When a person is diagnosed with esophageal cancer, the doctor must find out how far the cancer has spread. This process is called staging. Staging helps determine how serious the disease is and how it will respond to treatment. It also tells the doctor if the cancer can be completely removed (resected).
Most esophageal cancers start in the innermost layer of tissue, called the epithelium. The cancer cells can grow into the deeper layers of the esophagus or into adjacent tissues, such as the chest wall. The cancer can also spread to lymph nodes nearby. The stage of the esophageal cancer is determined by a combination of factors, including T (the size of the tumor), N (whether the cancer has reached the lymph nodes), and M (whether the cancer has spread to other parts of the body). The staging system used for esophageal cancers is the American Joint Committee on Cancer (AJCC) system. The stages are divided into groups, from stage 0 (lower stage) through stage IV (higher stage).
To assess the stage of a cancer, health care professionals perform a physical exam and take a person’s medical history. These include past illnesses and treatments. The health care team may also order a blood test to see how well the liver and kidneys are working. The esophagus can be examined by using a scope that goes down the throat. If there is a lump in the esophagus, a doctor may order a biopsy. A sample of the tissue is taken for study under a microscope. If the tissue is cancerous, a doctor may use a special tool to remove the portion of the esophagus that contains the tumor.
Other tests can be done to help in the staging of esophageal cancer. They include a chest x-ray, which is an imaging test that shows the organs and bones inside the chest. A CT scan is another type of imaging test that can show the esophagus and the surrounding tissues. A MRI can also be used to help in the staging of esophageal tumors.
Surgical removal of the tumor is the best way to cure esophageal cancer. However, for some people, the cancer is so advanced that it cannot be removed completely with surgery. In these cases, treatment is given to prevent the cancer from coming back or spreading. The types of treatment depend on the stage of the cancer and the cell type. Targeted therapy uses drugs or other substances to identify and attack specific tumor cells. Some examples of targeted therapy for esophageal cancer are monoclonal antibodies and radiation therapy.
