Stages?

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I am going on from diagnosis confirmed to Ultrasound & PET scan because my tumour apparently has not spread. 

Can anyone tell me please what is the significance of Stages in cancer & the relevance to ongoing chemo and/or surgery?

The consultant did mention that this type of cancer is awkward to operate.

Thanks.

  • Hi Karl74 

    This is a difficult question to answer as each case is individual and lots of factors are taken into consideration before your Consultant and Oncologist put your treatment plan into place .

    eg..The position of the tumour within your oesophagus   ..Is the tumour contained within the oesophagus ..Has the tumour spread to lymph nodes and/or surrounding organs . 

    All the extensive tests you will have prior to treatment will determine your OC stage and treatment path .You will be told usually by your Consultant.

    My husbands was assessed as Stage 2 ..His tumour was in the junction between his oesophagus and stomach ..It was contained within his oesophagus as during his surgery they discovered it had not broken  through the outer layer as previously thought . His treatment plan was four cycles of FLOT chemo pre surgery over eight weeks .Surgery was carried out via keyhole/robotic technique ..Two thirds of his oesophagus was removed ..a section of his stomach and surrounding tissue and lymph nodes taken ..Eight weeks post surgery he then had two FLOT chemo cycles.

    Sixteen months later it’s all looking good regarding the OC ..Although it will be another three and a half years until we know if he’s cured.

    Once all your tests are completed you will  know the stage and any other information relevant to your case.

    Hope  all goes well for you and you’re on your treatment path very soon.

    regards J 

  • Thanks J for your excellent reply

  • The Cancer Research website has really helpful information about staging and treatment.

    You may also have a staging lap, it's a day case, Here they look for spread on the liver which doesn't always show on scans. 

    The standard approach is for 4 doses (every 2 weeks) of FLOT chemo, it is a combination therapy delivered over 5 hours in hospital and with a slow delivery bottle which goes home with you for 24 hours. District nurses detach it. followed by a recovery period of approx. 6-8 weeks before standard oesophagectomy. You then have another period of rest/recovery of up to 8 weeks before the second instalment of FLOT (4 doses over 8 weeks).

    You can find footage of the surgery if you want to see what happens in the BBC series Surgeons at the Edge of Life on iPlayer. 

    They stage your cancer using a TNM number (this is explained fully in the cancer research website) but the T stages your tumour, T1 is superficial and can sometimes be treated without surgical removal of the oesophagus, going up to T4 where it has invaded nearby organs and structures. T4 is divided into two parts T4a is operable, T4b is not.

    The N number refers to the number of lymph nodes involved up to N3 which means 7 or more lymph nodes are showing active cancer. 

    The M number is for metastasis, this is either M0 which means you don't have spread to other organs or distant lymph nodes or M1 which means you do. 

    If the M is a 1 you are very unlikely to be offered the surgery. You can still be offered chemo, radiotherapy and if genetic testing shows your tumour will react well, then immunotherapy. Immunotherapy can be continued for as long as it works, which for some is years. 

    Other things that can influence the course of treatment they recommend/offer is where the cancer is located. They measure from the teeth to the stomach as 40cm. If the cancer is very high towards the throat then they cannot operate as they wouldn't be able to get sufficient margins to get all the cancer out. Normally these cancers are at the junction of the oesophagus and stomach, you may have skip lesions higher (like my husband did), this can make surgery as not possible. However, after chemo, these skip lesions disappeared so the surgery became possible again.  

    Age and health before diagnosis are also factors in the decision about treatment. 

    I know it's a lot to take in, but try to get a TNM number from them and the 0-40cm number will tell you where it is (ask for a copy of the scan report as all the info is hidden in there). The genetic make-up of the cancer may be found out later. 

    To give you a bit of hope, my husband was diagnoses December 2022 with a T3 N3 M0 cancer with genetics for the possibility of immunotherapy if needed. They finally went ahead with the surgery after a good response from the chemo and it all went well. The margins weren't clear in the specimen so in December 2023 he had 25 days of chemoradiation. Post-surgery they restaged him as T4a N2 M0 (the cancer had wrapped itself around the aorta, stuck to the diaphragm and pancreas).  He is now back working, we are currently in the US. He has no visible evidence of disease on scans. Life goes on. 

    It's a long road, but you can get through it. Hope this helps. Steph

  • Hi Karl 74

    I'm at a similar stage in my diagnosis as you. I had a gastroscope on 17th February, nothing visually reported only my hiatus hernia. My biopsies came back cancerous and was told on 3rd April. They tried to take it away by gastroscope but we're unable. Since the 3rd April I've had a CT scan, PET scan, a gastroscope which they tried to remove it and a gastroscope with ultrasound. All I've been told is it's caught early. I've had all my assessments and they say I'm a candidate for surgery and I will have chemo and or radiotherapy prior to surgery. After my gastroscope with ultrasound, the Dr mentioned T2, im not sure if T2 means stage 2. They have said it hasn't spread or not in any lymph nodes. I have my 1st appointment with oncology  this Thursday. I know it might sound strange. I just want to get my treatment started. My Mum was diagnosed with OG cancer a year ago today. We are both under the same consultant. My grandmother also had it. My brother and sisters are all getting checked by gastroscope. 

  • Thanks for that Steph

  • Hi FW75,

    How did your oncologist meeting go? We are in very similar scenario. I was diagnosed with T1,N0,M0 but later staged at T2,N1,M0. The N1 being 3mm of a lymph-node which they wasn’t sure if it was suspicious or not but treating it as it is which is for the best.

    I start FLOT chemo on the 6th of June which I am dreading as I have read all sorts. Being 28 hopefully age is on my side throughout the duration!

    My oncologist was brilliant she went over everything in detail and after the MDT meeting they’ve decided the plan will be 4 FLOT chemo sessions over 8 weeks and 4-6 weeks after the last chemo session I’ll have Surgery to remove part of my oesophagus and 1/3 stomach then 6 weeks after I’ll start chemo again for another 4 sessions.. it’s a strange feeling but having a plan in place has made me feel better about the scenario.

    I hope your oncologist meeting went well.

    Many thanks