Cancer is a scary and overwhelming diagnosis, and one of the first steps in the treatment process is staging. Staging is the process of determining how much cancer is in a person’s body and where it is located. It helps doctors determine the best treatment options for each patient, and can also be used to predict the course of the cancer and the likelihood of treatment success.
Staging of the primary Tumor
For solid tumors can be based on the size of the tumor or the depth of invasion into the layers of the skin or colon wall. For example, the difference in T1 or T2 stage for an early pancreas cancer is based on a size cutoff of 2cm.
For melanoma, T1 is less than 1mm invasion into the second layer of the skin and a T4 is more than 4mm invasion. The N stage determines if there is Nodal involvement and the M stage is a binary checkbox of whether there is Metastatic disease or now.
This TNM staging gives a Stage I, II, III, IV. However, from a patient perspective, the simplest way to think about this for most solid tumors is that Stage I/II is most early stage disease treated more often than not with surgery and/or radiation plus or minus systemic therapy.
Stage III is most often locally advanced with involvement of the nodes or direct invasion to local structures and most often are treated with a combination of local and systemic therapy.
Stage IV implies metastatic disease to distant organs of the body where more often a systemic problem requires a systemic solution. There are plenty of nuances to this staging depending the tumor type.
For example, early Stage I-II pancreas or hepato-biliary malignancy may sound like it was caught early however these folks still have a high risk for developing metastatic disease and require chemotherapy to improve their chances of long term remission.
Whereas, Stage IV metastatic disease may sound like a poor prognosis however we have curative intent treatment for limited colon cancer metastasis to the liver or lung using surgery and chemotherapy.
Or using immunotherapy for metastatic melanoma or other immunogenic malignancies (TMB High, MMR-deficient). Pathology and imaging are part of the workup to provide the necessary information to complete the staging process.
Here are 4 reasons why staging is so important in cancer care:
- Treatment planning: The stage of a cancer is a key factor in determining the best treatment options. For example, an early-stage cancer may be treated with surgery or radiation, while a more advanced-stage cancer may require treatments that reach all parts of the body, such as chemotherapy, targeted drug therapy, or immunotherapy.
- Prognosis: A cancer’s stage can also be used to predict the course of the cancer and the likelihood of treatment success. Although each person’s situation is different, cancers of the same type and stage tend to have similar outlooks.
- Clinical trials: Many clinical trials are only open to patients with certain stages of cancer. Staging helps match patients to the appropriate clinical trials.
- Communication: The cancer stage is also a way for doctors to describe the extent of the cancer when they talk with each other about a patient’s cancer.
Staging is an important step in the cancer treatment process. It helps doctors determine the best treatment options, predict the course of the cancer, and match patients to appropriate clinical trials. It also helps in communication among healthcare providers, in the event of recurrence and progression, and restaging.
It is also important to note that the TNM system is widely used for staging of cancers. If you have been recently diagnosed with cancer, it is important to understand the process of staging and how it will impact your treatment plan and long term prognosis.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.
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