The Importance of Cancer Staging

One of the important facts about any cancer at the time of diagnosis is its stage. We often wait and worry during the days or weeks of meeting with doctors, having tests, and surgery. We understand that, until all the information has been collected, we won't know much about our cancer treatment and prognosis. A big part of that, although certainly not the only part, is the stage of cancer.

Classified as Stage 0 – Stage IV, it makes a lot of difference in what we can expect. There are very specific rules for every kind of cancer, but the staging decision is based on the size and location of the tumor, whether it has spread to the nearby lymph nodes, and whether there has been spread of other organs or parts of the body.

Stage 0, which is not relevant for all kinds of cancer, means that the tumor is actually pre-cancer and some doctors dismiss these cases as not really cancer. I can promise you, however, that anyone who has this diagnosis is anxious and sad just like those who are diagnosed with later stage disease. Stage IV cancers are those that have spread beyond the primary site and are the most serious situation.

How Are Cancers Staged?

Cancers are most often staged with the TNM System. Used for many kinds of cancer, it is based on factors related to the primary tumor (T), the number of involved lymph nodes (N), and whether the cancer has spread to other organs or parts of the body (M),

Why Are Cancers Staged?

Cancer staging provides helpful information for both patients and doctors:

• The stage suggests the most likely outcome. Knowing the stage gives an educated estimate of life expectancy and the chance of a cure.
• Treatment will be planned and recommended based on the stage of the cancer. For example, surgery is almost always part of the treatment for earlier stage cancers but is not always recommended or possible for advanced or Stage IV cancers.
• Other therapies, including chemotherapy, radiation therapy, or immunotherapy, are also suggested based on the stage as well as characteristics of the cancer.
• Clinical trials that are available to test and understand new drugs or management strategies are designed to be available only to patients with a specific cancer at a specific stage. It would not be helpful, as part of a trial, to test new drugs on people with Stage I as well as Stage IV cancers. The goals and science are different.

Reminder: it is likely that people will ask you questions about your cancer diagnosis and planned treatment. What is your prognosis? What stage is the cancer? You are free to share as much or as little as you choose. You don't owe anyone more than you are comfortable saying. Remember that not everyone understands very much about the complexities of cancer, and, sadly, many people cannot be fully trusted not to pass on whatever you have told them. It can be helpful to be prepared with a ready response like I don't want to talk about the details.

When you are first diagnosed and staged, the news is likely either somewhat reassuring or more worrisome. Please remember that staging is an important part of describing and understanding the situation, but it is certainly not a crystal ball. Many people who are diagnosed with later stage cancers, and receive appropriate treatment, do fine.