After diagnosing a patient with cervical esophageal cancer, a doctor will need to determine what type of cancer it is, the grade of the tumor, and the stage of the cancer. Doctors often establish a preliminary disease stage based on physical exam as well as findings on imaging that helps to identify the spread of disease. Staging esophageal cancer requires special tests, such as endoscopic ultrasound, that a head and neck surgeon typically does not perform. Because of this, a head and neck surgeon will consult either a gastroenterologist or a thoracic surgeon. This is in addition to a team of radiation oncologists and medical oncologists. In patients who undergo surgery, a more well-defined disease stage is determined based on pathology after surgery.
Type
The most common type of cervical esophageal cancer is squamous cell carcinoma. Squamous cell carcinoma is a cancer that starts from abnormal cells in the upper part of the cervical esophagus. Adenocarcinoma is another common type of esophageal cancer that begins in the gland-type cells in the esophagus. Adenocarcinoma is very rare in the cervical esophagus. It is much more common in the lower third of the esophagus.
Less common types of cervical esophageal cancer
- Sarcomas such as chondrosarcoma, liposarcoma and synovial sarcoma.
- Malignant fibrous histiocytoma.
- Peripheral Neuroectodermal Tumor (PNET).
- Cancer spread from another site (metastasis).
Other possible diagnoses
- Lymphoma: The throat is lined with lymphoid cells. This is why lymphoma might appear as a lump in the throat area.
- Carcinoid: This is a very slow growing tumor that is very rarely found in the esophagus, particularly the cervical esophagus (the most common site for this type of tumor is the appendix). Carcinoid tumor is a neuroendocrine tumor, which means the tumor cells can actually secrete hormones into the bloodstream. It is typically a benign tumor but can occasionally become cancerous. Some carcinoids (about 10%) can actually secrete hormones and lead to “carcinoid syndrome,” which is characterized by flushed or red skin, diarrhea, cramps that come and go, wheezing and other symptoms (sometimes made worse with having wine and cheese).
Grade
A doctor will rely on final pathology of the tumor to determine the grade and stage of the cancer. The grade is usually only determined after the tumor has been biopsied and/or removed. The grade of cancer relates to how healthy or unhealthy cells look under a microscope. In other words, a pathologist will determine the grade of cancer by comparing the amount of the healthy-looking tissue to the amount of cancerous tissue. If most of the tumor cells look like normal tissue then the cancer is “well differentiated” or “low-grade.” However, if the tumor cells look very different from normal tissue then the cancer is “poorly differentiated” or “high-grade.” The grade of cancer may help to determine how quickly the cancer is likely to spread.
Cervical esophageal cancer grading is described as the following:
| Grade | Definition |
|---|---|
| GX | The grade cannot be evaluated. |
| G1 | The cells look more like normal tissue and are well differentiated. |
| G2 | The cells are only moderately differentiated. |
| G3 | The cells don’t look like normal tissue and are poorly differentiated. |
Stage
The stage of a cancer is determined by the TNM staging system:
- The ‘T’ stands for tumor size.
- The ‘N’ stands for lymph node involvement.
- The ‘M’ stands for distant metastases, or cancer spread to other areas of the body.
Staging helps doctors determine how serious the cancer is and how best to treat it. Staging systems often reference very specific anatomical structures. Please reference the anatomy page to learn more about these terms.
Staging is generally based on the American Joint Committee on Cancer (AJCC) 8th edition guidelines. To learn more about the staging for Squamous Cell Carcinoma and Adenocarcinoma , see the TNM Staging Tool below.
Staging gets a little complicated for esophageal cancer because:
- The cancer staging system is different for squamous cell carcinomas and adenocarcinomas
- The cancer staging system takes into account the grade of the tumor
- For squamous cell cancers of the esophagus, the cancer staging system takes into account the location of the tumor within the esophagus
| Location Category | Location Criteria |
| X | Location unknown. |
| Upper | Cervical esophagus or lower border of azygos vein. |
| Middle | Lower border of azygos vein or lower border of inferior pulmonary vein. |
| Lower | Lower border of inferior pulmonary vein to stomach, including gastroesophageal junction. |
