Staging of cancer is one of the most important elements in deciding the appropriate treatment. Staging of cancer in simple terms describes the severity of one’s cancer and helps in determining if the cancer has spread to the distant tissues or not. Staging is also very essential in determining the outcome and prognosis of cancer. When a diagnosis of cancer is done, a clinical staging is made mandatory before a treatment is planned because various stages of cancer require different treatments. Hence, a thorough knowledge of staging of cancer is very essential as it guides the patient and treating consultant at every step of treatment planning.
The most accepted clinical staging system of cancer worldwide is the TNM System which is also accepted by the American Joint committee on Cancer (AJCC) and Union for International Cancer Control (UICC). TNM system for clinical staging of cancer is widely used by most of the cancer specialist worldwide in diagnosing and treating cancer. In TNM system the T stands for primary tumor, N stands for the lymph nodes and M stands for metastasis or distant spread. The system can be elaborated as below.
(T) Primary tumor:
TX: The primary tumor cannot be evaluated
T0: There is no evidence of primary tumor
Tis: carcinoma in situ (this refers to preinvasive cancer or a cancer in which abnormal cells have not spread to the adjacent tissue).
T1, T2, and T3 & T4: These refer to the clinical stages where the cancer is clinically identifiable and is labeled accordingly depending upon the size and extent of the tumor.
(N)Regional Lymph Nodes:
NX: Lymph node involvement cannot be evaluated
N0: No regional lymph node involvement
N1, N2 & N3: Number and location of lymph nodes affected by cancer
(M) Distant Metastasis:
MX: Distant metastasis cannot be evaluated
M0: No distant metastasis
M1: Distant metastasis is present.
On the basis of the subsets of TNM a clinical staging of a cancer can be done as;
Stage 0 : Tis N0 M0
Stage I : T1 N0 M0
T2 N0 M0
Stage II: (A) T3 N0 M0
(B)T4 N0 M0
Stage III: (A) T1/T2 N1/N2 MO
(B) T3/T4 N1/N2 M0
Stage IV: (D) Any T Any N M1
In other simple terms the carious clinical stages of cancer can be explained as;
Stage 0: Tumors that have not grown beyond their site of origin and have not invaded the adjacent tissues
Stage I: Size of tumor is <2cm and no lymph node involvement or distant spread is noted
Stage IIa: Tumor > 2 cm in size but <4 cm in size with involvement of lymph nodes
Stage IIb: Tumor >4cm with involvement of lymph nodes without distant metastasis
Stage IIIa: Tumor >4 cm in size with spread to multiple lymph nodes without distant metastasis
Stage IIIb: Tumor of any size with multiple unilateral or bilateral lymph node involvement but no incidence of distant metastasis
Stage IV: Any size tumor with evidence of distant metastasis (spread of the tumor to the other parts of the body.
A brief understanding of the various stages of cancer helps an individual in better understanding of one’s condition and in understanding the various treatment modalities which can be applied to cure cancer. TNM staging system is a standard system and can be applied to clinical stage almost every type of cancer. Staging of cancer is usually done by a thorough clinical and physical examination guided by adjuncts like ultrasonography, CT scan, MRI scan and PET scan.
Grading of Cancer
Grading of cancer is another method of determining the status of cancer. Grading of cancer is usually done after a biopsy of the tissue is done or a primary treatment is initiated to check the progress of the treatment. Staging of cancer helps in determining the clinical status of cancer where as grading of cancer helps in identifying the type of cells in the tumor and whether the abnormal cells (cancerous cells) are invading the other tissues or not. Grading of cancer is usually done by a reporting pathologist who examines the cancer cells under a microscope. Grading of cancer is dependent on the type of the cells which form a cancer. Cancer can be graded as mentioned below:
Well differentiated Cancer: A cancer in which all the cells have differentiated very close to the normal cells and very few atypical features are observed.
Moderately differentiated Cancer: Cancer partially made up of atypical cells, which are identifiable on microscopic examination.
Poorly differentiated Cancer: Cancer predominantly made up of atypical cells which may or may not show invasion into the adjacent tissues.
Most of the pathologists worldwide use a grading system while reporting of cancer. For example, if a cancer is suspected and a biopsy is done to confirm the cancer then grading systems are used to decide the further treatment plan. Poorly differentiated tumors require more aggressive treatment as compared to well and moderately differentiated tumors and show poorer prognosis.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
