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Stages of Esophageal Cancer
If you are diagnosed with esophageal (esophagus) cancer, doctors will try to figure out whether it has spread, and if so, how far. This process is called staging.
The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
How is the stage determined?
The staging system most often used for esophageal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based mainly on:
- The extent (size) of the tumor (T): How far has the cancer grown into the wall of the esophagus? Has the cancer reached nearby structures or organs? (Most esophageal cancers start in the innermost lining of the esophagus, the epithelium, and then grow into deeper layers over time).
- Spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many?
- Spread (metastasis) to distant parts of the body (M): Has the cancer spread to distant lymph nodes or distant organs such as the lungs or liver?
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.
Other factors that can affect the stage of esophageal cancer
Two other factors might also affect the stage of esophageal cancer.
Grade
The grade describes how closely the cancer looks like normal esophagus tissue when seen through a microscope.
The scale used for grading esophageal cancers is from 1 to 3.
- GX: The grade cannot be evaluated (the grade is unknown).
- G1 (well differentiated; low grade): The cancer cells still look somewhat like normal esophagus cells.
- G2 (moderately differentiated; intermediate grade): Falls somewhere between G1 and G3.
- G3 (poorly differentiated; undifferentiated; high grade): The cancer cells look very abnormal.
Low-grade cancers tend to grow and spread more slowly than high-grade cancers. Most of the time, the outlook is better for low-grade cancers than it is for high-grade cancers.
Location of the tumor
For some stages of early squamous cell carcinoma, where the tumor is in the esophagus is also important. The location is assigned as either upper, middle, or lower based on where the middle of the tumor is.
Stage grouping
Once a person’s T, N, and M categories and the grade and location of the tumor have been determined, this information is combined in a process called stage grouping to assign an overall stage.
The earliest stage esophageal cancers are called stage 0 (high-grade dysplasia). Stages then range from I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage (IIA is lower than IIB).
For more general information about cancer stages, see Cancer Staging.
Esophageal cancer staging
The tables below are simplified versions of the most recent AJCC TNM pathological stages for esophageal cancers. They include separate staging systems for squamous cell carcinoma and adenocarcinoma, the two most common types of esophageal cancer.
Esophageal cancer staging can be complex. If you have any questions about the stage of your cancer or what it means, be sure to ask your doctor to explain it to you in a way you understand.
Squamous cell carcinoma stages
This stage is also known as high-grade dysplasia. The main tumor is only in the epithelium (the top layer of cells lining the inside of the esophagus) and has not started growing into the deeper layers (Tis). The cancer has not spread to nearby lymph nodes (N0) or to distant organs (M0). The cancer grade does not apply. The cancer can be located anywhere in the esophagus.
Stage IA
The main tumor is growing into the lamina propria or muscularis mucosa (the tissue under the epithelium) (T1a). The cancer has not spread to nearby lymph nodes (N0) or to distant organs (M0).
The cancer is grade 1 (G1) or an unknown grade (GX), and it can be located anywhere in the esophagus.
Stage IB
The main tumor is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), submucosa or the thick muscle layer known as the muscularis propria (T1 or T2). The cancer has not spread to nearby lymph nodes (N0) or to distant organs (M0).
If the cancer is growing into the thick muscle layer (T2), it is grade 1 (G1). Otherwise, it can be any grade (G1-G3) or an unknown grade (GX). It can be located anywhere in the esophagus.
Stage IIA
The main tumor is growing into the thick muscle layer known as the muscularis propria (T2). The cancer has not spread to nearby lymph nodes (N0) or to distant organs (M0).
The cancer can be grade 2 or 3 (G2 or G3) or an unknown grade (GX) and can be located anywhere in the esophagus.
OR
The main tumor is growing into the outer layer of the esophagus known as the adventitia (T3). The cancer has not spread to nearby lymph nodes (N0) or to distant organs (M0).
The cancer can be any of the following:
- Any grade (G1-G3 or GX) and located in the lower esophagus OR
- Grade 1 (G1) and located in the upper or middle esophagus.
Stage IIB
The main tumor is growing into the outer layer of the esophagus known as the adventitia (T3). The cancer has not spread to nearby lymph nodes or to distant organs.
The cancer can be any of the following:
- Grade 2 or 3 (G2 or G3) and located in the upper or middle of the esophagus OR
- An unknown grade (GX) and located anywhere in the esophagus OR
- Any grade (G1-G3 or GX) and have an unknown location in the esophagus.
