9/10/2015
CancerStaging
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CancerStaging
[Link]
doctordeterminesthestageofapersonscancer.
Formosttypesofcancer,doctorsusestaginginformationtohelpplantreatmentandtopredictapersonsoutlook
(prognosis).Althougheachpersonssituationisdifferent,cancerswiththesamestagetendtohavesimilaroutlooks
[Link]
whentheytalkwitheachotheraboutapersonscancer.
Whyisstagingneeded?
Doctorsneedtoknowtheamountofcancerandwhereitisinthebodytobeabletochoosethebesttreatment
[Link],thetreatmentforanearlystagecancermaybesurgeryorradiation,whileamoreadvanced
[Link]
courseitwilllikelytake.
Inalargersense,[Link]
makesurestudygroupsareactuallysimilarwhentheytestcancertreatmentsagainstoneanother,measure
[Link]
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outcomes,andmore.
[Link],leukemiasarecancersofthebloodcellsandthereforespreadthroughout
[Link].
Whatisthedoctorlookingforwhenstagingcancer?
Whentryingtodeterminetheextentofthecancerinthebody,doctorsfirstlookattheprimary(main)tumorforits
size,location,[Link].
[Link],
[Link]
reachotherpartsofthebody.
[Link]
partsofthebodyfarfromtheprimarytumor,itisknownasmetastasis.
Insomekindsofcancer,otherfactorsarealsousedtohelpdeterminethestage,suchasthecancercelltypeand
grade(howabnormalthecancercellslookunderamicroscope),ortheresultsofcertainbloodtests.
Howarecancersstaged?
[Link]
located,[Link],CTscans,
MRIs,ultrasound,andPETscansmayalsogiveinformationabouthowmuchandwherecancerisinthebody.
[Link]
[Link],thedoctorremovesatumororpiecesofatumorto
[Link],the
doctorremovessmallpiecesoftumorthroughathinneedleorthroughaflexiblelightedtubecalledanendoscope.
ThedifferentkindsofbiopsiesusedtocheckforcanceraredescribedinAGuidetoCancerSurgery.
Typesofstaging
Stagingisdonewhenapersonisfirstdiagnosed,[Link]:
Clinicalstaging
Thisisanestimateoftheextentofthecancerbasedonresultsofphysicalexams,imagingtests(xrays,CTscans,
etc.),[Link],theresultsofothertests,suchasbloodtests,arealsousedinstaging.
[Link]
lookingathowthecancerrespondstotreatment.
Pathologicstaging
Ifsurgeryisbeingdone,doctorscanalsodeterminethepathologicstage(alsocalledthesurgicalstage)ofthe
[Link],aswellaswhatis
[Link],but
sometimessurgerymaybedonetojustlookathowmuchcancerisinthebodyandtakeouttissuesamples.
Sometimes,thepathologicstageisdifferentfromtheclinicalstage(forinstance,ifthesurgeryshowsthecancerhas
spreadmorethanwasthought).Thepathologicstagegivesthehealthcareteammorepreciseinformationthatcanbe
usedtopredicttreatmentresponseandoutcomes(prognosis).
Stagingsystems
Therearedifferenttypesofstagingsystems,butthemostcommonandusefulstagingsystemformosttypesof
cancersistheTNMsystem.
TheTNMsystem
TheAmericanJointCommitteeonCancer(AJCC)andtheInternationalUnionforCancerControl(UICC)maintainthe
[Link]
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[Link]
updatedevery6to8yearstoincludeadvancesinourunderstandingofcancer.
IntheTNMsystem,eachcancerisassignedaletterornumbertodescribethetumor,node,andmetastases.
Tstandsfortheoriginal(primary)tumor.
[Link]
[Link]
TheTcategorygivesinformationaboutaspectsoftheoriginal(primary)tumor,suchasitssize,howdeeplyithas
grownintotheorganitstartedin,andwhetherithasgrownintonearbytissues.
TXmeansthetumorcantbemeasured.
T0meansthereisnoevidenceofaprimarytumor(itcannotbefound).
Tismeansthatthecancercellsareonlygrowinginthemostsuperficiallayeroftissue,withoutgrowingintodeeper
[Link].
NumbersaftertheT(suchasT1,T2,T3,andT4)mightdescribethetumorsizeand/oramountofspreadinto
[Link],thelargerthetumorand/orthemoreithasgrownintonearbytissues.
TheNcategorydescribeswhetherthecancerhasspreadintonearbylymphnodes.
NXmeansthenearbylymphnodescannotbeevaluated.
N0meansnearbylymphnodesdonotcontaincancer.
NumbersaftertheN(suchasN1,N2,andN3)mightdescribethesize,location,and/orthenumberofnearby
[Link],thegreaterthecancerspreadtonearbylymphnodes.
TheMcategorytellswhetherthecancerhasspread(metastasized)todistantpartsofbody).
M0meansthatnodistantcancerspreadwasfound.
M1meansthatthecancerhasspreadtodistantorgansortissues(distantmetastaseswerefound).
Mostcancertypeshavetheirownversionofthisclassificationsystem,solettersandnumbersdontalwaysmean
[Link],insometypesofcancer,theTcategoriesdescribethesizeof
themaintumor,whileinotherstheydescribehowdeeplythetumorhasgrownintotheorganitstartedin,orwhether
thetumorhasgrownintonearbystructures(regardlessofitssize).
[Link],forsome
cancers,classificationsmayhavesubcategories,suchasT3aandT3b,whileothersmaynothaveanN3category.
Stagegrouping
OncethevaluesforT,N,andMhavebeendetermined,[Link]
cancers,thestageisaRomannumeralfromItoIV,wherestageIV(4)isthehighestandmeansthecancerismore
[Link],usingletterssuchasAandB.
