Staging and grading of oesophageal cancer
The stage and grade of the cancer describes its position, whether it has spread and how quickly it may develop.
Staging of oesophageal cancer
The stage of the cancer describes its position and whether it has spread from where it started. Knowing the stage helps doctors decide on the best treatment for you.
Your cancer doctor can use the results of your tests to try to identify the stage of the cancer. They will do this before your treatment is planned to help decide the best treatment for you. But they may not know the exact stage of the cancer until it has been removed with surgery.
Your healthcare team may describe the cancer using the:
- TNM staging system
- number staging system.
The TNM staging system is the one most commonly used for oesophageal cancer.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. We are here if you need someone to talk to. You can:
- Call the Macmillan Support Line for free on 0808 808 00 00 to talk to a cancer information specialist.
- Chat to our specialists online.
TNM staging system
T is for tumour, N is for nodes and M is for metastasis. It can help to review the information about the oesophagus when you read this to understand the staging:
- T describes how far the tumour has grown into the oesophageal wall.
- N describes whether the cancer has spread to the lymph nodes.
- M describes whether the cancer has spread to other parts of the body (metastases).
Tumour
- T1 means the tumour is in the inner layer (mucosa or submucosa) of the oesophagus. It has not grown outside of it:
- T1a – the tumour is only in the mucosa.
- T1b – the tumour has grown into the submucosa.
- T2 means the tumour has grown into the muscle layer (muscularis) of the oesophagus.
- T3 means the tumour has grown into the outer layer (adventitia) of the oesophagus.
- T4 means the tumour has grown through the outer layer of the oesophagus and into nearby structures, such as the diaphragm or a blood vessel. Doctors sometimes put the letter ‘a’ or ‘b’ after this. This gives extra detail about where the tumour is.
Nodes
- N0 means there are no cancer cells in any nearby lymph nodes.
- N1 means there are cancer cells in 1 to 2 nearby lymph nodes.
- N2 means there are cancer cells in 3 to 6 nearby lymph nodes.
- N3 means there are cancer cells in 7 or more nearby lymph nodes.
Metastases
- M0 means the cancer has not spread to other parts of the body.
- M1 means the cancer has spread to other parts of the body, such as the lungs or liver.
Number staging system
Another system used to describe the stage of the cancer is the number staging system. This is a combination of the TNM stages. It uses the numbers 1 to 4.
Your cancer doctor can explain number staging to you and how the number stage relates to the TNM stage. There are different number staging systems, depending on whether the cancer is staged before or after surgery.
Grading of oesophageal cancer
Grading compares cancer cells under the microscope with normal cells:
- Grade 1 means the cancer cells look similar to normal cells, usually grow slowly and are less likely to spread. Grade 1 is also called low grade or well differentiated.
- Grade 2 means the cancer cells look more abnormal and grow slightly faster. Grade 2 is also called moderate or intermediate grade.
- Grade 3 means the cancer cells look very different from normal cells, may grow more quickly and are more likely to spread. Grade 3 is also called high grade or poorly differentiated.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our oesophageal cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
European Society for Medical Oncology. Oesophageal Cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up. 2022. Available from www.esmo.org/guidelines/guidelines-by-topic/gastrointestinal-cancers/oesophageal-cancer [accessed July 2023].
National Institute for Care and Health Excellence. Oesophago-gastric cancer: assessment and management in adults NICE guideline [NG83]. 2018. Available from www.nice.org.uk/guidance/ng83 [accessed July 2023].
Dr Chris Jones
Reviewer
Speciality Registrar in Clinical Oncologist and Clinical Lecturer in Clinical Oncology
Date reviewed
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