Oesophageal Squamous Cell Carcinoma Stage III

Stage III oesophageal squamous cell carcinoma is an advanced form of cancer that affects the food pipe, where the disease has spread beyond the oesophagus lining into deeper tissues or nearby lymph nodes, but has not yet reached distant parts of the body.

Table of contents

• What is Stage III Oesophageal Squamous Cell Carcinoma?
• How Staging Works
• Stage 3A and 3B: Understanding the Differences
• Treatment Options
• Survival and Outlook

What is Stage III Oesophageal Squamous Cell Carcinoma?

Stage 3 oesophageal squamous cell carcinoma means the cancer has grown significantly within the oesophagus and may have spread to nearby structures and lymph nodes (small bean-shaped organs that are part of the body’s immune system). However, there is no sign of the cancer spreading to distant body parts such as the liver or lungs^[1][2].

Squamous cell carcinoma develops from squamous cells that make up the inner lining of the oesophagus. This type of cancer is most often found in the upper and middle part of the oesophagus^[5]. The oesophagus is the long muscular tube that moves food and liquid from your throat to your stomach^[5].

At stage 3, 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^[2].

How Staging Works

Staging for oesophageal squamous cell carcinoma is very complicated. It depends on several factors including the grade of the cancer (how abnormal the cells look) and whether doctors stage the cancer using tests and scans (clinical staging) or after surgery (pathological staging)^[2].

Clinical staging means your doctor uses test and scan results to stage your cancer. This is different to pathological staging, which doctors use after surgery. Your doctor might tell you your clinical stage to begin with, and if you go on to have surgery, your stage might change when the doctor finds out your pathological stage^[2].

Doctors use the TNM system to describe the cancer in detail. 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].

Stage 3A and 3B: Understanding the Differences

Stage 3 squamous cell cancer is split into two stages when using pathological staging: stage 3A and stage 3B. Both can be any grade^[4].

Stage 3A means the cancer has grown no further than the thick muscle wall of the oesophagus and has spread to up to 6 nearby lymph nodes. In TNM staging, stage 3A includes T1, N2, M0 and T2, N1, M0^[4].

Stage 3B means the cancer has spread into the thick muscle wall or outer layer (adventitia) of the oesophagus, or it has spread into nearby tissue such as the tissue covering the lungs, the outer covering of the heart, or the muscle at the bottom of the rib cage. It might have spread into up to 6 lymph nodes. In TNM staging, stage 3B includes T2, N2, M0; T3, N1 or N2, M0; and T4a, N0 or N1, M0^[4].

For clinical staging of stage 3 squamous cell cancer, the cancer has grown no further than the outer layer (adventitia) of the oesophagus and is in up to 6 nearby lymph nodes. In TNM staging, this is T1, T2 or T3, N1 or N2, M0^[4].

Treatment Options

Treatment options for stage 3 oesophageal squamous cell carcinoma vary based on the location of the tumour and whether the patient is healthy enough for different treatments. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan^[8].

Chemotherapy and Chemoradiation

Chemotherapy is usually combined with radiation therapy to treat stage 3 oesophageal cancer. This is called chemoradiation, where the two treatments are given during the same time period. Chemoradiation may be offered before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy)^[8].

For squamous cell carcinoma outside the cervical oesophagus (the part near the neck), the recommended approach is preoperative chemoradiation followed by surgery to remove part of the oesophagus. For tumours in the cervical oesophagus, definitive chemoradiation without surgery is recommended^[5].

People with stage 3 oesophageal cancer who are not healthy enough to have surgery, or who do not want to have surgery, may be offered chemoradiation as the main treatment. Chemotherapy may also be offered without radiation therapy before surgery for stage 3 tumours^[8].

Common chemotherapy drugs used to treat stage 3 oesophageal cancer include cisplatin and fluorouracil, cisplatin and capecitabine, carboplatin combinations, and other multi-drug regimens^[8].

Surgery

Surgery called esophagectomy may be performed to remove the cancerous portion of the oesophagus. This is typically done after chemoradiation therapy to improve outcomes. After surgery, if there is cancer remaining or the surgical margins are not clear, additional treatment may be recommended^[5].

Immunotherapy

Immunotherapy may be used for stage 3 oesophageal squamous cell carcinoma. Pembrolizumab may be offered in combination with cisplatin and fluorouracil as the first treatment for squamous cell carcinoma of the oesophagus^[8].

Nivolumab may be offered if there is cancer left after neoadjuvant therapy with chemoradiation and surgery^[8]. Recent advances in immunotherapy have significantly changed the treatment approach for oesophageal squamous cell carcinoma^[14].

Supportive Care

You may have a feeding tube put in so that you can gain weight and maintain good nutrition during treatment. This is important because many patients with oesophageal cancer experience difficulty swallowing and weight loss^[8].

Survival and Outlook

Survival statistics for stage 3 oesophageal cancer are based on large groups of people and cannot predict what will happen in any individual case. Statistics available from England show that around 20 out of 100 people (around 20%) with stage 3 oesophageal cancer will survive their cancer for 5 years or more after they are diagnosed^[20].

These statistics do not take into account what treatment people had, and treatment advances continue to improve outcomes. Many factors affect survival, including the exact location and extent of the cancer, response to treatment, overall health, and individual characteristics^[20].

It is important to talk to your doctor about your own outlook and prognosis, as they can give you more specific information based on your individual situation^[20].