CISN - Understanding Cancer Staging

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Cancer Staging:

What You Need to Know

Overview

“Staging” is one way doctors describe your cancer and compare it with others so they can put together a treatment plan best suited to your particular cancer.

It is important to know the stage of your cancer, so be sure to ask your doctor and write it down. Keep this with a copy of your pathology report in your binder.

You may be asking yourself, “Why is this important?”

  • First: After hurricane Katrina, many cancer patients showed up in Doctors offices around the South with no records (lost in the storm) and very little knowledge of their cancer.

Newspaper reports documented the struggle of cancer patients and their new doctors as they tried to determine how to continue treatment when patients came in with not only no records but no knowledge of what stage they were, what treatment they had received and sometimes not even what type of cancer they had.

  • Second: Your treatment should be based on scientific evidence, not on your insurance coverage, convenience, or where you live. Knowing your stage is an important part of that evidence.

Keep a binder with all of your important information, including:

  • your cancer stage
  • your treatment plan (ask for one if you are not given one)
  • your pathology report
  • copies of other reports for tests you have had (i.e. CT, Pet, MRI, etc.)
  • a schedule of the type and timing of your treatments
  • questions you have discussed with your health care provider
  • contact numbers for health care providers and cancer support organizations
  • literature you may receive about your cancer
  • treatment options including clinical trials
  • URL’s of websites you have found useful
  • Other info.

This will help if you move, change doctors, insurance plans or just want to refer to something years later.

You may not want to know all of the information about your cancer but it will help if you can find someone in your circle of family and friends who will keep a binder for you. Then if/when you are ready to learn more, you will have all the information you need.


What is Staging:

Staging is the extent or severity of an individual’s cancer. Stage 0 is sometimes referred to as pre-cancer and stage IV is advanced cancer that has spread beyond its original organ site.

After cancer has been diagnosed, doctors ask and answer the following three questions to determine how far your disease has progressed:

  • How large is your tumor, and how deeply has it invaded (spread into) surrounding tissues?
  • Have cancer cells spread to regional lymph nodes?
  • Has the cancer spread (metastasized) to other regions of your body?

Based on the answers to these questions, the cancer is assigned a "stage." A patient's chances for survival are better when cancer is detected at a lower stage.


How cancer staging is determined:

Exams and tests are done to learn the extent of the cancer within the body. In this process, doctors evaluate whether or not the cancer has spread from the original site to other parts of your body.

Staging systems for cancer have evolved over time and continue to change as scientists learn more about cancer.

What types of tests are used to determine stage?

  • Physical exams
  • Imaging studies
  • Laboratory tests
  • Pathology report (microscopic examination of your cancer)
  • Surgical reports

Help understanding tumor size:

Doctors refer to tumor size in centimeters rather than inches.
   
*rulers not to scale
 

2 ½ centimeters = ~ 1 inch.

A penny = ~ 2 centimeters = ~ 3/4 th of an inch

So if your doctor tells you that you have a 2 centimeter tumor, go find a penny and look at it. This will be very close to the size of your tumor.


Stage Definition

It is important to know what stage you are as most treatment decisions are based on your tumor stage. Write down your stage in your diagnosis binder for future reference.

  • Stage 0

Carcinoma in situ (early cancer that is present only in the layer of cells in which it began; may be referred to as pre-cancer by some doctors).

  • Stage I, Stage II, and Stage III

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.

  • Stage IV

The cancer has spread to another organ.

What else should you know about staging?

Doctors might estimate prognosis or survival time, based on the cancer stage.

However, survival is different in every individual and estimates are averages calculated from a large group of people. Nobody can predict survival. Remember, fifty percent of people live longer than the average.

Always remember that statistics are about large groups, not about you. Always talk to your doctor about information read here or on other web-sites.


Learn More:

Systems of Staging

Often competing staging systems exist for the same type of cancer; however, the universally-accepted staging system is that of the UICC, which has the same definitions of individual categories as the AJCC.

Systems of staging may differ between diseases or specific manifestations of a disease.


What is the TNM system?

The TNM staging system is based on the extent of the tumor (T), spread to lymph nodes (N), and metastasis (spread to other parts of the body) (M).

The TNM system is one of the most commonly used staging systems. Most medical facilities use the TNM system as their main method for cancer reporting. PDQ®, the National Cancer Institute's (NCI) comprehensive cancer database, also uses the TNM system.

The TNM system 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 More Information

American Cancer Society:
www.cancer.org

Lance Armstrong Foundation:
www.livestrong.org

National Cancer Institute:
www.cancer.gov

People Living With Cancer:
www.plwc.org

Also visit: The CISN Resources Links section to find organizations focused on your disease.