OR
The main tumor is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium) or into the submucosa (T1). The cancer has spread to 1 or 2 nearby lymph nodes (N1), but it has not spread to distant parts of the body (M0). The cancer can be any grade (G1-G3 or GX) and can be located anywhere in the esophagus.
Stage IIIA
The main tumor is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), or the submucosa (T1). The cancer has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant organs (M0).
The cancer can be any grade (G1-G3 or GX) and can be located anywhere in the esophagus
OR
The main tumor is growing into the thick muscle layer known as the muscularis propria (T2). The cancer has spread to 1 or 2 nearby lymph nodes (N1), but it has not spread to distant organs (M0).
The cancer can be any grade (G1-G3 or GX) and can be located anywhere in the esophagus.
Stage IIIB
The main tumor is growing into:
- The thick muscle layer (muscularis propria) (T2), and the cancer has spread to 3 to 6 nearby lymph nodes (N2) OR
- The outer layer of the esophagus known as the adventitia (T3), and the cancer has spread to 1 to 6 nearby lymph nodes (N1 or N2) OR
- The pleura (the thin layer of tissue covering the lungs), the pericardium (the thin sac surrounding the heart), the diaphragm (the muscle below the lungs that separates the chest from the abdomen), or the lining of the abdomen known as the peritoneum (T4a), and the cancer has spread to no more than 2 nearby lymph nodes (N0 or N1).
The cancer has not spread to distant lymph nodes or organs (M0). The cancer can be any grade (G1-G3 or GX) and can be located anywhere in the esophagus.
Stage IVA
The main tumor is growing into:
- The pleura (the thin layer of tissue covering the lungs), the pericardium (the thin sac surrounding the heart), the diaphragm (the muscle below the lungs that separates the chest from the abdomen), or the lining of the abdomen known as the peritoneum (T4a), and the cancer has spread to 3 to 6 nearby lymph nodes (N2) OR
- The trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine, or other crucial structures (T4b), and the cancer has spread to no more than 6 nearby lymph nodes (N0 to N2) OR
- Any layers of the esophagus (Any T), and the cancer has spread to 7 or more nearby lymph nodes (N3).
The cancer has not spread to distant lymph nodes or organs (M0).
The cancer can be any grade (G1-G3 or GX) and can be located anywhere in the esophagus.
Stage IVB
The main tumor can be growing into any level of the esophagus (Any T), and the cancer might or might not have spread to nearby lymph nodes (Any N). The cancer has spread to distant lymph nodes and/or other organs. such as the liver and lungs (M1).
The cancer can be any grade (G1-G3 or GX) and can be located anywhere in the esophagus.
Adenocarcinoma stages
The location of the cancer in the esophagus does not affect the stage of adenocarcinomas.
This stage is also known as high-grade dysplasia. The main tumor is only in the epithelium (the top layer of cells lining the inside of the esophagus) and has not started growing into the deeper layers (Tis). The cancer has not spread to nearby lymph nodes (N0) or to distant lymph nodes or organs (M0). The cancer grade does not apply.
Stage IA
The main tumor is growing into the lamina propria or the tissue under the epithelium known as the muscularis mucosa (T1a). The cancer has not spread to nearby lymph nodes (N0) or to distant lymph nodes or organs (M0).
The cancer is grade 1 (G1) or an unknown grade (GX).
Stage IB
The main tumor is growing into the lamina propria or the tissue under the epithelium known as the muscularis mucosa (T1a), or it is growing into the submucosa (T1b). The cancer has not spread to nearby lymph nodes (N0) or to distant lymph nodes or organs (M0).
If the cancer is growing only into the lamina propria or muscularis mucosa (T1a), it is grade 2 (G2). Otherwise, it can be grade 1 or 2 (G1 or G2) or an unknown grade (GX).
Stage IC
The main tumor is growing into:
- The lamina propria, muscularis mucosa (the tissue under the epithelium), or submucosa (T1), and is grade 3 (G3) OR
- The thick muscle layer (muscularis propria) (T2), and is grade 1 or 2 (G1 or G2).
The cancer has not spread to nearby lymph nodes (N0) or to distant lymph nodes or organs (M0).
Stage IIA
The main tumor is growing into the thick muscle layer known as the muscularis propria (T2). The cancer has not spread to nearby lymph nodes (N0) or to distant lymph nodes or organs (M0).
The cancer can be grade 3 (G3) or an unknown grade (GX)
Stage IIB
The main tumor is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), or the submucosa (T1). The cancer has spread to 1 or 2 nearby lymph nodes (N1). It has not spread to distant organs (M0). The cancer can be any grade (G1-G3 or GX).
