The primary determinants of survival are the size of the primary tumor at diagnosis and the presence of extraesophageal involvement. Patients with tumors less than 5 cm and no lymph node involvement usually have the best prognosis. Tumors limited to the submucosa have a 5-year survival rate of over 60%. If the muscularis propria is involved, then the survival rate drops. Involvement of the adventitia, or the innermost layer of the esophagus, decreases the odds of survival. If the cancer is found early and is superficial, the prognosis for a cure with surgical intervention is good. A poorer prognosis is associated with vascular invasion and nodal metastasis.