Cancer Staging a Brief Guide

Image
The most important question that a cancer patient and his care giver want to know is
“What is the stage of cancer I have?”
Basically a patient wants to know whether he’s disease is curable or not and he tries to correlate with the stage of the disease.

For the benefit of the patient I would like to emphasize that the stage is a statistical construct and the outcome is in no way determined by the stage. It is the biological nature of the disease that determines how the disease will evolve and respond to the treatment.

So please don’t take advanced stage as a death sentence and early stage as an excuse to try out non conventional treatments.

From the patients perspective the stats hold little significance except in making decisions regarding which treatment to choose or disregard. Most importantly it should be remembered that the dreaded stage IV cancer is not the same for every cancer and DOESN’T imply that the disease has become incurable.

Here I am writing this post to briefly describe about the staging of cancer and its importance. In order to know what is cancer and its diagnosis plz go through the following link

http://drsumandas.wordpress.com/2011/11/27/diagnosis-of-cancer-few-important-things-to-know/

What is staging of Cancer ?
This is a common language that describes the extent or severity of a cancer diagnosis based on information about the tumor.

How is Cancer staging Determined?

The facts to be considered in most staging systems are:
• Location of the primary tumor,
• Tumor size and number of tumors,
• Spread of cancer into lymph nodes,
Cell type and tumor grade (how closely the cancer cells resemble normal tissue)
• Presence or absence of metastasis (the spread of the cancer)

What is significance of Cancer Staging ?
• The stage can be used to estimate your prognosis (likely outcome or course of the disease).
• It helps the doctor plan treatment

TNM staging

The oncologists commonly write the TNM stage,  in fact this is an internationally accepted common method of staging so that any oncologist any where can know about the exact stage of disease and it can also help him to understand the treatment as the treatment is mostly guided by the TNM staging.

The TNM system is one of the most commonly used staging systems. It is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis (M). A number is added to each letter to indicate the size or extent of the tumor and the extent of spread.
Primary Tumor (T)

  • TX Primary tumor cannot be evaluated
  • T0 No evidence of primary tumor
  • Tis Carcinoma in situ (early cancer that has not spread to neighboring tissue)
  • T1, T2, T3, T4 Size and/or extent of the primary tumor 

Regional Lymph Nodes (N)

  • NX Regional lymph nodes cannot be evaluated
  • N0 No regional lymph node involvement (no cancer found in the lymph nodes)
  • N1, N2, N3 Involvement of regional lymph nodes (number and/or extent of spread)

Distant Metastasis (M)

  • MX Distant metastasis cannot be evaluated
  • M0 No distant metastasis (cancer has not spread to other parts of the body)
  • M1 Distant metastasis (cancer has spread to distant parts of the body)

For example, breast cancer T3 N2 M0 refers to a large tumor that has spread outside the breast to nearby lymph nodes, but not to other parts of the body. Prostate cancer T2 N0 M0 means that the tumor is located only in the prostate and has not spread to the lymph nodes or any other part of the body.
Stage Definition

  • What is Stage 0 Cancer:Carcinoma in situ (early cancer that is present only in the layer of cells in which it began).
  • What is Stage I, II, and III Cancer: Higher numbers indicate more extensive disease: greater tumor size, and/or spread of the cancer to nearby lymph nodes and/or organs adjacent to the primary tumor.
  • What is Stage IV Cancer:  The cancer has spread to another organ.

Cancers of the blood or bone marrow, including most types of leukemia, do not have a clear-cut staging system.

What are the tests that help in establishing stage of cancer?
Physical examination:A doctor examines the body by looking, feeling, and listening for anything unusual. The physical exam may show the location and size of the tumor(s) and the spread of the cancer to the lymph nodes and/or to other organs.

Imaging :These produce pictures of areas inside the body. Procedures such as x-rays, computed tomography(CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans can show the location of the cancer, the size of the tumor, and whether the cancer has spread.

Laboratory tests:These studies of blood, urine, other fluids, or tissues can provide information about the cancer.

Pathology reports:A biopsy (the removal of cells or tissues from the body for examination under a microscope) may be performed to provide information for the pathology report. Cytology reports also describe findings from the examination of cells in body fluids.Surgical reports. These describe the size and appearance of the tumor as observed during surgery and often include observations about lymph nodes and nearby organs.

What is Immuno-histochemistry (IHC):It is the process of detecting antigens (e.g., proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in the tissue. It is done from the biopsy specimen. A battery of IHC tests is done and it helps to come to a final decision about the type of cancer and also it has got prognostic significance for a specific type of cancer. The IHC test is not available in all the pathology labs and all pathologists are not well versed with the IHC testing. It is very important to ask your surgeon to send it to the pathologist who does IHC and is good in the subject.

I hope this post would help my readers have an brief idea about the staging of cancer and could guide them while discussing with the oncologist. please feel free to give your feedback thanx.

7 responses

  1. [...] 4. What is the stage of the cancer and how do u define it? http://drsumandas.wordpress.com/2013/01/20/cancer-staging-a-brief-guide/ [...]

  2. dr prabir ranjan moharana | Reply

    Great job, Suman. Keep up.

  3. Great job Suman. keep up.

  4. You are doing a positive thing by sharing your expertise through this site..plz keep doing

    1. Thanks your appreciation is encouragement for me

  5. Nice Suman. For the benefit of the patient I would like to emphasize that the stage is a statistical construct and the outcome is in NO way determined by the stage. It is the biological nature of the disease that determines how the disease will evolve and respond to the treatment. So please dont take a advanced stage as a death sentence and a early stage as an excuse to try out non conventional treatments. From the patients perspective the stats hold little signifiacance except in making decisions regarding which treatment to choose or disregard. Most importantly it should be remembered that the dreaded stage IV cancer is not the same for every cancer and DOESNOT imply that the disease has become incurable.

    1. Thanks santam bhai. This is comment is very important for every patient.

Please feel free to give your opinion

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 1,889 other followers

%d bloggers like this: