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Prognosis and survival for esophageal cancer
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.
Cancer has spread to lymph nodes
The fewer lymph nodes that have cancer, the better the prognosis.
Cancer has spread to distant organs
Esophageal cancer that has spread to distant organs has a less favourable prognosis.
Cancer that remains after surgery
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.
Cancer that responds to neoadjuvant therapy
Esophageal cancer that responds to neoadjuvant therapy 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.
Cancer cells in the surgical margins
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.
Treatment given to shrink a tumour before the first-line therapy (the first or standard treatment), which is usually surgery.
Neoadjuvant therapy may be given if a tumour is too large to be removed by surgery. It may include chemotherapy, radiation therapy or hormone therapy.
A standard measure of a person’s ability to perform ordinary tasks and carry out daily activities.
The Karnofsky performance status scale is used to assess a person’s prognosis, to monitor changes in a person’s ability to function or decide if a person is suitable for a clinical trial. The person’s performance status is given a score out of 100. The higher the score, the better able a person is to carry out daily activities.
Also called Karnofsky performance scale or Karnofsky scale.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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