Stage 4 oesophageal cancer
The stage of your cancer tells the doctor how far it has grown and if it has spread.
Staging is very complicated. It depends on:
- what type of oesophageal cancer you have (squamous cell or adenocarcinoma)
- the grade of your cancer (how abnormal the cells look)
- whether doctors stage your cancer using tests and scans (clinical staging) or after surgery (pathological staging)
When you read the information on this page, it's helpful to know what type of oesophageal cancer you have and whether the doctor is using pathological or clinical staging. Talk to your specialist doctor or nurse if you are unsure. They can help you understand more about your cancer stage.
You can call the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
Staging systems
Doctors use different systems to stage oesophageal cancer. This page is about stage 4 cancer, which is part of the number staging system. This system has 5 stages, stage 0 (high grade dysplasia) to stage 4.
This page also tells you what stage 4 means in the TNM system. This system describes:
- the size of the primary tumour (T)
- whether the cancer has spread to the lymph nodes (N)
- whether the cancer has spread to another part of the body (M)
Squamous cell oesophageal cancer
Squamous cell cancers develop from squamous cells that make up the inner lining of your oesophagus.
Clinical staging means your doctor uses test and scan results to stage your cancer. This is different to pathological staging, which doctors use after surgery.
Your doctor might tell you your clinical stage to begin with. And if you go on to have surgery, your stage might change when the doctor finds out your pathological stage.
Stage 4 squamous cell cancer (clinical stage) can be any grade.
It’s split into 2 stages - stage 4A and stage 4B.
Stage 4A means the cancer has grown into nearby tissues or body structures next to the oesophagus such as the windpipe (trachea) or the outer covering of the heart (pericardium). And it is in up to 6 nearby lymph nodes.
Or it means the cancer is any size and has spread into 7 or more nearby lymph nodes.
In TNM staging, stage 4A includes:
- T4, N0 - N2, M0
- Any T, N3, M0
Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes.
In the TNM system, stage 4B is:
- any T, any N, M1
Stage 4 squamous cell cancer (pathological stage) can be any grade.
It’s split into 2 stages - stage 4A and stage 4B.
Stage 4A means the cancer has grown into nearby tissues or body structures such as the windpipe (trachea) or the outer covering of the heart (pericardium). It might have spread to up to 6 nearby lymph nodes.
Or, the cancer is any size but has spread to 7 or more nearby lymph nodes.
In the TNM system, stage 4A includes:
- T4a, N2, M0
- T4b, N0 - N2, M0
- Any T, N3, M0
Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes.
In TNM staging, stage 4B is the same as:
- any T, any N, M1
Adenocarcinoma
Adenocarcinomas are cancers that develop in gland cells. These cells make mucus in the lining of the oesophagus.
Clinical staging means your doctor uses test and scan results to stage your cancer. This is different to pathological staging, which doctors use after surgery.
Your doctor might tell you your clinical stage to begin with. And if you go on to have surgery, your stage might change when the doctor finds out your pathological stage.
Stage 4 adenocarcinoma (clinical stage) can be any grade.
It’s split into 2 stages - stage 4A and stage 4B.
Stage 4A means your cancer might be any size or has grown as far as nearby tissues or structures. And it might have spread into up to 6 nearby lymph nodes.
Or, the cancer is any size but has spread to 7 or more nearby lymph nodes.
In TNM staging, stage 4A includes:
- T1 – T4a, N2, M0
- T4b, N0-2, M0
- Any T, N3, M0
Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes.
In TNM staging, stage 4B is the same as:
- any T, any N, M1
Stage 4 adenocarcinoma (pathological stage) can be any grade.
It’s split into 2 stages - stage 4A and stage 4B.
Stage 4A means your cancer has grown into nearby tissues or body structures such as the windpipe (trachea) or the outer covering of the heart (pericardium). It might have spread to up to 6 nearby lymph nodes.
Or, the cancer is any size but has spread to 7 or more nearby lymph nodes
In TNM staging, stage 4A includes:
- T4a, N2, M0
- T4b, N0 - N2, M0
- Any T, N3, M0
Stage 4B means the cancer has spread to other parts of your body, such as the lungs or liver. It is any size and has spread to any number of lymph nodes.
In TNM staging, stage 4B is the same as:
- any T, any N, M1
Treatment
Your treatment depends on how far your cancer has spread.
If your cancer hasn't spread to distant body parts, such as the lungs or liver, you might be able to have:
- chemoradiotherapy on its own or before surgery
- chemotherapy and surgery
- targeted or immunotherapy drug treatment
If your cancer has spread further and you can't have surgery, then your treatment aims to control the cancer and maintain a good quality of life. You might have:
- chemotherapy
- radiotherapy
- targeted or immunotherapy drug treatment
- symptom control, such as treatment to help you swallow food