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Esophageal Cancer Diagnosis

MD Anderson's experts use the most advanced technology and techniques to pinpoint esophageal cancer. Precise diagnosis often improves your chances for successful treatment. Since esophageal cancer often does not have symptoms in early stages, it may be found during procedures or tests for other conditions.

Esophageal Cancer Diagnostic Tests

If you have symptoms that may signal esophageal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have esophageal cancer and if it has spread. These tests also may be used to find out if treatment is working.

Imaging tests, which may include:

  • X-rays
  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans

Biopsy

One of the following methods may be used to biopsy tissue to find out if you have esophageal cancer: 

Esophagoscopy: An endoscope is inserted through the mouth or nose into the esophagus. The doctor looks at the esophagus and removes small pieces of tissue.

Endoscopic ultrasound (EUS) or endosonography: An endoscope is inserted through an opening in the body, usually the mouth or rectum. At the end of the tube are a light, a tiny camera and a device that sends out ultrasound (high-energy sound) waves to make images of internal organs.

Video endoscopy: An endoscope with a special fiber-optic camera is inserted through the mouth, allowing the doctor to view the esophagus and biopsy the suspicious area.

Bronchoscopy: Using a tool called a bronchoscope, which is similar to the endoscope, the doctor looks at the trachea (windpipe) and the tubes that go into the lungs.

Laryngoscopy: With a tool called a laryngoscope, which is similar to the endoscope, the doctor examines the larynx (voice box).

Thoracoscopy: A small incision is made between two ribs, and an instrument called a thoracoscope is inserted through it into the chest. The thoracoscope is similar to the endoscope. It lets the doctor view and biopsy the lymph nodes inside the abdomen and chest.

If you have been diagnosed with esophageal cancer, we’re here to help. Call 1-877-632-6789 to make an appointment or request an appointment online.

Why Choose MD Anderson?

  • Innovative esophageal cancer treatments including proton therapy, minimally invasive surgery, photodynamic therapy and targeted therapies
  • Endoscopic mucosal resection for early stage disease
  • One of the most-active programs in the country
  • Advanced diagnostic tools including video endoscopy
  • Clinical trials of new therapies

Esophageal Cancer Knowledge Center

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Esophageal Cancer Staging

(source: National Cancer Institute)

The most common system used to stage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The TNM system describes three key pieces of information:

  • T refers to the size of the primary tumor and how far it has spread within the esophagus and to nearby organs
  • N refers to cancer spread to nearby lymph nodes
  • M indicates whether the esophageal cancer has metastasized (spread to distant organs)

Staging also takes into account the cell type of the cancer and the grade of the cancer. For squamous cell cancers, the location of the tumor can be a factor in staging.

T Stages

  • Tis: The cancer is only in the epithelium (the top layer of cells lining the esophagus). It has not started growing into the deeper layers. This stage also is known as high-grade dysplasia. In the past it was called carcinoma in situ.
  • T1: The cancer is growing into the tissue under the epithelium, such as the lamina propria, muscularis mucosa or submucosa
  • T2: The cancer is growing into the muscle layer (muscularis propria)
  • T3: The cancer is growing into the outer layer of tissue covering the esophagus (the adventitia)
  • T4: The cancer is growing into nearby structures
  • T4a: The cancer is growing into the pleura (the tissue covering the lungs), the pericardium (the tissue covering the heart), or the diaphragm (the muscle powering the lungs). The cancer can be removed with surgery.
  • T4b: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe), aorta (the large blood vessel coming from the heart), spine or other crucial structures.

N Stages

  • N0: The cancer has not spread (metastasized) to nearby lymph nodes
  • N1: The cancer has spread to one or two nearby lymph nodes
  • N2: The cancer has spread to three to six nearby lymph nodes
  • N3: The cancer has spread to seven or more nearby lymph nodes

M Stages

  • M0: The cancer has not spread (metastasized) to distant organs or lymph nodes
  • M1: The cancer has spread to distant lymph nodes and/or other organs

Grade

The grade of a cancer is based on how normal (or differentiated) the cells appear when they are looked at under the microscope. The higher the number, the more abnormal the cells look. Higher-grade tumors tend to grow and spread faster than lower-grade tumors.

  • GX: The grade cannot be assessed (treated in stage grouping as G1)
  • G1: The cells are well differentiated
  • G2: The cells are moderately differentiated
  • G3: The cells are poorly differentiated
  • G4: The cells are undifferentiated (these cells are so abnormal that doctors can't tell if they are adenocarcinoma or squamous cell carcinoma). For staging, G4 cancers are grouped with G3 squamous cell cancers.

