Oesophageal Adenocarcinoma Stage III

Stage 3 oesophageal adenocarcinoma is a serious form of cancer where the disease has grown deeper into the oesophagus and may have spread to nearby lymph nodes, but has not reached distant parts of the body. Understanding this stage helps patients and their families prepare for treatment and know what to expect.

Table of contents

• What is stage 3 oesophageal adenocarcinoma?
• Understanding staging systems
• Treatment options
• Survival and outlook

What is stage 3 oesophageal adenocarcinoma?

Stage 3 oesophageal adenocarcinoma means the cancer has grown beyond the inner layers of the oesophagus (the tube that carries food from your throat to your stomach) into deeper tissues or nearby structures. Adenocarcinomas are cancers that develop in gland cells, which make mucus in the lining of the oesophagus^[2].

At this stage, the cancer might have spread beyond the outer layer of the oesophagus into nearby tissue such as the covering of the lungs (pleura), the outer covering of the heart (pericardium), or the muscle at the bottom of the rib cage (diaphragm). The cancer might also have spread to up to 6 nearby lymph nodes (small bean-shaped structures that are part of your immune system). However, there is no sign of the cancer spreading to distant parts of the body^[2].

Staging for oesophageal cancer is complicated. It depends on what type of cancer you have (squamous cell or adenocarcinoma), the grade of your cancer (how abnormal the cells look under a microscope), and whether doctors stage your cancer using tests and scans (clinical staging) or after surgery (pathological staging)^[2].

Understanding staging systems

Doctors use different systems to describe how far cancer has spread. The number staging system has 5 stages, from stage 0 (high grade dysplasia) to stage 4. Stage 3 is part of this system^[2].

Another system is called TNM staging. This system describes the size of the primary tumour (T), whether the cancer has spread to the lymph nodes (N), and whether the cancer has spread to another part of the body (M)^[2].

For adenocarcinoma, stage 3 can be divided based on whether doctors use clinical staging (based on tests and scans) or pathological staging (based on findings during surgery). Your doctor might tell you your clinical stage first. If you have surgery, your stage might change when the doctor finds out your pathological stage^[2].

Stage 3 adenocarcinoma (clinical stage) can be any grade. It means the cancer has spread into the thick muscle wall of the oesophagus or beyond, and may have reached up to 6 nearby lymph nodes^[2].

Treatment options

Treatment for stage 3 oesophageal adenocarcinoma typically involves a combination of approaches. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan^[6].

You may have a feeding tube put in so that you can gain weight and maintain good nutrition during treatment^[6].

Chemotherapy and chemoradiation

Chemotherapy (drugs that kill cancer cells) is usually combined with radiation therapy (treatment using high-energy rays) to treat stage 3 oesophageal cancer. This combination is called chemoradiation, where the two treatments are given during the same time period^[6].

Chemoradiation may be offered before surgery (neoadjuvant therapy), after surgery (adjuvant therapy), or as the main treatment for people who are not healthy enough to have surgery or don’t want surgery^[6].

Common chemotherapy drugs used include cisplatin and fluorouracil, cisplatin and capecitabine, carboplatin and paclitaxel, and various combinations with drugs like epirubicin, oxaliplatin, docetaxel, and irinotecan^[6].

Targeted therapy

Targeted therapy drugs may be used to treat stage 3 adenocarcinoma tumours at the gastroesophageal (GE) junction, where the oesophagus meets the stomach. They are usually combined with chemotherapy^[6].

Trastuzumab is used with chemotherapy drugs to treat HER2-positive tumours. Ramucirumab is a monoclonal antibody (a laboratory-made protein) that stops cells from forming new blood vessels they need to grow. Zolbetuximab works by attaching to a specific protein on cancer cells to stop their growth^[6].

Immunotherapy

Immunotherapy helps your immune system fight cancer. Pembrolizumab may be offered in combination with chemotherapy as the first treatment for HER-2 negative adenocarcinoma tumours found at the gastroesophageal junction, or with trastuzumab for HER-2 positive tumours^[6].

Nivolumab may be offered if there is cancer left after treatment with chemoradiation and surgery, or in combination with chemotherapy for tumours at the gastroesophageal junction^[6].

Surgery

Surgery may be part of treatment for stage 3 oesophageal cancer. One patient example describes having chemotherapy for 6 weeks followed by 30 days of radiation and 60 days of rest before surgery. The surgical procedure removed most of the oesophagus and part of the stomach^[9].

Survival and outlook

Survival depends on many factors, and no one can tell you exactly how long you will live. Statistics are based on large groups of people and cannot predict what will happen in your individual case^[17].

According to statistics from England for people diagnosed between 2016 and 2020, around 20 out of 100 people (around 20%) with stage 3 oesophageal cancer will survive their cancer for 5 years or more after they’re diagnosed. These figures do not take into account what treatment people had^[17].

Many factors affect survival, including your age, overall health, how well you respond to treatment, and the specific characteristics of your cancer. Your doctor can give you more information about your own outlook^[17].

Treatment advances and access to comprehensive care at specialized centres that see many cases of oesophageal cancer can improve outcomes. Patients benefit from teams of experts who work closely together to provide personalized treatment plans^[16].

• Oesophagus
• Stomach
• Lymph nodes
• Pleura (covering of the lungs)
• Pericardium (covering of the heart)
• Diaphragm