Cancer patients often come to the oncologist’s office with minimal information about their disease. The oncologist is consulted either when there is a strong suspicion of cancer or after a confirmation of cancer has been made from preliminary tests. Patients are often disappointed that cancer treatment doesn’t start immediately upon their first meeting with the doctor.
Why is there a delay? In many cases, it is important for the doctor to gather more information about the cancer. To determine this information, the doctor orders a “staging work-up”. The goal of staging is to determine the location of the original tumor, size and severity of the tumor, whether the lymph nodes contain cancer, and if the cancer is confined to a specific area of the body or has metastasized (spread) to other areas of the body.
Clinical staging is based on the results of detailed physical examinations, imaging scans, and biopsies. Pathological staging is based on surgical tumor findings as well as clinical findings. Pathological staging gives the most amount of information to make a prognosis but is not always an option depending on the location of the tumor and/or the health of the individual.
The oncologist then analyzes the staging data and compares the information to internationally recognized and scientifically based classification systems to determine the stage. One must know too that not all cancers are staged the same way or that all cancers can be staged. Further, other factors, such as the microscopic examination of cells as well as the specific location of the tumor in the organ/structure of the body provide necessary information to best “stage” cancer.
Stage I Often called early-stage cancer, it is usually a small cancer or tumor that has not grown deeply into nearby tissues or spread to the lymph nodes or other parts of the body.
Stages II and III indicate that the cancer has extended beyond the immediate region of the tumor and may have invaded nearby lymph nodes and muscles but has not spread to distant organs. Typically, both stages indicate larger cancers or tumors that have grown more deeply into nearby tissue.
Stage IV cancer, also referred to as advanced or metastatic cancer, refers to a cancer that has already spread to a distant part of the body when it’s first diagnosed.
Staging provides important information that can help an oncologist determine the best treatment plans for their patient. Generally, the earlier the cancer is diagnosed, the better the prognosis for the patient. It cannot be stressed enough the value of adhering to the cancer screening recommendations. Currently, screening is available to detect the following cancers: cervical, prostate, colon, lung, and breast.
When doctors use the term, “restaging” it can be misleading. Once a stage is determined, it never changes. The cancer may grow or shrink, spread to other organs or come back after treatment, but it will still be referred to as it was originally staged. Restaging simply refers to the process of determining the current extent and nature of the cancer either after treatment or over time. This information is still highly valuable in determining whether the cancer has gotten better, worse or returned, and guides treatment strategies such as when to start or discontinue therapy.