Esophageal cancer is a malignancy that develops in the cells that line the esophagus, which is a hollow muscular tube that connects the mouth to the stomach. Typically, cancer that starts in the lining of the esophagus does not spread to other organs. The most common symptom is difficulty swallowing (dysphagia).
Treatment options vary according to the stage of the disease. In general, early stage esophageal cancers are treated by removal of the tumor with surgery and local mucosal treatments such as photodynamic therapy or radiofrequency ablation. More advanced stages of esophageal cancer that have spread to the lymph nodes or nearby structures may not be surgically removed. In these cases, additional treatments such as radiation or chemotherapy are usually recommended.
In stage 1, esophageal cancer has moved into the inner lining of the esophagus and has not spread to the main muscular layer or to nearby lymph nodes. Patients in this stage have a five-year survival rate of 34 percent.
By stage 2, esophageal cancer has spread deeper into the tissues of the esophagus, and it may have reached nearby lymph nodes or other vital structures such as the trachea (windpipe), aorta or spine. At this point, the five-year survival rate drops to 17 percent.
If the esophageal cancer has progressed to stage 3, it has reached the main muscular tissue of the esophagus and spread to nearby lymph nodes or other vital structures. In most cases, cancer that has reached stage 3 cannot be removed with surgery. However, if it has not spread to the aorta or trachea, some patients in stage III can be treated with surgery combined with chemotherapy.
The American Joint Committee on Cancer, or AJCC, establishes tumor-node-metastasis, or TNM, staging for esophageal cancer. This system subclassifies esophageal cancers based on the depth of invasion, involvement of regional lymph nodes and presence of metastatic disease.
T stands for the primary tumor, N for number of involved lymph nodes and M for metastatic disease. The TNM staging system was designed to facilitate communication among healthcare professionals and between physicians and their patients, and to help determine the most appropriate treatment.
Your doctor uses a variety of tests to evaluate your esophageal cancer and its stage, which is essential in developing an individualized treatment plan. Your care team may also recommend that you enroll in a clinical trial, which is an ongoing research program that tests new drugs or treatment approaches in patients with the same type of cancer as yours. Clinical trials may offer the best hope for new treatment strategies that can improve survival rates. For example, researchers are studying a variety of drugs that show promise for preventing or controlling the progression of esophageal cancer. Some of these drugs are being tested in combination to see if they provide better results than a single drug alone.
