All the World’s a Stage

Before we go any farther it is important to have a brief digression into the various types, stages, and potential outcomes for esophageal cancer. This will become key soon for reasons that will become obvious.

There are two types of esophageal cancer.  Squamous sarcoma is one and it usually occurs in the upper part of the esophagus and is usually caused by things like smoking and drinking.  It is nasty and rarely survivable.

Andenocarcinoma is the other and it happens lower in the esophagus, usually caused by acid reflux. This is the kind I have and it too can be nasty but it depends a lot on how far it has progressed.

Stage 1A is what Gastro-Guy originally thought I had – that’s the cancer with an asterisk or carcinoma in situ.  The cancer is just sitting there on top of the tissue not really doing anything other than looking around, trying to decide where it’s going to go.  It’s like Hitler before he invaded Poland.  This is easy to get rid of through a simple outpatient procedure and the recurrence rate is negligible.

Stage 1B is what Gastro-Guy thinks I have after going in there with his fancy toys.  It means that the cancer has invaded Poland (aka the sub-mucosal layer of the esophagus) but it hasn’t gone any further.  The most common treatment is the esophagectomy surgery that I have described and the recurrence rate is very low – 5 year survival is in the 90-95% range.

Stage 2 is when the cancer has moved on to Denmark and Norway, otherwise known as 1 or 2 lymph nodes near the tumor.  The treatment here involves chemo and radiation to try to ensure that it isn’t spreading anywhere else and THEN the surgery.  Survival drops precipitously here and is only around 50%.

Stage 3 is when the cancer has marched into Belgium, Holland, and Luxembourg, also known as more than 2 lymph nodes.  That’s right 3 or more lymph nodes is Stage 3.  Treatment is high dose chemo and radiation – the kind you often have to be hospitalized for – and then surgery.  Survival is only around 10%.

Stage 4 is France.  Or Russia. Or Egypt.  Basically anywhere in any other part of the body.  At that point it is time to go sit on a beach somewhere and enjoy the view.

The short version of all of this is that If what I have isn’t stage 1, well, then it becomes a whole other kind of fancy cocktail with fruit hanging off the rim  (I refuse to use sports metaphors like ball game and I don’t eat seafood so kettle of fish is out).

Scared yet?