Español
Questions About Cancer? 1-800-4-CANCER
  • View entire document
  • Print
  • Email
  • Facebook
  • Twitter
  • Google+
  • Pinterest

Esophageal Cancer Treatment (PDQ®)

Stages of Esophageal Cancer

After esophageal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the esophagus or to other parts of the body.

The process used to find out if cancer cells have spread within the esophagus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Bronchoscopy : A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
  • Thoracoscopy : A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure may be used to remove part of the esophagus or lung.
  • Laparoscopy : A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples to be checked under a microscope for signs of disease.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if esophageal cancer spreads to the lung, the cancer cells in the lung are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not lung cancer.

The grade of the tumor is also used to describe the cancer and plan treatment.

The grade of the tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grades 1 to 3 are used to describe esophageal cancer:

  • In grade 1, the cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.
  • In grade 2, the cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells.
  • In grade 3, the cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 and 2 cancer cells.

The following stages are used for squamous cell carcinoma of the esophagus:

Stage 0 (High-grade Dysplasia)

In stage 0, abnormal cells are found in the mucosa or submucosa layer of the esophagus wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called high-grade dysplasia.

Stage I squamous cell carcinoma of the esophagus

Stage I is divided into Stage IA and Stage IB, depending on where the cancer is found.

  • Stage IA: Cancer has formed in the mucosa or submucosa layer of the esophagus wall. The cancer cells are grade 1. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.
    Stage IA squamous cell cancer of the esophagus; drawing shows the esophagus and stomach. An inset shows cancer cells in the mucosa and submucosa layers of the esophagus wall. Also shown are the muscle and connective tissue layers of the esophagus wall and lymph nodes.
    Stage IA squamous cell cancer of the esophagus. Cancer has formed in the mucosa or submucosa layer of the esophagus wall. The cancer cells are grade 1 or the grade is unknown. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2-3 cancer cells.
  • Stage IB: Cancer has formed:
    • in the mucosa or submucosa layer of the esophagus wall. The cancer cells are grade 2 and 3; or
    • in the mucosa or submucosa layer and spread into the muscle layer or the connective tissue layer of the esophagus wall. The cancer cells are grade 1. The tumor is in the lower esophagus or it is not known where the tumor is.

    Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.

    Stage IB squamous cell cancer of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa, submucosa, muscle, and connective tissue layers. Also shown are lymph nodes. The left panel shows cancer in the mucosa and submucosa layers. The right panel shows cancer in the mucosa, submucosa, and muscle layers.
    Stage IB squamous cell cancer of the esophagus. Cancer has formed in the mucosa or submucosa layer of the esophagus wall, and the cancer cells are grade 2-3; OR cancer has formed in the mucosa or submucosa layer and spread into the muscle layer or the connective tissue layer of the esophagus wall, and the cancer cells are grade 1. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2-3 cancer cells. The tumor is in the lower esophagus or it is not known where the tumor is.

Stage II squamous cell carcinoma of the esophagus

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

  • Stage IIA: Cancer has spread:
    • into the muscle layer or the connective tissue layer of the esophagus wall. The cancer cells are grade 1. The tumor is in either the upper or middle esophagus; or
      Stage IIA squamous cell cancer of the esophagus (1); drawing shows the esophagus and stomach. An inset shows the layers of the esophagus wall with cancer in the mucosa, submucosa, muscle, and connective tissue layers. Also shown are lymph nodes.
      Stage IIA squamous cell cancer of the esophagus (1). The tumor is in either the upper or middle esophagus. Cancer has spread into the muscle layer or the connective tissue layer of the esophagus wall. The cancer cells are grade 1. Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2-3 cancer cells.
    • into the muscle layer or the connective tissue layer of the esophagus wall. The cancer cells are grade 2 and 3. The tumor is in the lower esophagus or it is not known where the tumor is.
      Stage IIA squamous cell cancer of the esophagus (2); drawing shows the esophagus and stomach. An inset shows the layers of the esophagus wall with cancer in the mucosa, submucosa, muscle, and connective tissue layers. Also shown are lymph nodes.
      Stage IIA squamous cell cancer of the esophagus (2). The tumor is in the lower esophagus or it is not known where the tumor is. Cancer has spread into the muscle layer or the connective tissue layer of the esophagus wall. The cancer cells are grade 2-3. Grade 2-3 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells.

    Grade 1 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells.

  • Stage IIB: Cancer:

    Grade 2 and 3 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells.

    Stage IIB squamous cell cancer of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa, submucosa, muscle, and connective tissue layers. The left panel shows cancer in the mucosa, submucosa, muscle, and connective tissue layers. The right panel shows cancer in the mucosa, submucosa, and muscle layers and in 1 lymph node.
    Stage IIB squamous cell cancer of the esophagus. The tumor is in either the upper or middle esophagus. Cancer has spread into the muscle layer or the connective tissue layer of the esophagus wall, and the cancer cells are grade 2-3; OR cancer is in the mucosa or submucosa layer and may have spread into the muscle layer of the esophagus wall, and cancer is found in 1 or 2 lymph nodes near the tumor. Grade 2-3 cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells.

Stage III squamous cell carcinoma of the esophagus

Stage III is divided into Stage IIIA, Stage IIIB, and Stage IIIC, depending on where the cancer has spread.

