Doctors stage a patient’s cancer at the time of diagnosis. Doctors determine the extent of your cancer, such as how large the tumor is, and if it has spread, using x-rays, lab tests, and other tests or procedures. This is called the “stage” of your cancer. By staging cancer, your doctor can determine among other things, how aggressive the cancer is and how aggressive the treatment will have to be. Today we will look at how these staging systems work.
Most staging systems include information about (1):
- Where the tumor is located in the body
- The cell type (such as adenocarcinoma or squamous cell carcinoma)
- The size of the tumor
- Whether cancer has spread to nearby lymph nodes
- Whether cancer has spread to a different part of the body
- Tumor grade, which refers to how abnormal the cancer cells look and how likely the tumor is to grow and spread
The most commonly used system of staging is the TNM System, usually seen on a pathology report.
What is the TNM System?
T stands for tumor.
Numbers (and sometimes the letter X) accompany the T.
X means the main tumor can’t be measured. O means that it can’t be found. Numbers 1-4 indicate the size and extent of the primary tumor. The higher the number, the larger the tumor, and the more it is invading nearby tissue. These numbers are sometimes broken down further, to give a more precise picture of how extensive the cancer is. For example, T2a and T2b. A would be closer to T2 and b would be closer to T3.
N stands for regional lymph nodes.
The number (or the letter X) accompanying the N indicates the number of nearby nodes that are cancerous.
X means that cancer in nearby nodes can’t be measured. 0 means there is no cancer in the nearby lymph nodes. Numbers 1-3 indicate the number of cancerous lymph nodes, and where they are. The higher the number, the more lymph nodes there are that contain cancer. Localized cancer is limited to the location where it started, with no indication that it has spread. Regional cancer has spread to nearby lymph nodes, tissues, or organs.
M stands for metastasis.
There are three possible letters/numbers that can accompany the M. X indicates that metastasis can’t be measured. 0 means that cancer hasn’t spread to other parts of the body. 1 means that it has spread to other parts of the body. When cancer is described as “distant,” it has spread to distant parts of the body.
From this TNM staging system, doctors derive the more commonly known…
Stages I to IV
- Stage 0 means that abnormal cells are present but haven’t spread. Doctors call this, “in situ,” or CIS. CIS isn’t cancer but could become cancer.
- Stage I, II, and III mean that cancer is present. The higher the number, the greater the concern. Doctors assess the size of the cancer and how invasively it has spread into nearby tissue.
- Stage IV is cancer that has spread to distant parts of the body.
The doctor said Dan’s cancer was at least stage IIIb. This was based on his tumor and lymph nodes. But was he stage IV? To find that out, doctors ordered a PET scan. It showed that cancer had crossed his thoracic region and was, therefore, distant. That made it stage IV.
Doctors stage lymphoma using a different system. They look at which lymph node regions are affected, and how many are affected. Again, as the number of the stage increases so does the extent of the cancer’s effect on the patient. Progressive or refractory lymphoma is when cancer continues to grow or spread despite treatment. When doctors treat lymphoma successfully and then it returns, they call it recurrent or relapsed lymphoma. (2)
Leukemia uses a completely different staging system known as the Rai staging system. The Rai system takes several things into consideration, including whether there are high levels of lymphocytes in the blood, also known as lymphocytosis. Does the patient have enlarged lymph nodes or lymphadenopathy? Is the patient’s spleen enlarged? This is called splenomegaly. Does the patient have anemia or low red blood cell counts? Are the patient’s platelets low, also known as thrombocytopenia? Is the patient’s liver enlarged? This is called hepatomegaly.
All stages of the Rai symptom include lymphocytosis (high levels of lymphocytes). Stage:
- 0 …means that there is lymphocytosis, but no other staging conditions present.
- I …is when lymphadenopathy accompanies lymphocytosis.
- II …adds an enlarged spleen and/or liver, and possibly lymphadenopathy, as well.
- III …includes anemia, and possibly lymphadenopathy and/or enlarged spleen and/or liver.
- IV …includes thrombocytopenia (low levels of platelets) and possibly the other symptoms.
To make things even more complicated, European doctors use a completely different system known as Binet classification. Since I am writing in the United States, I won’t go into that system. (3)
Brain and Spinal Cord Tumors
Cancers of the brain and spinal cord tumors do not have a formal staging system. That’s because these kinds of tumors rarely spread to other parts of the body. This risk with these cancers is their effect on the brain and central nervous system. (4)
The Stage Stays the Same
The stage doesn’t change, even though the cancer might. Doctors refer to cancer by the stage it was given at diagnosis. It doesn’t matter if your cancer has improved due to successful treatment, or if it gets worse and spreads. If it was stage III, in the beginning, it’s still stage III after it has metastasized. Doctors add new information to the original stage over time as the cancer changes.
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In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace. My books are available at Amazon.com:
I also blog at Heather Erickson Author/Writer/Speaker
- National Cancer Institute, Diagnosis, and Staging. Staging.
- Cancer.Net Non-Hodgkin‘s Lymphoma Stages
- Cancer.Net Leukemia Stages
- Baylor Scott and White Health, The Stages of Brain and Spinal Cord Cancer