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Stages of Cancer

Staging is the process of determining how advanced a cancer is and whether it has spread outside the esophagus.

The method of treatment depends upon the stage of the cancer. If it is found at an early stage, there is a much better chance for survival. At later stages, the cancer can be treated, but rarely cured.

The following tests and procedures are used in the staging process:

  • Chest X-ray

  • Computerized Axial Tomography (CAT Scan)

  • Positron Emission Tomography (PET) scan - used to detect metastases

  • Endoscopic Ultrasound (EUS) - used to determine the size of the tumor, the extent of invasion of nearby tissue, and can take biopsies (tissue samples)

  • Bronchoscopy - used to look inside the airway for any abnormalities and can take biopsies

How the Stage of Cancer is Defined

NYU physicians use the Tumor, Node, Metastasis System of the American Joint Committee on Cancer, which evaluates the cancer in three parts to form an opinion.
The first part considers the placement of the tumor:

  • T1: Only within lining of the esophagus

  • T2: In the layer of muscles in the esophageal wall

  • T3: Has advanced through the entire esophageal wall

  • T4: Has invaded nearby tissues

The second part examines the spread of cancer to the nodes of the lymphatic system:
  • NX: Cannot determine involvement of lymph nodes

  • N0: Has not invaded nearby lymph nodes

  • N1: Has invaded nearby lymph nodes.

The third part investigates metastasis, which involves the lymphatic system transporting cancer cells to distant parts of the body where they grow into new tumors:
  • MX: Cannot determine existence of metastasis

  • M0: Metastasis is not present

  • M1: Metastasis is present

The status results for each area are then combined to produce the stage of the esophageal cancer:
  • Stage 0: Cancer is confined to the innermost layer of the esophagus (carcinoma in situ)

  • Stage I: Cancer has spread beyond the innermost layer, but is confined to the inner lining of the esophagus (T1N0M0)

  • Stage IIA: Cancer has spread into the muscle wall or through the esophageal wall (T2N0M0 or T3N0M0)

  • Stage IIB: Cancer is within the esophageal wall, but has spread to nearby lymph nodes (T1N1M0 or T2N1M0)

  • Stage III: Cancer has spread to the esophageal wall and has invaded adjacent lymph nodes or adjacent organs (T3N1M0 or T4/Any N/M0)

  • Stage IV: Cancer has spread to lymph nodes or to other parts of the body (Any T/Any N/ M1)

  • Recurrent Esophageal Cancer: Cancer has reappeared after being treated, either within the esophagus or in other parts of the body

Determining the stage of the cancer plays an important role in establishing a course of treatment. NYU Thoracic Oncology Program's multidisciplinary staff of experts treats all stages of esophageal cancer.