Stages

If esophageal cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The Spreading of Cancer

There are three ways that cancer spreads in the body:

Through tissue.
Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis. The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if esophageal cancer spreads to the bones, the cancer cells in the bones are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not bone cancer.

Stages of Esophageal Cancer

Stage 0 (Carcinoma in Situ) - In stage 0, abnormal cells are found in the innermost layer of tissue lining the esophagus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I - In stage I, cancer has formed and spread beyond the innermost layer of tissue to the next layer of tissue in the wall of the esophagus.

Stage II - This stage is divided into stage IIA and stage IIB, depending on where the cancer has spread.

Stage IIA: Cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus.
Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes.

Stage III - In this stage, cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.

Stage IV - This stage is divided into stage IVA and stage IVB, depending on where the cancer has spread

Stage IVA: Cancer has spread to nearby or distant lymph nodes
Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required. Generally, treatment for the different stages are as follows:

Stage 0 (Carcinoma in Situ) - Treatment during this stage is surgery.

Stage I - Treatment during this stage is also surgery.

Stage II - Treatment during Stage II may include surgery and chemoradiation (treatment that combines chemotherapy with radiation therapy.)

Stage III - Treatment during Stage II may include surgery and chemoradiation (treatment that combines chemotherapy with radiation therapy.)

Stage IV - Treatment during Stage IV may include an esophageal stent, external or internal radiation therapy and laser surgery as palliative therapy to relieve symptoms and improve quality of life. Also, chemotherapy and clinical trial participation may be used.

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