The stages of a cancer
This page tells you about cancer staging. There is information about
Staging is a way of describing the size of a cancer and how far it has grown. When doctors first diagnose a cancer, they carry out tests to investigate the extent of the cancer locally and to see whether it has spread to another part of the body. This is different to the grade of cancer, which describes how similar a cancer cell is to a normal cell.
Staging is important because it usually tells the specialist which treatments you need. If a cancer is just in one place, then a local treatment such as surgery or radiotherapy could be enough to get rid of it completely. A local treatment treats only one area of the body.
If a cancer has spread, then local treatment alone will not be enough. A 'systemic' treatment will be needed as well. Systemic means treating the whole body. Chemotherapy, hormone therapy and other drug treatments are systemic treatments because they circulate throughout the body in the bloodstream.
Sometimes doctors aren't sure if a cancer has spread to another part of the body or not. They look at the lymph nodes near to the cancer. If there are cancer cells in these nodes, it is a sign that the cancer has begun to spread. Cancer doctors call this having 'positive lymph nodes'. The cells have broken away from the original cancer and got trapped in the lymph nodes. But we can't always tell if they have gone anywhere else. In this situation, doctors usually suggest 'adjuvant' treatment . This means treatment alongside the treatment for the main primary tumour (chemotherapy after surgery, for example). The aim is to kill any cancer cells that have broken away from the primary tumour.
Staging systems are worked out for most types of cancer. The systems are there so that
- Doctors have a common language to describe cancers
- Treatment results can be accurately compared between research studies
- Guidelines for treatment can be standardised between different treatment centres
'TNM' stands for Tumour, Node, Metastasis. This system can describe the size of a primary tumour, whether the cancer has spread to the lymph nodes and whether the cancer has spread to a different part of the body (metastasised). The system uses numbers to describe the cancer.
- 'T' refers to the size of the cancer - it can be 1, 2, 3 or 4, with 1 being small and 4 large
- 'N' refers to whether the cancer has spread to the lymph nodes - it can be between 0 (no positive nodes) and 3 (lots of positive nodes)
- 'M' refers to whether the cancer has spread to another part of the body - it can either be 0 (the cancer hasn't spread) or 1 (the cancer has spread)
Sometimes the letters A, B or C are used to further divide the number categories - for example, stage 3C cervical cancer.
As well as T1 - T4, you can get 'Tis'. This means 'carcinoma in situ', which is a very small and very early stage cancer. It is such an early stage that it is sometimes called pre-cancer.
P is sometimes be used before the letters TNM to mean a tumour that has been removed by surgery (the stage is based on a 'pathological' examination of the cells after surgery).
So for example, a small cancer that has spread to the lymph nodes but not to anywhere else in the body may be T2N1M0. Or a more advanced cancer that has spread may be T4N3M1.
These usually have a scale of 1 to 4 (or sometimes A to D). '1' typically means a small tumour that has not spread and no positive lymph nodes. '4' would mean that the cancer had spread to other major organs in the body.
There is information about staging for each type of cancer in the treatment sections of your cancer type.
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