • N0 to N3: This refers to the number of lymph nodes containing cancer.
  • M0 to M1: This refers to whether there are metastases to distant organs, usually lung, liver, and bone.

Stages are as follows:

  • Stage IA: T1, N0, M0
  • Stage IB: T2, N0, M0
  • Stage IIA: T3, N0, M0
  • Stage IIB: T1, T2, N1, M0
  • Stage IIIA: T4a, N0, M0; or T3, N1, M0; or T1, T2, N2, M0
  • Stage IIIB: T3, N2, M0
  • Stage IIIC: T4a, N1, N2, M0; or T4b, any N, M0; or any T, any N, M1
  • Stage IV: any T, any N, M1
Medically Reviewed by a Doctor on 11/30/2016

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