[Link],isonlyinthearea
whereitfirstdeveloped,andhasnotspread.Notallcancershaveastage0.
StageIcancersarethenextleastadvancedandoftenhaveagoodprognosis(outlook).Theoutlookisusuallynotas
goodforhigherstages.
Otherfactorsthatcanaffectthestage
Forsomecancers,thevaluesforT,N,[Link]
maybetakenintoaccountinclude:
Grade:Formostcancers,[Link]
[Link]
[Link]
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spreadfaster.
[Link](welldifferentiated)cancers,thecancercellslookalotlike
[Link],[Link](poorlydifferentiated)cancers,
[Link]
worseoutlook,[Link]
cancersstage,itmaystillaffecttheoutlookand/ortreatment.
Celltype:[Link]
treatmentandoutlook,[Link],cancersoftheesophagusaremainlyeither
[Link]
esophagealadenocarcinomas.
Tumorlocation:Forsomecancers,[Link]
stageofcanceroftheesophagus,forexample,dependsonwhetherthecancerisintheupper,middle,orlowerthird
oftheesophagus.
Tumormarkerlevels:Forsomecancers,thebloodlevelsofcertainsubstances(calledtumormarkers)canaffect
[Link],inprostatecancer,thelevelofprostatespecificantigen(PSA)inthebloodis
takenintoaccountinassigningastage.
Otherstagingsystems
[Link],
manycancersinoraroundthebrainarenotstagedusingtheTNMsystem,sincethesecancerstendtospreadto
[Link]
systemareoftenusedforHodgkindiseaseandotherlymphomas,too,aswellasforsomechildhoodcancers.
TheInternationalFederationofGynecologistsandObstetricians(FIGO)hasastagingsystemforcancersofthe
[Link],whichmakesitfairlyeasytoconvert
stagesbetweenthese2systems.
Other,olderstagingsystems(suchastheDukessystemforcolorectalcancer)[Link]
yourdoctorusesanotherstagingsystem,youmaywanttofindoutifthestagecanbetranslatedintotheTNM
[Link],sincetheTNMsystemis
morewidelyused.
Acancersstagedoesnotchange
Animportantpointsomepeoplehavetroubleunderstandingisthatthestageofacancerisdeterminedonlywhen(or
soonafter)[Link],evenifthecancershrinks,grows,
spreads,[Link]
foundanddiagnosed,althoughinformationaboutthecurrentextentofthecancerisadded(andofcourse,the
treatmentisadjustedasneeded).
Forexample,[Link],
[Link],nowwith
recurrentdiseaseinthebones.
IfthebreastcancerdidnotgoawaywiththeoriginaltreatmentandspreadtothebonesitwouldbecalledastageII
[Link],theoriginalstagedoesnotchangeanditsnotcalledastageIV
[Link]
itsfirstdiagnosed.
Thisisimportanttounderstandbecausesurvivalstatisticsandinformationontreatmentbystageforspecificcancer
[Link]
thathasrecurredinthebonesmaynotbethesameasthesurvivalstatisticsforstageIVbreastcancer.
[Link]
[Link],butitmaybeusedtomeasurethecancersresponseto
treatmentortoassesscancerthathascomeback(recurred)[Link]
weredonewhenthecancerwasfirstdiagnosed(suchasphysicalexams,imagingtests,biopsies,andmaybe
surgery)[Link]
[Link]
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[Link]
[Link],actuallyassigninganewstage
israrelydone,exceptinclinicaltrials.
Findingoutmoreaboutyourtypeofcancer
Fordetailsonstagingorgradingforacertaintypeofcancer,[Link]
findthisinformationonourwebsite,orcallourtollfreenumberbelow.
Tolearnmore
MoreinformationfromyourAmericanCancerSociety
[Link]
number,18002272345,[Link].
Dealingwithcancer
CopingWithCancerinEverydayLife(alsoinSpanish)
AfterDiagnosis:AGuideforPatientsandFamilies(alsoinSpanish)
TalkingWithYourDoctor(alsoinSpanish)
Cancertestsandtreatments
Imaging(Radiology)Tests
TestingBiopsyandCytologySpecimensforCancer
AGuidetoCancerSurgery(alsoinSpanish)
AGuidetoChemotherapy(alsoinSpanish)
UnderstandingRadiationTherapy(alsoinSpanish)
Nationalorganizationsandwebsites*
AlongwiththeAmericanCancerSociety,othersourcesofinformationandsupportinclude:
NationalCancerInstitute
Tollfreenumber:18004CANCER(18004226237)
Website:[Link]
PartoftheUSNationalInstitutesofHealth,theNCIprovidesfree,accurate,uptodatecancerinformationfor
patients,theirfamilies,andthegeneralpublic
AmericanJointCommitteeonCancer(AJCC)
Phonenumber:13122025313
Website:[Link]
OffersCancerStagingWhatYouNeedtoKnow([Link]/staging/[Link]),abrochurefor
patientsandfamiliesthatexplainstheTNMsystem,listssomecommonlystagedcancers,definestheconceptof
stagegrouping,anddiscussesthepurposeofthecancerregistry
*InclusiononthislistdoesnotimplyendorsementbytheAmericanCancerSociety.
Nomatterwhoyouare,[Link],dayornight,forcancerrelatedinformationandsupport.
[Link].
References
EdgeSB,ByrdDR,ComptonCC,FritzAG,GreeneFL,TrottiA,[Link]
[Link],NY:Springer2010.
[Link]
5/6
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[Link]
[Link]/cancertopics/factsheet/detection/stagingonMarch20,2015.
YarbroCH,FroggeMH,GoodmanM,GroenwaldSL,[Link],
MA:JonesandBartlettPublishers,Inc.2000.
LastMedicalReview:03/20/2015
LastRevised:03/25/2015
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