Esophageal cancer does not usually cause symptoms early on, and people may only notice it when tumors have progressed enough to cause symptoms. After symptoms start, it typically progresses quickly.

Esophageal cancer is rare and accounts for about 1% of cancer cases in the United States. Due to the speed of its progression, about 20% of people with esophageal cancer survive for at least 5 years after their diagnosis.

The outlook is generally poor because of the fast progression and late diagnosis typical of esophageal cancer. However, there are ways to manage and prevent the condition.

This article looks at esophageal cancer progression and the stages and outlook for the cancer. It also looks at early and late stage symptoms of esophageal cancer and where to find support.

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People often miss esophageal cancer in the early stages, as most do not experience symptoms early on.

The tumor begins to grow in the inner layer of the wall of the esophagus — a flexible, muscular tube connecting the stomach and throat.

Because the esophageal wall is flexible, the tumor may continue to grow unimpeded, pushing surrounding tissue out of the way.

Consequently, a person may not notice the tumor growth and may only become aware of esophageal cancer when symptoms occur.

Most esophageal cancers do not cause symptoms until they have already progressed to an advanced stage. While the initial progression of the tumor may be slow, esophageal cancer typically progresses quickly once symptoms occur.

As esophageal cancer progresses, tumor-causing esophageal cancer cells spread to other areas of the body and may reach distant lymph nodes and organs, such as the liver and lungs.

Once esophageal cancer progresses beyond the esophagus to a certain degree, doctors may not be able to remove it through surgery.

After diagnosing esophageal cancer, a doctor will try to determine whether it has spread and how far.

Doctors refer to this process as staging, and it can help them understand the severity and extent of the cancer and how best to treat it. The stages of esophageal cancer are from 0–4B.

Doctors typically use the American Joint Committee on Cancer (AJCC) TNM system to stage esophageal cancer. This involves the use of three factors to determine the stage:

  • Tumor (T): Doctors look at the extent, or size, of the tumor, how far into the esophageal wall it has grown, and whether it has reached nearby organs or structures.
  • Nodes (N): Doctors determine whether the cancer has spread to any nearby lymph nodes.
  • Metastasis (M): Doctors determine whether the cancer has metastasized, or spread, to distant organs such as the liver or distant lymph nodes in other areas of the body.

Below is a table that describes the stages of esophageal cancer.

StageDescription of stage
0The tumor is in the top layer of cells in the esophagus and has not grown into the deeper layers, or spread to lymph nodes or other areas of the body.
1AThe tumor is growing into tissue in the esophagus called the epithelium but has not spread to lymph nodes or other areas of the body.
1BThe cancer continues to grow into the thick muscle layer of the esophagus or the tissue under the epithelium, but it has not spread to lymph nodes or other areas.
2AThe tumor is growing into either the thick muscle layer or the outer layer of the esophagus, but it has not spread to lymph nodes or other organs.
2BThe tumor is growing into the outer layer of the esophagus, the submucosa, or the tissue under the epithelium, but it has not spread to lymph nodes or other areas.
3AThe tumor is growing into various tissues in the esophagus and has spread to six or fewer lymph nodes but not to distant organs.
3BThe cancer has either:
• grown into the outer layer or thick muscle layer of the esophagus and has spread to six or fewer nearby lymph nodes
or
• grown into the tissue surrounding the lungs or heart, or the diaphragm, and has spread to no more than two nearby lymph nodes
4AThe cancer has either:
• grown into any of the layers of the esophagus and spread to seven or more lymph nodes
or
• grown into the diaphragm and tissue surrounding the heart and lungs and spread to no more than six nearby lymph nodes
or
• spread to crucial structures such as the trachea, spine, or aorta and no more than six nearby lymph nodes
4BThe cancer has spread to distant structures, lymph nodes, or organs, such as the lungs or liver.

The 5-year relative survival rate refers to the likelihood that a person will survive for at least 5 years after their diagnosis with esophageal cancer compared with the general population.

The 5-year survival rates for each stage of esophageal cancer are as follows:

  • localized esophageal cancer, stages 0–2B: 47%
  • regional esophageal cancer, stages 3A–3B, unless the cancer has spread to distant areas: 26%
  • distant esophageal cancer, stages 3B–4B: 6%

People rarely experience early symptoms of esophageal cancer. In many cases, doctors discover the cancer in its early stages by accident while testing for other medical issues.

People typically experience symptoms of esophageal cancer in the advanced stages. Common symptoms include:

There are many resources available to help people cope with esophageal cancer following a diagnosis. A doctor may be able to offer helpful advice and information and suggest support groups and other resources.

Esophageal cancer typically progresses quickly once it reaches the advanced stages.

Doctors do not often diagnose the cancer during the early stages, as people typically do not experience symptoms until the cancer has metastasized, or spread to other areas of the body.

Because doctors are usually only able to diagnose esophageal cancer in the advanced stages, the outlook is generally poor.

The overall 5-year survival rate for esophageal cancer is about 20%, although it is 6% for those whose cancer has metastasized to distant areas of the body.