Like with any other cancer it is important prior to any treatment to know exactly staging of esophageal cancer, in other words how widespread the esophageal cancer is.
Otherwise there might be cancer spread, which has been overlooked. Due to this oversight radiotherapy may be missed that would have led to a better cancer survival rate. Unfortunately, if patients are found to have end stage cancer at the time of diagnosis, not much therapy can be offered other than symptomatic and palliative therapy.
Here is a definition for the stages of esophageal cancer (modified from Ref. 1). Staging is used by clinicians to know which patient would benefit from treatment.
Staging of esophageal cancer
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Stage: Comments:
I : localized cancer confined to lining
II : cancer invades locally +/- lymph node metastases
III : cancer invades neighboring structures
IV : cancer has spread systemically
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This is important because some of the treatments are invasive and carry their own risks and a patient with an advanced stage IV esophageal cancer would for instance not benefit from local surgery.
We know from other studies that patients with distant metastases live only for another 6 months on average. So, there is no point in doing surgery in a stage IV patient as his condition has been extremely weakened by the cancer. In this weak condition the surgery might kill such a patient.
References:
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter 25. Cancer of the esophagus.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Cancer of the esophagus.
3. D Sharma J Indian Med Assoc 1999 Sep;97(9): 360-364.
4. MJ Roth et al. Cancer Res 2001 May 15;61(10):4098-4104.
5. K Schumacher et al. Cancer Res 2001 May 15;61(10):3932-3936.
6. M Tachibana et al. Virchows Arch 2001 Apr;438(4):350-356.
7. SJ Spechler et al. JAMA 2001 May 9;285(18):2331-2338.
