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PATIENT PAGES |
The first two questions that most people ask their doctor upon learning they have cancer are:
In answering these questions, doctors start by considering the kind of cancer you have (for example, lung cancer, colon cancer, skin cancer) and how advanced the cancer is. Staging is the process of finding out how much cancer there is in your body and where it is located. Your doctor needs this information to predict the course your disease is likely to take and to plan the best treatment for you.
THE TNM STAGING SYSTEM
The TNM staging system is a standardized way for doctors to describe how far a cancer has spread. An organization called the American Joint Committee on Cancer (AJCC for short) holds conferences of experts on each cancer type. These experts review information from medical research studies and agree on which features for each cancer type best predict prognosis and the likely response to treatment. Although the details of staging systems for each cancer type are a little different, their main concepts are the same. With a few rare exceptions (such as leukemia and brain tumors) the staging system for every type of cancer is based on:
ABOUT THE COLON AND RECTUM
The large intestine is a muscular tube about 5 feet long. The colon is the first and major part of the large bowel; the final 6 inches of the large bowel is called the rectum. Both the colon and rectum are formed by several layers. These layers, from the inner to the outer, include:
T categories of colorectal cancer describe the extent of spread through the layers of the colon and rectum.
N categories indicate whether or not the cancer has spread to nearby lymph nodes and, if so, how many lymph nodes are involved.
M categories indicate whether or not the cancer has spread to distant organs, such as the liver, lungs, or lymph nodes farther away.
STAGE GROUPING
Once a patient’s T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to determine the stage, expressed in Roman numerals from stage 0 (the least advanced stage) to stage IV (the most advanced stage). The following guide shows how TNM categories are grouped together into stages.
DOES YOUR STAGE EVER CHANGE?
Staging information is collected at the time of diagnosis and initial treatment, and the stage assigned at that time never changes. For example, if lymph nodes from an N1 cancer are removed, the cancer is not restaged as N0. If liver metastases become apparent years after a patient is treated for an M0 cancer, the cancer is not reclassified as M1.
This is not to say that doctors don’t pay attention to whether your cancer shrinks, disappears, or continues to grow. Doctors observe these changes very carefully and base their treatment plans on these observations. However, these changes do not change your stage.
Although surgery is the first treatment for most people with colorectal cancer, some (especially those with rectal cancer) may receive radiation and/or chemotherapy before having surgery. The stage of a cancer after radiation and/or chemotherapy is important information for the doctor to know in considering a patient’s prognosis and treatment choices. But radiation and/or chemotherapy are expected to shrink the tumor before surgery, so the stage of the cancer when it’s finally removed does not really reflect its extent before treatment started. For this reason, a note is added that alerts other doctors that surgery was not the first treatment in these cases.
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