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People with esophageal cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for esophageal cancer.
The most reliable prognostic factor for esophageal cancer is the stage of the tumour at the time of diagnosis. As with most cancers, the lower the stage, the better the outcome. Tumours that are only in the lining of the esophagus have a more favourable prognosis than those that have grown through the muscle wall or that have spread to other organs.
Small tumours have a more favourable prognosis than large tumours.
The fewer lymph nodes that have cancer, the better the prognosis.
Esophageal cancer that has spread to distant organs has a less favourable prognosis.
The amount of cancer that remains after surgery is called residual disease. No residual disease has a better prognosis than if there is cancer remaining after surgery.
Esophageal cancer that responds to neoadjuvant therapyneoadjuvant therapyTreatment given to shrink a tumour before the first-line therapy (the first or standard treatment), which is usually surgery. is more likely to be completely removed by surgery. As a result, cancer that responds to neoadjuvant therapy has a better prognosis than cancer that doesn’t respond to it.
During surgery, the surgeon removes the esophageal tumour along with a margin of healthy tissue around it. The tissue removed along with the tumour is called the surgical margin. If there are cancer cells in the healthy tissue removed along with the tumour, it is called positive surgical margins. Surgical margins that don’t have cancer cells (called negative surgical margins) have a better prognosis than positive surgical margins.
A low-grade, or well-differentiated, tumour (G1) often grows slower and is less likely to spread than a high-grade tumour (G3 or G4).
Performance status is the measure of how well a person can perform ordinary tasks and carry out daily activities. It is often measured with the Karnofsky performance status scale. People with a Karnofsky score of 70 or greater have a more favourable prognosis than those with a lower performance status.