Staging oesophageal cancer

After diagnosis, your cancer specialist will carry out tests to stage the cancer. This will help doctors plan the most appropriate treatment for you. The stage of a cancer describes its size and whether it has spread beyond its original site. 

Doctors mostly use the TNM staging system to describe the stage of the cancer. This records information about how far the tumour has grown into the layers of the oesophagus and whether it has spread into nearby lymph nodes or distant organs. Information from the TNM system can also be used to give a numbered stage, showing how far the cancer may have spread on a scale of 0–4.

Both staging systems are very detailed in order to give as much information as possible to the doctors. This will then enable your medical team to plan the most appropriate treatment for you.

What does staging mean?

The stage of a cancer is a term used to describe its size and whether it has spread beyond the area where it started. Staging systems are constantly being updated to help doctors plan the best treatment and help give an idea of the likely outcome. This means they are becoming more detailed and complicated.

Your doctors will describe your cancer using either the TNM staging system or number staging.


TNM staging

This system gives precise information about the stage of the cancer.

T stand for tumour

This describes the size of the tumour and whether it has begun to spread. Doctors put a number next to the ‘T’ to describe the size and spread of the cancer.

  • T1 – The cancer has grown into the inner layer (mucosa or submucosa) of the oesophagus.
  • T2 – The cancer has grown into the muscle layer (muscularis) of the oesophagus.
  • T3 – The cancer has grown into the outer layer (adventitia) of the oesophagus.
  • T4 – The cancer has spread to nearby structures. T4 is divided into two stages:

T4a - The cancer has spread to the covering of the lungs (the pleura), the outer covering of the heart (the pericardium) or the muscle layer under the lungs (the diaphragm).

T4b - The cancer has spread to other nearby structures, such as the windpipe (trachea), spine or major blood vessels (aorta).

Gullet staging
Gullet staging

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N stands for nodes

This describes whether the cancer has spread to the lymph nodes. The ‘N’ may have an ‘X’ or a number written next to it, which gives extra information about the nodes that were examined.

  • NX – The lymph nodes cannot be assessed.
  • N0 – There are no cancer cells in any lymph nodes.
  • N1 – There are cancer cells in 1–2 lymph nodes.
  • N2 – There are cancer cells in 3–6 lymph nodes.
  • N3 – There are cancer cells in 7 or more lymph nodes.

If cancer cells have spread to the lymph nodes, the nodes are said to be positive.

M stands for metastasis

This describes whether the cancer has spread to another part of the body, such as the liver or lungs. The ‘M’ may have a number written next to it, which gives extra information about where the cancer has spread to.

  • M0 – The cancer has not spread to other parts of the body.
  • M1 – The cancer has spread to other parts of the body. This is called secondary or metastatic oesophageal cancer.


Number staging

Stage 0 – This is a very early stage of oesophageal cancer. It’s sometimes called carcinoma in situ (CIS) or high-grade dysplasia (HGD). This is when there are severely abnormal cells present but they’re contained within the lining of the oesophagus. If left untreated, the cells may develop into an invasive cancer. There are usually no symptoms at this stage.

Stage 1A – The cancer is only found in the inner layer of the oesophagus. It has not spread to nearby tissues, lymph nodes or other organs.

Stage 1B – The cancer has begun to spread into the muscle layer of the oesophagus, but not to nearby lymph nodes or other organs.

Stage 2A – The cancer has grown through the outer layer of the oesophagus, but not to nearby lymph nodes or other organs.

Stage 2B – The cancer is in the top two layers of the oesophagus and has spread to 1–2 lymph nodes. It has not spread to other organs.

Stage 3A – The cancer has:

  • spread to the covering of the lungs, the outer covering of the heart or the muscle layer under the lungs, but not to any lymph nodes or anywhere else, OR
  • grown into the outer layer of the oesophagus and into 1–2 lymph nodes, but not to other organs, OR
  • spread into the top two layers of the oesophagus and has spread to 3–6 lymph nodes, but no other parts of the body.

Stage 3B – The cancer has grown into the outer layer of the oesophagus and to 3–6 lymph nodes. It has not spread to any other organs.

Stage 3C – The cancer has:

  • spread to the covering of the lungs, the outer covering of the heart or the muscle layer under the lungs, and up to 6 lymph nodes are affected, OR
  • spread to nearby structures, such as the windpipe or spine, and to any number of lymph nodes, OR
  • grown to any size and has spread to 7 or more lymph nodes, but not to other organs.

Stage 4 – The cancer has spread to lymph nodes and other parts of the body, such as the liver, lungs or stomach (secondary or metastatic cancer).

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