Stage 0

This is the earliest stage of esophageal cancer. The cancer cells are only found in the inner layer of cells lining of the esophagus. Often, this stage is diagnosed when a routine biopsy is done in someone with Barrett esophagus. Options include endoscopic treatments, such as photodynamic therapy, radiofrequency ablation, or endoscopic mucosal resection (EMR). Still, surgery to remove the esophagus remains the standard treatment.

Stage I

In this stage the cancer has grown into some of the deeper layers of the esophagus (past the innermost layer of cells). Most patients with this stage of esophageal cancer have their cancer (and their esophagus) removed with surgery. Because cancer cells have grown into the deeper layers of the esophagus, photodynamic therapy and EMR are not options. Chemotherapy and radiation therapy may be given before surgery.

Patients who cannot have surgery because of other serious health problems may be treated with chemotherapy, radiation therapy, or both together. Patients who have received chemotherapy and radiation therapy may be cured and not need surgery at all. Combined chemotherapy and radiation therapy is an option for people who cannot or do not want to undergo surgery.

Stage II

Stage II includes cancers that have grown into the muscle layer of the esophagus and cancers that have grown through the muscle layer into the connective tissue on the outside of the esophagus. This stage also includes cancers that have spread to nearby lymph nodes (N1).

Treatment options for people with this stage of esophageal cancer include surgery or chemoradiation followed by surgery. In some instances, the surgery may not be needed after chemoradiation therapy. Skipping surgery is only an option when no cancer can be seen on endoscopy. Unfortunately, even when cancer cannot be seen, it can still be present below the inner lining of the esophagus. Therefore, follow-up is very important. Patients with adenocarcinoma at the place where the stomach and esophagus meet (the gastroesophageal junction) are often treated with chemotherapy followed by surgery.

Stage III

Cancers in this stage include those that have grown through the wall of the esophagus to the outer layer with spread to nearby lymph nodes. Stage III also includes cancers that have grown through all the layers of esophagus and into nearby organs or tissues (T4).

This stage is treated much like stage II disease. Treatment may include chemotherapy followed by surgery, chemoradiation followed by surgery, or surgery alone. In some cases, the cancer may go away completely after chemoradiation therapy, and surgery may be avoided. However, there is no test to definitely prove this. If cancer is found in nearby lymph nodes when they are removed at surgery, chemo, often with radiation, may be offered after surgery. This treatment is given more often for adenocarcinomas (than for squamous cell carcinomas) of the esophagus.

Stage IV

Stage IVA esophageal cancer has spread to distant lymph nodes, while in stage IVB the cancer has spread to other organs or tissues. Some stage IVA cancers can be completely removed with surgery. If the doctor thinks that removing all of the cancer is possible, then surgery may be an option. Another option is to give chemoradiation first. Then, if the cancer shrinks enough to be able to be removed, surgery can be done. Often, no treatment can cure stage IV esophageal cancer. If that is the case, treatment is only used to help relieve symptoms. Radiation therapy may be used to help with pain or trouble swallowing. Chemotherapy may also be given to try to help patients feel better and live longer, but the benefit of giving chemo is not clear. Some people prefer not to undergo treatments that have serious side effects, and choose to receive only those therapies that will keep them comfortable and add to their quality of life.

Recurrent esophageal cancer

When a cancer comes back after treatment, it is called recurrent or relapsed. If the cancer can comes back in or near the same area it started, it is called a local recurrence. If the cancer comes back in distant organs or tissues (such as the liver), it is called a distant recurrence. Treatment of a recurrence of esophageal cancer depends on where the cancer grows back, as well as how it was treated the first time.

If the first cancer was treated endoscopically (with endoscopic mucosal resection or photodynamic therapy), it most often comes back in the esophagus. This type of recurrence is often treated by removing the esophagus. If the patient is unable to have surgery due to other health problems, the cancer may be treated with chemotherapy, radiation, or both.

If cancer recurs locally after surgery, radiation and/or chemotherapy may be used. If radiation was given before, more radiation is rarely an option. When chemotherapy was given before, it is usually still possible to give more chemo. Sometimes the same drugs that were used before are given again, but often other drugs are used.

Esophageal cancer that recurs in other organs or tissues is treated like a stage IV cancer. Palliative treatments (see below) are used as needed.

Last Medical Review: 05/04/2009
Last Revised: 05/13/2009