Esophageal Cancer Survival Rates: What You Need to Know

“While esophageal cancer remains a deadly disease, incremental progress in treatments has been improving the prognosis,” says Ryan Sugarman, MD, a gastrointestinal medical oncologist and the medical site director of Memorial Sloan Kettering Cancer Center in Nassau, New York.

“As we learn more about different targets for esophageal cancer, I am optimistic we will have new treatments available that will continue to improve prognosis,” says Dr. Sugarman.

Esophageal cancer is a cancer that starts in the esophagus, the part of the digestive system that passes food and liquids from the mouth to the stomach. It happens when cancerous cells begin to multiply and eventually create a tumor.

Although the cancer is aggressive and grows quickly, people often don’t notice the symptoms until the cancer has spread.

“The five-year overall survival rate is the percentage of people who are alive five years after diagnosis, a number that is determined regardless of cause of death,” says Sugarman.

The five-year disease-free survival rate is the percentage of people who have no evidence of disease five years after treatment, he says.

Survival rates depend on several factors, including the stage of cancer, a person’s overall health, and how well the cancer responds to treatment.

How are survival rates calculated? The American Cancer Society uses information from the Surveillance, Epidemiology, and End Results (SEER) database, which is run by the National Cancer Institute. That database tracks five-year survival rates for esophageal cancer in the United States based on how far the cancer has spread.

Esophageal cancer survival rates are assessed according to whether the cancer is localized, regional, or distant.

Localized The cancer is growing only in the esophagus.

Regional The cancer has spread to nearby lymph nodes or tissues.

Distant The cancer has spread to organs or lymph nodes away from the main tumor.

The most recent five-year survival rates are based on cases of esophageal cancer diagnosed between 2013 and 2019 (meaning that the survival rates were calculated between 2018 and 2024).

The five-year survival rates are:

• 49 percent for localized cancer
• 28 percent for regional cancer
• 6 percent for distant cancer

The survival rates don’t separate squamous cell carcinomas from adenocarcinomas, although people with adenocarcinomas usually have a slightly better prognosis (outlook) overall.

“The most important factor that determines a patient's likelihood of survival is their initial stage. The hope of long-term survival is greatest if a patient is a candidate for curative intent therapy (treatment that aims to cure the cancer and restore health to what it was precancer),” says Sugarman.

There are other factors besides stage at diagnosis that play a role as well.

Stage at Diagnosis

“It is important to stage esophageal cancer, because it will help determine the goals of therapy (curative versus palliative), the type of therapy recommended, as well as the prognosis,” says Sugarman.

Doctors use a variety of methods to assess the size and spread of the cancer. This information, along with the cancer's location in the esophagus (upper, middle, or lower) is used to classify the cancer into stages, ranging from 0 to 4, which guides treatment decisions and provides insights into the patient's chances of survival.

Speed of Metastasis

Age and Gender

Lifestyle Factors

There are risk factors associated with a higher risk of developing esophageal cancer. They include conditions and lifestyle factors that cause irritation in the esophagus.

• Drinking very hot liquids on a regular basis
• Bile reflux
• Achalasia, a condition that causes difficulty swallowing because a muscle in the esophagus won't relax
• Alcohol consumption
• Gastroesophageal reflux disease (GERD)
• A diet lacking in fruits and vegetables
• Obesity
• Barrett esophagus, which is precancerous changes in the cells of the esophagus
• Radiation treatment to the chest or upper abdomen
• Smoking

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Treatment Response

People can respond to the same treatment in different ways, and those with a stronger response increase their likelihood of five-year survival.

In people with advanced disease there are biomarkers that determine how likely a patient is to respond to a treatment, says Sugarman.

“For example, tumor tissue can be tested for proteins, and if a patient expresses high PD-L1 (programmed death–ligand 1) or deficiency of mismatch repair protein they are more likely to respond to immunotherapy. If a patient has overexpression of the HER2 protein, there is an anti-HER2 therapy that can be added to chemotherapy,” he says.

A protein called claudin has been found to be a targetable protein, and there is now an approved treatment, Vyloy (zolbetuximab) that is used in combination with chemotherapy to treat claudin-expressing gastroesophageal cancer, says Sugarman.

“If a patient has additional treatment options, I am generally more optimistic about their chances of longer term survival than if there are more limited options,” he says.

Esophageal cancer may not present noticeable symptoms until it has reached an advanced stage. This is why it’s often diagnosed late, which limits treatment options.

Some of the most common signs and symptoms to watch for include:

• Difficulty swallowing (dysphagia): This is often the first noticeable symptom of esophageal cancer. This may begin as a sensation that food is “sticking” in the chest.
• Unexplained weight loss: Unintentional weight loss, especially when accompanied by difficulty swallowing, could be a sign of esophageal cancer.
• Pain: Pain in the throat or back, behind the breastbone or between the shoulder blades.
• Persistent cough or hoarseness: A persistent cough, hoarseness, or a change in voice can occur if the cancer spreads to the lungs or affects the nerves controlling the vocal cords.
• Heartburn or indigestion: While common in many people, persistent or severe heartburn could be a sign of esophageal cancer, especially when associated with other symptoms like difficulty swallowing.

• Early detection significantly improves survival rates — the earlier esophageal cancer is diagnosed, the better the chance for successful treatment and long-term survival.
• Survival rates determine prognosis and can vary dramatically by stage, with earlier stages offering a much better outlook than more advanced cancers.
• Lifestyle changes can impact outcomes. Quit smoking, reduce alcohol intake, and manage obesity and GERD to improve your treatment response and overall survival.
• Watch for warning signs including difficulty swallowing, unexplained weight loss, and persistent chest pain that may indicate esophageal cancer and warrant early medical attention.