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Tumor staging: Helping doctors attack cancer

Oncologists—the doctors who battle cancer—never attack a patient’s disease without first developing a complete picture of the tumor’s size, location and other important features. To do this, they use a method called “staging” to decide what therapy will work best to defeat the malignancy.

Staging is a means of gathering as much information about the cancer as possible, through a battery of tests and examinations. Once that’s done, doctors can stage, or rank, tumors from “0” to “4” based on their size and how much they’ve spread inside the body.

A zero stage means no tumor has yet appeared. A tumor discovered at stage 1 is small, hasn’t spread and can most likely be killed. But a stage 4 tumor indicates that the primary tumor is large and the cancer has metastasized, or spread, to distant organs.

Letters and numbers

Tumor staging is not a snap decision; instead, it’s a meticulous process that weighs the patient’s condition, the type of cancer and the course it is likely to follow. There are several staging systems, but most doctors use the TNM method:

  • T (for tumor), along with a number from 0 to 4, indicates a tumor’s size and whether it’s spreading to nearby tissue.
  • N (for nodes), along with a number from 0 to 2, indicates if any nearby lymph nodes have been invaded. If nodes are affected, cancer cells can travel to areas of the body far from the primary cancer rate.
  • M (for metastasis), along with either a 0 for “no” or a 1 for “yes,” shows if the cancer has spread.

For example, T2 N1 M0 describes a growing tumor that involves the nearby lymph nodes but has not yet metastasized.

Staging a recovery

Once the TNM values are established, doctors combine them to give the tumor its stage. Keep in mind that not every cancer is staged the same way. Some children’s cancers, for instance, have their own staging system. That said, staging is arrived at by:

  • examination, including seeing and feeling the tumor and lymph nodes and analyzing X-rays and tests
  • pretreatment evaluation of cells from the tumor and nodes using biopsies or exploratory surgery
  • pathologic staging, which lets doctors examine the tumor and lymph nodes under a microscope following surgery

Improving your chances

Staging lets oncologists know what’s most likely to cure patients—if surgery will remove all the cancer, say, or if other therapies will be needed. Proper staging spares many patients from debilitating, unnecessary chemotherapy and radiation regimens and allows seriously ill patients to receive a full course of treatment to help them survive.

Still, staging doesn’t automatically dictate treatment. Even patients with identical staging might receive different therapies to cure cancers. That’s why it’s important for cancer patients to fully understand what their stage means.

If you or a loved one is face to face with cancer, your doctor is your best source for answers about how staging may help chart the path to recovery.