AT THE TIME OF DIAGNOSIS, cancer patients are usually informed of the stage at which their cancer was discovered, giving them a sense of how far their disease has progressed. How is the stage of a cancer determined, and what do those staging numbers actually mean? More important, how does knowing this information benefit patients and their treatment team?
According to Faheem Ahmad, MD, of The Toledo Clinic Cancer Centers, numerous factors influence the stage of a cancer and most oncology practices determine cancer staging using a globally standardized system called TNM.
The “TNM staging system looks at three different categories,” Dr. Ahmad says. “The ‘T’ category refers to the location, size, and extent of the tumor; ‘N’ describes whether there is any involvement of the lymph nodes, which is one of the first places cancer travels; and ‘M’ refers to the degree of metastasis, or spread to distant parts of the body.”
Dr. Ahmad explains that a wide range of information is taken into consideration when determining the stage of a cancer using TNM, including the results of X-rays, CT scans, PET scans, and other imaging studies; lab work; biopsy or surgery to determine the cancer type; the grade, location, and size of the cancer; and other factors such as the hormonal status of the cancer (e.g., whether the HER2/neu gene is involved in breast cancer) and the age of the patient.
Though doctors use the TNM system to determine staging, they usually talk to patients in terms of group stage—the numbered stages, 0-4, with which most people are at least somewhat familiar. Dr. Ahmad defines these different stages as follows:
Stage 0 means the cancer is non-invasive and has been found at the earliest, most curable stage. “Not all cancer types have a stage 0, but a good example of one that does is a form of breast cancer called ductal carcinoma in situ, which is confined to the duct of the breast, so the chanceof spread is extremely low. Other examples of cancers that can have a stage 0 are skin cancer, testicular cancer, bladder cancer, and colon cancer,” Dr. Ahmad says.
Stage 1, which can occur with most cancer types, is a very-early-stage invasive cancer that is oftentimes highly curable with surgery, radiation, or chemotherapy alone depending on the cancer type.
In stages 2 and 3, the cancer has become a bit more advanced and more invasive locally, and there may be local lymph node involvement. Treatment becomes more complex in these stages, often involving a combination of surgery, radiation and/or chemotherapy, and other modalities.
By stage 4, a cancer is usually incurable—though in most cases treatable—and primary treatment typically involves some form of systemic therapy, such as chemotherapy, immunotherapy, targeted drug therapies, or hormonal therapy. However, in some cases, surgery and/or radiation may still be offered in a palliative setting.
“The bottom line is, cancers caught at an earlier stage are oftentimes more curable with less-toxic treatment options. On the other hand, more advanced cancers commonly require more involved treatment and have a lower cure rate. That’s why it’s so important to follow through with cancer screenings such as mammogram, colonoscopy, pelvic exams and PAP smears, and getting your prostate checked as appropriate,” says Dr. Ahmad.
How does knowing the stage of a cancer benefit the treatment team and patient? From the treatment team’s standpoint, cancer staging helps determine the extent of disease in a standardized fashion, helps in determining the best treatment options, and facilitates the coordination of interdisciplinary care. “Staging also allows us to evaluate treatment results and compare outcomes around the world between various institutions,” Dr. Ahmad states. “In essence, it gives doctors a common language to use so we know we’re comparing apples to apples.”
Staging benefits patients because it gives them a better understanding of the extent of their cancer, the treatment options available to them, and their long-term prognosis, i.e., whether their cancer is curable or palliative but treatable. Armed with all this information, the patients ultimately decide which treatment option they’re most comfortable pursuing.
The Toledo Clinic Cancer Centers, located at 4126 N. Holland Sylvania Road, Suite 105, also provides imaging, laboratory, chemotherapy, specialized pharmacy, and IV services. The cancer center consists of 8 medical and 3 radiation oncologists along with 11 nurse practitioners and 4 research nurses. The cancer center also has satellite centers in Maumee, Napoleon, Bowling Green, Wauseon, and Monroe.
The Toledo Clinic Cancer Centers has earned Patient-Centered Specialty Practice level 3 recognition and Oncology Medical Home recognition from the National Committee for Quality Assurance. Oncology homes align systems and resources with coordinated care focused on cancer patients and their needs. This reduces fragmentation, supports shared decision making, and improves the patient experience. They are the first oncology practice in the state of Michigan and the second oncology practice in the state of Ohio to receive this recognition.
For more information, please call The Toledo Clinic Cancer Centers at 419-479-5605.
