Stage four esophageal cancer occurs once esophageal cancer has spread to other organs or distant lymph nodes in the body. The esophagus is a hollow tube which connects the stomach to the throat while moving food and liquid down to the stomach. Cancer of the esophagus is rare and has two main types, adenocarcinoma and squamous cell carcinoma. Adenocarcinoma is more common and squamous cell carcinoma is often associated with excessive drinking or smoking.
What Is a Stage 4 Esophageal Cancer?
Stage 4 esophageal cancer is an advanced stage of cancer where it has metastasized or spread throughout the body. Stage IV is divided into IVA and IVB, which only differ in where the cancer has spread in the body. To be in Stage IVA, the cancer spreads to:
- Up to 6 nearby lymph nodes and to structures such as the spine, aorta, or airway.
- 3 to 6 nearby lymph nodes or has spread to the diaphragm, azygos vein, peritoneum, pleura, or the sac around the heart, it is stage IVA.
- 7 or more lymph nodes surrounding the tumor
If the cancer has spread to other parts of the body such as the lungs or liver, the cancer is in Stage IVB. Due to the cancer no longer being only in the esophagus or nearby lymph nodes, surgery to remove the tumor is typically not an available treatment option.
Survival Rates for Esophageal Cancer
Stage 4 esophageal cancer prognosis depends on several factors such as the patient’s age, cancer subtype, stage of disease and more. The Surveillance, Epidemiology, and End Results (SEER) database from the National Cancer Institute (NCI), combines different factors to track the survival rates of esophageal cancer and other cancer types. Instead of stage 1, 2, 3, or 4, survival rates are classified by localized, regional, or distant to more accurately calculate the rate of survival. Similar to most cancer types, the earlier the cancer is caught and treated, the more likely the treatment will be successful. If the cancer is diagnosed when it is already advanced, the prognosis will not be as favorable.
Localized cancer is only in the esophagus. Regional cancer has spread to nearby lymph nodes or tissues. Distant esophageal cancer has spread to different organs or parts of the body that are away from the original tumor site. The stage 4 metastatic esophageal cancer survival rate would be included in the Distant category in the SEER database.
Esophageal cancer life expectancy by stage according to SEER:
- Localized: 47 percent
- Regional: 25 percent
- Distant: 5 percent
- All SEER stages combined: 20 percent
Once stage 4 esophageal cancer spreads to the liver and lungs, life expectancy is lowered even more, and the prognosis is less favorable. As the cancer spreads throughout the body, treatment is more complicated and there are less available options.
How Esophageal Cancer Is Staged and Graded
If symptoms are experienced, imaging tests will be performed to confirm there is a tumor and the size of it. These tests include:
- Barium Swallow
- CT Scan
- PET Scan
In some cases, doctors may use a long tube with a light to see inside the esophagus and nearby parts of the body. This can be used in esophagoscopy, thoracoscopy, or bronchoscopy. After an imaging test determines there is a tumor present, additional testing determines what kind of tumor is present through a biopsy. A sample of tissue is taken and then viewed under a microscope by a pathologist.
Once diagnosed, doctors will determine the stage of the disease by its size, whether it is in nearby lymph nodes, and where in the body the cancer has spread. The stages of esophageal cancer include:
- Stage 1: the tumor is 7 cm or less and has not spread outside the esophagus.
- Stage 2: the tumor has not spread outside the esophagus but is slightly larger
- Stage 3: the tumor has spread outside the esophagus and grown larger. The tumor may or may not have spread to any nearby lymph nodes.
- Stage 4: the tumor’s size may have grown beyond the esophagus. The disease may or may not have spread to distant organs in the body like the liver, abdominal cavity, or lymph nodes.
The grade of esophageal cancer also gives patients an insight on the outlook of your cancer. Doctors view the cancer cells under a microscope and the closer the cancer cells appear to healthy cells, the lower the grade is. The more abnormal the cells appear, the higher the grade and the cancer will be more difficult to treat. These grades range from G1, which appear close to normal esophageal cells, to G3, which are cells that appear very abnormal.
Signs and Symptoms of End Stage Esophageal Cancer
In the early stages of esophageal cancer, patients often do not have symptoms. As the tumor gets larger, patients will likely start to experience symptoms. This makes diagnosing esophageal cancer in early stages difficult. Stage 4 esophageal cancer symptoms can include:
- Difficulty swallowing
- Unexplained weight loss
- Throwing up or mucus with spots of blood
- Frequent hiccups
Treatment of Stage IV of Esophageal Cancer
For patients with esophageal cancer stage 4, treatment may include several different options. Your doctor will determine the best option for you based on the stage of disease, subtype, and previous treatments used. Stage 4 treatments may include:
- Radiation therapy
- Targeted therapies such as Larotrectinib (Vitrakvi) and Entrectinib (Rozlytrek)
- Immunotherapy drugs such as pembrolizumab
Targeted therapies are able to locate specific biomarkers in the cancerous cells and attack them. Since these drugs do not target normal, healthy cells, there are often fewer side effects. One or more treatments are often used with chemotherapy pills. For example, a targeted therapy called ramucirumab (Cyramza) is combined with chemotherapy when esophageal cancer begins in the gastroesophageal junction and spreads to distant organs, also referred to as GE junction cancer stage 4.
Clinical Trials for Esophageal Cancer
Esophageal cancer clinical trials give patients access to new and innovative treatments that go through strict, FDA regulatory processes before being approved for use. Participating in a clinical trial provides patients with new studies they would otherwise not have access to for years until the FDA approves the drug.
New drugs are continually being researched and developed for esophageal cancer and other cancer types. These drugs and therapies must be shown to be safe and effective before doctors can give them to patients. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat cancer, its safety, and any possible side effects.
If you’ve been diagnosed with any of the following subtypes of esophageal cancer, we’re here to help:
- Squamous cell cancer of the esophagus
- Esophageal adenocarcinoma
- Small cell carcinoma of the esophagus
If you don’t know which type of esophageal cancer you have that’s okay. Additional testing can help you determine your exact diagnosis and which treatment options could be available to you.