  • Stage IIIA: Cancer:
    • is in the mucosa or submucosa layer and may have spread into the muscle layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
    • has spread into the connective tissue layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor; or
      Stage IIIA squamous cell cancer of the esophagus (1); drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa, submucosa, muscle, and connective tissue layers. The left panel shows cancer in the mucosa and submucosa layers and in 3 lymph nodes. The right panel shows cancer in the mucosa, submucosa, muscle, and connective tissue layers and in 1 lymph node.
      Stage IIIA squamous cell cancer of the esophagus (1). Cancer is in the mucosa or submucosa layer and may have spread into the muscle layer of the esophagus wall, and cancer is found in 3 to 6 lymph nodes near the tumor; OR cancer has spread into the connective tissue layer of the esophagus wall, and cancer is found in 1 or 2 lymph nodes near the tumor.
    • has spread into the diaphragm, pleura (tissue that covers the lungs and lines the inner wall of the chest cavity), or sac around the heart. The cancer can be removed by surgery.
      Stage IIIA squamous cell cancer of the esophagus (2); drawing shows the esophagus, trachea, and lung. The top inset shows cancer that has spread from the esophagus into the diaphragm and pleura; the aorta, chest wall, and rib are also shown. The bottom inset shows cancer that has spread from the esophagus into the membrane (sac) around the heart.
      Stage IIIA squamous cell cancer of the esophagus (2). Cancer has spread into the (a) diaphragm, (b) pleura (tissue that covers the lungs and lines the inner wall of the chest cavity), or (c) membrane (sac) around the heart. The cancer can be removed by surgery.
  • Stage IIIB: Cancer has spread into the connective tissue layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor.
    Stage IIIB squamous cell cancer of the esophagus; drawing shows the esophagus and stomach. An inset shows the layers of the esophagus wall with cancer in the mucosa, submucosa, muscle, and connective tissue layers. Also shown is cancer in 4 lymph nodes.
    Stage IIIB squamous cell cancer of the esophagus. Cancer has spread into the connective tissue layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor.
  • Stage IIIC: Cancer has spread:
    • into the diaphragm, pleura (tissue that covers the lungs and lines the inner wall of the chest cavity), or sac around the heart. The cancer can be removed by surgery. Cancer is found in 1 to 6 lymph nodes near the tumor; or
      Stage IIIC squamous cell cancer of the esophagus (1); drawing shows the esophagus, trachea, and lung. The top inset shows cancer that has spread from the esophagus into the diaphragm and pleura; the aorta, chest wall, and rib are also shown. The bottom inset shows cancer that has spread from the esophagus into the membrane (sac) around the heart. Also shown is cancer in lymph nodes near the esophagus.
      Stage IIIC squamous cell cancer of the esophagus (1). Cancer has spread into the (a) diaphragm, (b) pleura (tissue that covers the lungs and lines the inner wall of the chest cavity), or (c) membrane (sac) around the heart. The cancer can be removed by surgery. Cancer is found in 1 to 6 lymph nodes near the tumor.
    • into other nearby organs such as the aorta, trachea, or spine, and the cancer cannot be removed by surgery; or
    • to 7 or more lymph nodes near the tumor.
      Stage IIIC squamous cell cancer of the esophagus (2); drawing shows cancer that has spread from the esophagus into the trachea, aorta, and spine. Also shown is cancer in lymph nodes near the esophagus.
      Stage IIIC squamous cell cancer of the esophagus (2). Cancer has spread into nearby organs, such as the aorta, trachea, or spine, and the cancer cannot be removed by surgery; OR cancer has spread to 7 or more lymph nodes near the tumor.

Stage IV squamous cell carcinoma of the esophagus

In Stage IV, cancer has spread to other parts of the body.

Stage IV squamous cell cancer of the esophagus; drawing shows other parts of the body where esophagus cancer may spread, including the lung, liver, adrenal gland, kidney, and bone. An inset shows cancer spreading through the blood and lymph nodes to other parts of the body.
Stage IV squamous cell cancer of the esophagus. Cancer has spread to other parts of the body.


The following stages are used for adenocarcinoma of the esophagus:

Stage 0 (High-grade Dysplasia)

In stage 0, abnormal cells are found in the mucosa or submucosa layer of the esophagus wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called high-grade dysplasia.

Stage I adenocarcinoma of the esophagus

Stage I is divided into Stage IA and Stage IB, depending on where the cancer is found.

  • Stage IA: Cancer has formed in the mucosa or submucosa layer of the esophagus wall. The cancer cells are grade 1 or 2. Grade 1 and 2 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 3 cancer cells.
  • Stage IB: Cancer has formed:
    • in the mucosa or submucosa layer of the esophagus wall. The cancer cells are grade 3; or
    • in the mucosa or submucosa layer and spread into the muscle layer of the esophagus wall. The cancer cells are grade 1 or 2.

    Grade 1 and 2 cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 3 cancer cells.

Stage II adenocarcinoma of the esophagus

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

Stage III adenocarcinoma of the esophagus

Stage III is divided into Stage IIIA, Stage IIIB, and Stage IIIC, depending on where the cancer has spread.

Stage IV adenocarcinoma of the esophagus

In Stage IV, cancer has spread to other parts of the body.

  • Updated: November 26, 2014