What is Stage II Oesophageal Squamous Cell Carcinoma?

Stage II oesophageal squamous cell carcinoma is a type of cancer that develops in the squamous cells, which are thin, flat cells that line the inside of the oesophagus^[2]. The oesophagus is the long, muscular tube that carries food from your throat to your stomach. At stage II, the cancer has grown beyond the innermost layers but has not spread to distant parts of the body^[2].

• Oesophagus
• Lymph nodes near the oesophagus

Stage II means that your cancer might have spread as far as the outer layer covering your oesophagus. Some stage II cancers have also spread into one or two nearby lymph nodes. However, the cancer has not spread to other body parts, structures or distant organs^[2].

The way doctors stage this cancer is complicated because it depends on several factors. These include what grade your cancer is, which means how abnormal the cells look under a microscope. It also depends on whether doctors stage your cancer using tests and scans, called clinical staging, or after surgery, which is called pathological staging^[2].

For some stage II squamous cell oesophageal cancers, the doctor also considers where the cancer is located in your oesophagus. Your oesophagus has three parts: the upper, middle and lower part^[2].

Understanding the Staging Details

Doctors use the TNM staging system to describe oesophageal cancer in detail. This system looks at three important features. The letter T stands for tumour and describes how deeply the cancer has grown into the layers of the oesophagus. The letter N stands for nodes and tells whether the cancer has spread to nearby lymph nodes. The letter M stands for metastasis and indicates whether cancer has spread to distant organs^[2].

Stage II squamous cell cancer can be divided into two groups: stage IIA and stage IIB^[5]. Stage IIA means the cancer has grown into the thick muscle wall or outer layer of your oesophagus. It has not spread to nearby lymph nodes. Stage IIB means the cancer has grown into either the supportive tissue layer or outer layer of your oesophagus, and it might have spread to one or two nearby lymph nodes^[5].

When using clinical staging, which relies on test and scan results, stage II squamous cell cancer can be any grade and located anywhere in the oesophagus. The cancer has grown into the thick muscle wall or outer layer of the oesophagus, and it might have spread to one or two nearby lymph nodes^[2].

When using pathological staging, which doctors determine after surgery, the stage depends on the grade of your cancer and where it is located in the oesophagus^[5].

Treatment Options

Treatment for stage II oesophageal squamous cell carcinoma typically involves multiple approaches. Your healthcare team will suggest treatments based on your individual needs and work with you to develop a treatment plan^[12].

Before treatment begins, you may have a feeding tube put in so that you can gain weight and maintain good nutrition during treatment^[12].

Chemotherapy and Radiation Therapy

Chemotherapy is usually combined with radiation therapy to treat stage II oesophageal cancer. This combination is called chemoradiation, and the two treatments are given during the same time period^[12]. Chemotherapy uses drugs to kill cancer cells, while radiation therapy uses high-energy rays to destroy cancer cells.

Chemoradiation may be offered before surgery to shrink the tumour, after surgery to reduce the risk that the cancer will come back, or as the main treatment for tumours that are found in the upper part of the oesophagus^[12].

Sometimes chemotherapy by itself may be offered before surgery^[12]. People with stage II oesophageal cancer who are not healthy enough to have surgery, or who do not want to have surgery, may be offered chemotherapy or chemoradiation as the main treatment^[12].

Surgery

Esophagectomy is surgery to remove all or part of the oesophagus and lymph nodes around it. Part of the stomach may be removed as well^[12]. Before you are offered surgery, your healthcare team will do tests to make sure that you are healthy enough to have it done.

Esophagectomy is the type of surgery offered for stage II oesophageal cancer when the person is healthy enough to have surgery. You may be offered surgery by itself or after chemoradiation^[12].

Immunotherapy

Immunotherapy is a treatment that helps your body’s immune system fight cancer. An immunotherapy drug called nivolumab may be offered for stage II oesophageal cancer. It may be given to people who still have cancer remaining after treatment with chemoradiation and surgery to completely remove the tumour^[12].

It is very important that treatment decisions are based on your informed wishes and are discussed in a team of specialists from different medical fields^[14]. Talk to your specialist doctor or nurse if you are unsure about anything. They can help you understand more about your cancer stage and treatment options^[2].