OR
The main tumor is growing into the outer layer of the esophagus known as the adventitia (T3). The cancer has not spread nearby lymph nodes (N0) or to distant lymph nodes or organs (M0). The cancer can be any grade (G1-G3 or GX).
Stage IIIA
The main tumor is growing into the lamina propria, muscularis mucosa (the tissue under the epithelium), or the submucosa (T1). The cancer has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant organs (M0). The cancer can be any grade (G1-G3 or GX).
OR
The main tumor is growing into the thick muscle layer known as the muscularis propria (T2). The cancer has spread to 1 or 2 nearby lymph nodes (N1), but it has not spread to distant organs (M0). The cancer can be any grade (G1-G3 or GX).
Stage IIIB
The main tumor is growing into:
- The thick muscle layer known as the muscularis propria (T2), and the cancer has spread to 3 to 6 nearby lymph nodes (N2) OR
- The outer layer of the esophagus known as the adventitia (T3), and the cancer has spread to 1 to 6 nearby lymph nodes (N1 or N2) OR
- The pleura (the thin layer of tissue covering the lungs), the pericardium (the thin sac surrounding the heart), the diaphragm (the muscle below the lungs that separates the chest from the abdomen), or the peritoneum (the lining of the abdomen) (T4a), and the cancer has spread to no more than 2 nearby lymph nodes (N0 or N1).
The cancer has not spread to distant lymph nodes or organs (M0). The cancer can be any grade (G1-G3 or GX).
Stage IVA
The main tumor is growing into:
- The pleura (the thin layer of tissue covering the lungs), the pericardium (the thin sac surrounding the heart), the diaphragm (the muscle below the lungs that separates the chest from the abdomen), or the peritoneum (the lining of the abdomen) (T4a), and the cancer has spread to 3 to 6 nearby lymph nodes (N2) OR
- The trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine, or other crucial structures (T4b), and the cancer has spread to no more than 6 nearby lymph nodes (N0 to N2) OR
- Any layers of the esophagus (Any T), and the cancer has spread to 7 or more nearby lymph nodes (N3).
The cancer has not spread to distant lymph nodes or organs (M0). The cancer can be any grade (G1-G3 or GX).
Stage IVB
The main tumor can be growing into any level of the esophagus (Any T), and the cancer might or might not have spread to nearby lymph nodes (Any N). The cancer has spread to distant lymph nodes and/or other organs. such as the liver and lungs (M1).
The cancer can be any grade (G1-G3 or GX).
Resectable versus unresectable esophageal cancer
The AJCC staging system provides a detailed summary of how far an esophageal cancer has spread. But for treatment purposes, doctors are often more concerned about whether the cancer can be removed (resected) completely with surgery.
- If the cancer could be removed completely by surgery, it is considered potentially resectable.
- If the cancer has spread too far to be removed completely, it is considered unresectable.
In general, stage 0, I, and II esophageal cancers are potentially resectable. Most stage III cancers are potentially resectable as well, even when they’ve spread to nearby lymph nodes, as long as the cancer hasn’t grown into important nearby structures such as the trachea (windpipe), the aorta (the large blood vessel coming from the heart), or the spine.
Surgery to remove esophageal cancer is a major operation, and unfortunately some people whose cancer is potentially resectable still might not be able to have the surgery if they aren’t healthy enough.
If you have localized esophageal cancer, it is often recommended that your case be discussed at a multidisciplinary meeting (often referred to as a tumor board). In this meeting, your medical information is reviewed by doctors from different specialties (for example, medical oncology, pathology, surgery, and radiation oncology) who, as a group, recommend a treatment plan for you.
Cancers that have grown into nearby vital structures or that have spread to distant lymph nodes or to other organs are generally considered unresectable, so treatments other than surgery are usually the best option.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Esophagus and Esophagogastric Junction. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:185.
Ku GY, Ilson DH. Chapter 71: Cancer of the Esophagus. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier: 2020.
National Cancer Institute. Esophageal Cancer Treatment (PDQ®)–Patient Version. 2025. Accessed at https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq on June 3, 2025.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. V.3.2025. Accessed at www.nccn.org on June 3, 2025.
Saltzman JR, Gibson MK. Clinical manifestations, diagnosis, and staging of esophageal cancer, UpToDate. 2025. Accessed at https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-staging-of-esophageal-cancer on June 3, 2025.
Last Revised: August 14, 2025
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