Staging

If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment.

Staging is a careful attempt to find out the following

• how deeply the cancer invades the walls of the esophagus
• whether the cancer invades nearby tissues
• whether the cancer has spread, and if so, to what parts of the body

When esophageal cancer spreads, it's often found in nearby lymph nodes. If cancer has reached these nodes, it may also have spread to other lymph nodes, the bones, or other organs. Also, esophageal cancer may spread to the liver and lungs.

Your doctor may order one or more of the following staging tests:

• Endoscopic ultrasound: The doctor passes a thin, lighted tube (endoscope) down your throat, which has been numbed with anesthetic. A probe at the end of the tube sends out sound waves that you can't hear. The waves bounce off tissues in your esophagus and nearby organs. A computer creates a picture from the echoes. The picture can show how deeply the cancer has invaded the wall of the esophagus. The doctor may use a needle to take tissue samples of lymph nodes.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your chest and abdomen. Doctors use CT scans to look for esophageal cancer that has spread to lymph nodes and other areas. You may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
• MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside your body. An MRI can show whether cancer has spread to lymph nodes or other areas. Sometimes contrast material is given by injection into your blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.
• PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether esophageal cancer may have spread.
• Bone scan: You get an injection of a small amount of a radioactive substance. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
• Laparoscopy: After you are given general anesthesia, the surgeon makes small incisions (cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen. Lymph nodes or other tissue samples may be removed to check for cancer cells.

Sometimes staging is not complete until after surgery to remove the cancer and nearby lymph nodes.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if esophageal cancer spreads to the liver, the cancer cells in the liver are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not liver cancer. For that reason, it's treated as esophageal cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.

These are the stages of esophageal cancer:

• Stage 0: Abnormal cells are found only in the inner layer of the esophagus. It's called carcinoma in situ.
• Stage I: The cancer has grown through the inner layer to the submucosa. (The picture ¹ shows the submucosa and other layers.)
• Stage II is one of the following:
  • The cancer has grown through the inner layer to the submucosa, and cancer cells have spread to lymph nodes.
  • Or, the cancer has invaded the muscle layer. Cancer cells may be found in lymph nodes.
  • Or, the cancer has grown through the outer layer of the esophagus.
• Stage III is one of the following:
  • The cancer has grown through the outer layer, and cancer cells have spread to lymph nodes.
  • Or, the cancer has invaded nearby structures, such as the airways. Cancer cells may have spread to lymph nodes.
• Stage IV: Cancer cells have spread to distant organs, such as the liver.

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