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Stages of Esophageal Adenocarcinoma Cancer

Esophageal adenocarcinoma cancer is a type of cancer of the esophogus. It is primarily caused by Barrett's esophagus, a condition that occurs when the esophagus is damaged because of continued exposure to stomach acid. The continued exposure to stomach acid causes scar tissue or irregular cells to form on the walls of the esophagus. These abnormal cells, or dysplasia, progress to adenocarcinoma. Like other cancers, adenocarcinoma cancer has four stages.

  1. Esophageal Adenocarcinoma Cancer

    • Esophageal cancer refers to all cancers that begin in the inner mucosa layer of the esophagus and that grow out towards the submucosa and muscular layer of the esophagus. The two main types of esophageal cancer are adenocarcinoma cancer and squamous cell carcinoma. Adenocarcinomas refer to all cancers that begin in the gland cells of the esophagus. The gland cells are not normally found within the esophagus's inner lining, but when a patient has Barrett's esophagus, the normal squamous cells in this inner lining are replaced by the glandular cells. Generally, adenocarcinomas are found in the lower portion of the esophagus, which has the greatest exposure to stomach acids. The extent of the size of the adenocarcinoma determines the stage of the cancer.

    Staging

    • Like the majority of cancers, esophageal adenocarcinoma is staged using the four-part staging system designed by the American Joint Committee on Cancer. This test is called the AJCC test after its creator, or the TNM test after the three factors that compose the test. The "T" factor relates to the size of the tumor, the "N" factor relates to the extent of the involvement of the lymph nodes and the "M factor refers to whether the cancer has spread (metastasized) to other areas of the body.

    Stage 0

    • Stage 0 has a T number of "is" and an N and M number of 0. There is no lymph node involvement of metastases. The size of the adenocarcinoma is very small, and the cancer cells exist only in the lining of the esophagus (the epithelium) and not the connective tissue.

    Stage I

    • In stage I esophageal adenocarcinoma, there is a T number of 0 and an N and M number of 0. This means there is no metastases or lymph node involvement. The cancer cells have spread into the lamina propia (the tissue outside the inner layer) or the submucosa but no deeper.

    Stage II

    • There are two different clinical diagnoses for stage II esophageal adenocarcinoma. The first is stage IIA, which is characterized by a T number of 2 or 3 and an M and N number of 0. This means there is again no lymph node involvement or metastases. The cancer itself has grown into the muscularis propia (for T2) or into the connective tissue covering the esophagus (the adventitia) for T3.

      Stage IIB has a T number of 1 or 2 and an N number of 1. This means that the cancer has either grown into the laminia propoia and submucosa (for T1) or the muscular propia (for T2) and at least one lymph node near the esophagus has been infiltrated by cancer cells. Again, there is no metastases, and the "M" number is 0.

    Stage III

    • Stage III esophageal adenocarcinoma also has two clinical components leading to its diagnosis. The first is a T number of 3 with an N number of 1 and an M number of 0. The second is a T number of 4 with an N number of 0 or 1 and an M number of 0. This means that the cancer has either grown all the way to the outermost layer of the esophagus (the adventita) in the case of T3, and has penetrated at least one nearby lymph node or that the cancer has spread from the esophagus into nearby tissue or organs (for T4). In either case, there is no metastases.

    Stage IV

    • Stage IV means that the cancer has spread from the esophagus. Stage IV A means the M number is M1a, signifying that the cancer has spread to distant lymph nodes in the neck (for cancers originating in the upper esophagus) or in the abdominal (for cancers in the lower esophagus, like most adenocarcinomas). Stage IVB means the cancer has spread to a distant site in the body distinct from the esophagus, including the brain, bones, liver or distant lymph nodes. The M and N numbers are not important in diagnosing stage IV because it is the spread of the cancer that is characteristic of this stage.

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