I wouldn't swear the FISH report. It is simple... your cancer is evaluated a few ways that will determine what treatments could be most effective. Usually we are evaluated by EUS, biopsies, and scans. Our initial staging is considered "clinical"... and so, if you are given an actual staging (many are not) it will have a little "c" in front... like for me, I was cT3N1M0. But what really matters is spread. If the solid esophageal tumor is truly confined to the esophagus... that's a good start. Because now surgery will most likely come into play. If there is already metastasis to distant lymph nodes, bones, or organs... then being declared stage 4 makes surgery much less likely. But remember... tumor biology showing HER2-Positivity, or high PDL1 values, or Claudin 18.2 positivity... are double edged swords. It may mean your cancer might be more responsive to certain immunotherapies... but it also means your cancer is more aggressive and faster growing.

What's important is to get chemo and radiation going soon... to begin kicking the crap out of your cancer... and get it ready for removal. Surgery is the thing that is most considered a chance at a cure. What is used in the neoadjuvant and adjuvant settings will vary depending on what is seen upon dx... and in post-op pathology.

I'll also visit you with a private message... to talk more immunotherapy.

Gary