Location

Some staging of early squamous cell esophageal cancer also takes into account where the tumor is in the esophagus. The location is upper, middle or lower based on where the upper edge of the tumor is.

Stage Grouping

Information about the tumor, lymph nodes and any cancer spread is then combined to assign the stage of esophageal cancer. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. The stage groupings for adenocarcinoma and squamous cell carcinomas are different.

Squamous cell carcinoma

Stage 0: Tis, N0, M0, GX or G1; any location: This is the earliest stage of esophageal cancer. It also is called high-grade dysplasia or carcinoma in situ. The cancer: 

  • Is found only in the epithelium (the layer of cells lining the esophagus)
  • Has not grown into the connective tissue beneath these cells (Tis)
  • Has not spread to lymph nodes (N0) or other organs (M0)
  • Is a grade 1 (or grade information is not available, GX)
  • Can be anywhere in the esophagus

Stage IA: T1, N0, M0, GX or G1; any location: The cancer:

  • Has grown from the epithelium into the connective tissue underneath (the lamina propria)
  • May have grown through that tissue into the layer below (the submucosa)
  • Has not grown any deeper (T1)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is a grade 1 (or grade information is not available, grade X)
  • Can be anywhere in the esophagus

Stage IB: Either of the following:T1, N0, M0, G2 or G3; any location: The cancer:

  • Has grown from the epithelium into the connective tissue underneath (the lamina propria)
  • May have grown through that tissue into the layer below (the submucosa)
  • Has not grown deeper than the submucosa (T1)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is a grade 2 or grade 3
  • Can be anywhere in the esophagus

OR

T2 or T3, N0, M0, GX or G1; location lower: The cancer:

  • Has grown into the muscle layer called the muscularis propria (T2)
  • May also have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is grade 1 (or grade information is not available; grade X)
  • Is in the lower part of the esophagus

Stage IIA: T2 or T3, N0, M0, GX or G1; location upper or middle; or G2 or G3; location lower: The cancer:

  • Has grown into the muscle layer called the muscularis propria (T2)
  • May also have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is either in the upper or middle part of the esophagus
  • Is grade 1 (or grade information is not available, grade X)
  • Is in the lower part of the esophagus
  • Is a grade 2 or grade 3

Stage IIB: Either of the following:T2 or T3, N0, M0, G2 or G3; location upper or middle: The cancer:

  • Has grown into the muscle layer called the muscularis propria (T2)
  • May have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is in the upper or middle part of the esophagus
  • Is grade 2 or grade 3

OR

T1 or T2, N1, M0, any G; any location: The cancer:

  • Has grown into the lamina propria (T1)
  • May have grown into layers below: the submucosa (T1) and the muscularis propria (T2)
  • Has not grown through to the outer layer of tissue covering the esophagus
  • Has spread to one or two lymph nodes near the esophagus (N1)
  • Has not spread to lymph nodes further away from the esophagus or to distant sites (M0)
  • Can be any grade
  • Can be any location

Stage IIIA: Either of the following: T1 or T2, N2, M0, any G; any location: The cancer:

  • Has grown into the lamina propria (T1)
  • May have grown into the submucosa (T1) and the muscularis propria (T2)
  • Has not grown through to the outer layer of tissue covering the esophagus
  • Has spread to three to six lymph nodes near the esophagus (N2) but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade
  • Can be any location

OR

T3, N1, M0, any G; any location: The cancer:

  • Has grown through the wall of the esophagus to its outer layer, the adventitia (T3)
  • Has spread to one or two lymph nodes near the esophagus (N1)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade
  • Can be any location

OR

T4a, N0, M0, any G; any location: The cancer:

  • Has grown all the way through the esophagus and into nearby organs or tissues (T4a)
  • Can be removed
  • Has not spread to nearby lymph nodes (N0) or to distant sites (M0)
  • Can be any grade
  • Can be any location

Stage IIIB: T3, N2, M0, any G; any location: The cancer:

  • Has grown through the wall of the esophagus to its outer layer, the adventitia (T3)
  • Has spread to three to six lymph nodes near the esophagus (N2)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade
  • Can be any location

Stage IIIC: Either of the following: T4a, N1 or N2, M0, any G; any location: The cancer:

  • Has grown all the way through the esophagus and into nearby organs or tissues (T4a)
  • Can be removed
  • Has spread to one to six lymph nodes near the esophagus (N1 or N2)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade
  • Can be any location

OR

T4b, any N, M0, any G; any location: The cancer:

  • Cannot be removed with surgery because it has grown into the trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine or other crucial structures (T4b)
  • May have spread to nearby lymph nodes (any N)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade
  • Can be located anywhere

