Cancer
Stages of Cancer
'Staging’ is a way to describe cancer. The stage is a shorthand way of telling the patient their cancer location , size, growth rate , and spread to nearby lymph nodes or other parts of the body.
Before any cancer treatment is undertaken, doctors will use physical exams, imaging scans, and other tests to determine the cancer's stage. Staging may not be completed until all the tests are finished.
Staging helps your doctor plan the best treatment. It may include opting for surgery, chemotherapy, or radiation therapy. Knowing the cancer stage allows your entire health care team talk about your diagnosis the same way. It facilitates communication – an essential element in the quest for healing.
Doctors can also use staging to:
Understand the chance that the cancer will come back or spread after the original treatment.- Forecast the prognosis, which is the chance of recovery.
- Determine which cancer clinical trials may be open to you.
- See how well the treatment worked.
- Compare how well new treatments work among large groups of people with the same diagnosis.
How Staging Works and What it Means
The TNM system is used for most types of cancer. The TNM system uses letters and numbers to describe the tumor (T), lymph nodes (N), and metastases (M), or whether the cancer has spread.
Each letter and number tells you and your treatment team something about the cancer. The specific definitions for each category are different for each type of cancer that is staged using this system.
Tumor (T)
The letter T and the number after it describe the tumor by answering these questions:
- How large is the primary tumor?
- Does it go into other tissues or organs in the same area?
- Where is it located?
For instance:
- TX means that there is no information about the tumor, or it cannot be measured.
- T0 means that there is no evidence of a tumor.
- Tis refers to a tumor "in situ," meaning the tumor is only found in the cells where it started and has not spread to any surrounding tissue.
- T1-T4 describe the size and location of the tumor, on a scale of 1 to 4. A larger tumor or a tumor that has grown deeper into nearby tissue will get a higher number.
For some types of cancer, the T stage is broken down into subcategories for even more detail. This is noted with a lowercase letter, like an "a" or "b", such as "T2b". What these letters mean depends on the type of cancer. A lowercase "m" can also be used to show that there are multiple tumors.
Node (N)
The letter N and the number after it describe if cancer has affected the lymph nodes. The lymph nodes are small, bean-shaped organs that help fight infection. They are a common spot where cancer first spreads.
This part of the staging system answers these questions:
- Has the tumor spread to the lymph nodes?
- If so, which lymph nodes and how many?
After the letter N, there is a number from 0 (zero) to 3. N0 means there are no lymph nodes with cancer. Typically, the more lymph nodes with cancer, the larger the number. However, for some tumors, the location of the lymph nodes with cancer may determine the "N" category.
Metastasis (M)
The letter M and the number after it describes if the cancer has spread. It answers these questions:
- Has the cancer spread to other parts of the body?
- If so, where, and how much?
If cancer has not spread, the stage is M0. If the cancer has spread to other parts of the body, it is stage M1.
Other Factors Used in Cancer Staging
For some cancer types, other factors may be included in the cancer's stage, such as:
Grade : The grade describes how much cancer cells look like healthy cells. It compares cancer tissue with healthy tissue. Healthy tissue often contains many types of cells grouped together. If the cancer looks like healthy tissue and has different cell groupings, it is called a differentiated or low-grade tumor. However, if it looks very different from healthy tissue, it is called a poorly differentiated or high-grade tumor. This may help predict how quickly cancer will spread. Different types of cancer have different methods to assign a cancer grade.
Biomarkers : Biomarkers, or tumor markers, are substances found in higher-than-normal levels in the cancer, blood, urine, or tissues of some people with cancer. Biomarkers help figure out how likely some types of cancer are to spread. They can also help doctors choose the best treatment.
Tumor genetics : Researchers have found ways to figure out the genes involved in many types of cancer, which may help predict the spread or potential treatments for the cancer. This information may help doctors target treatment to each person's cancer.
Cancer Stage Grouping
The information collected to determine the TNM stage is then used to give you a cancer stage specific to your condition.
Most types of cancer have four stages: stage I (1) to IV (4). Some cancers also have a stage 0 (zero). Here is a general description of cancer stage groupings:
Stage 0 : This stage describes cancer in situ. In situ means "in place." Stage 0 cancers are still located in the place they started. They have not spread to nearby tissues. This stage of cancer is often curable by removing the entire tumor surgically.
Stage II and Stage III : In general, these two stages are cancers that have grown more deeply into nearby tissue. They may have also spread to lymph nodes, but not to other parts of the body.
Stage I : This stage is usually a cancer that has not grown deeply into nearby tissues, spread to the lymph nodes, or gone to other parts of the body. It is often called early-stage cancer.
Stage IV : This stage means that the cancer has spread to other organs or parts of the body. It may also be called advanced or metastatic cancer.
Other Staging Systems
The TNM staging is used mainly to describe cancers that form solid tumors, such as breast, colon, and lung cancers. Doctors use other staging systems to classify other types of cancer, such as:
Central nervous system tumors (brain tumors) - Cancerous brain tumors do not normally spread outside the brain and spinal cord. Therefore, only the "T" description of the TNM system applies. No single staging system exists for central nervous system tumors. Learn more about brain tumor staging and prognostic factors.
Childhood cancers - The TNM system does not include childhood cancers. Doctors stage most childhood cancers using systems that are specific to that cancer.
Blood cancers - The TNM system does not describe blood cancers, such as leukemia, lymphoma, or multiple myeloma, because they usually do not form solid tumors. Each blood cancer has its own staging system.
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