OR

Any T, N3, M0, any G; any location: The cancer:

  • Has spread to seven or more nearby lymph nodes (N3)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade
  • Can be located anywhere

Stage IV: Any T, any N, M1, any G; any location: The cancer:

  • Has spread to distant lymph nodes or other sites (M1)
  • Can be any grade
  • Can be located anywhere

Adenocarcinoma

Stage 0: Tis, N0, M0, GX or G1: This is the earliest stage of esophageal cancer. It also is called high-grade dysplasia. The cancer:

  • Is found only in the epithelium (the layer of cells lining of the esophagus)
  • Has not grown into the connective tissue beneath these cells
  • Has not spread to lymph nodes or other organs
  • Is grade 1 (or grade information is not available; grade X)

Stage IA: T1, N0, M0, GX, G1, or G2: The cancer:

  • Has grown from the epithelium into the connective tissue underneath (the lamina propria)
  • May have grown through that tissue into the layer below (the submucosa)
  • Has not grown deeper (T1)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is a grade 1 or grade 2 (or grade information is not available, grade X)

Stage IB: Either of the following: T1, N0, M0, G3: The cancer:

  • Has grown from the epithelium into the connective tissue underneath (the lamina propria)
  • May have grown through that tissue into the layer below (the submucosa)
  • Has not grow deeper (T1)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is a grade 3

OR

T2, N0, M0, GX, G1, or G2: The cancer:

  • Has grown into the muscle layer called the muscularis propria (T2)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is a grade 1 or grade 2 (or grade information is not available, grade X)

Stage IIA: T2, N0, M0, G3: The cancer:

  • Has grown into the muscle layer called the muscularis propria (T2)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Is a grade 3

Stage IIB: Either of the following: T3, N0, M0, any G: The cancer:

  • Has grown through the wall of the esophagus to its outer layer, the adventitia (T3)
  • Has not spread to lymph nodes (N0) or to distant sites (M0)
  • Can be any grade

OR

T1 or T2, N1, M0, any G: The cancer:

  • Has grown into the lamina propria (T1)
  • May have grown into the submucosa (T1) and the muscularis propria (T2)
  • Has not grown through to the outer layer of tissue covering the esophagus
  • Has spread to one or two lymph nodes near the esophagus (N1)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade

Stage IIIA: Either of the following: T1 or T2, N2, M0, any G: The cancer:

  • Has grown into the lamina propria (T1)
  • May have grown into layers below: the submucosa (T1) and the muscularis propria (T2)
  • Has not grown through to the outer layer of tissue covering the esophagus
  • Has spread to three to six lymph nodes near the esophagus (N2)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade

OR

T3, N1, M0, any G: The cancer:

  • Has grown through the wall of the esophagus to its outer layer, the adventitia (T3)
  • Has spread to one or two lymph nodes near the esophagus (N1)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade

OR

T4a, N0, M0, any G: The cancer:

  • Has grown all the way through the esophagus and into nearby organs or tissues (T4a)
  • Can be surgically removed
  • Has not spread to nearby lymph nodes or to distant sites (M0)
  • Can be any grade

Stage IIIB: T3, N2, M0, any G: The cancer:

  • Has grown through the wall of the esophagus to its outer layer, the adventitia (T3)
  • Has spread to three to six lymph nodes near the esophagus (N2)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade

Stage IIIC: Either of the following: T4a, N1 or N2, M0, any G: The cancer:

  • Has grown all the way through the esophagus and into nearby organs or tissues (T4a)
  • Can be surgically removed
  • Has spread to one to six lymph nodes near the esophagus (N1 or N2)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade

OR

T4b, any N, M0, any G: The cancer:

  • Cannot be removed with surgery because it has grown into the trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine or other crucial structures (T4b)
  • May have spread to nearby lymph nodes (any N)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade

OR

Any T, N3, M0, any G: The cancer:

  • Has spread to seven or more nearby lymph nodes (N3)
  • Has not spread to lymph nodes farther away from the esophagus or to distant sites (M0)
  • Can be any grade

Stage IV: Any T, any N, M1, any G: The cancer has spread to distant lymph nodes or other sites (M1). It can be any grade.

Getting a Second Opinion at MD Anderson

The pathologists at MD Anderson are highly specialized in diagnosing and staging every type and stage of esophageal cancers. We welcome the opportunity to provide second opinions for esophageal cancers.

If you would like to get a second opinion at MD Anderson, call 1-877-632-6789 to make an appointment or request an appointment online.


© 2014 The University of Texas MD Anderson Cancer Center