Staging

What are the words used to describe the various stages of cancer?
The "primary" generally refers to the site where the cancer started. As an example, an adenocarcinoma can have a primary site in the breast, the lung, the stomach, the colon, and other organs. "Metastases" generally refers to a tumor that has spread from the primary site. As an example, metastases to the bone can originate from a primary site in the breast.

Cancers are also described by stage. The most common staging system uses the so-called, "TNM(G)," which then determines the stage of the cancer. "T" refers to the size of the primary tumor. Depending on the primary site, T1 tumors are generally the smallest, T2 tumors are intermediate size, T3 are generally the largest, with T4 tumors used to describe primary cancers that have locally invaded other tissue. "N" refers to lymph node involvement. N0 are lymph nodes that are free of the tumor. N1 generally refers to minimal nodal involvement with tumor, as an example, one node involved. N2 and N3 are used to designate increasingly greater nodal involvement with tumor. "M" refers to metastases. M0 is used when there is no evidence of metastases, while M1 is used when there is evidence of metastases. "G" refers to the grade of the cancer, with the grade being a general term used to describe the "grade" or degree of abnormality in the cells of the tumor.

Stage is generally described by the Roman numerals I, II, III, IV or A, B, C, D. Stage is determined by factoring in the tumor size, "T," the degree of nodal involvement, "N," whether or not there are metastases, "M0" or "M1", and for some cancers the histologic grade, "G." Stage I cancers are those cancers with generally small tumors and no evidence of nodal spread or metastases. Stage II cancers are those cancers with somewhat larger tumors and/or normal spread, but no evidence of metastases. Stage III cancers are generally those cancers that have larger primary tumors with more extensive nodal involvement. Stage IV are generally those cancers that have metastasized. Higher histologic grade in a tumor can result in a higher stage.

It is important to understand that staging is used at the time of the first presentation of the cancer. The staging system is very specific for each type of tumor and can get quite complicated by virtue of the use of various sub-classifications. You should feel comfortable to ask your doctor to explain the stage of your cancer and the basis for determining stage in your particular case.

"Adjuvant treatment" refers to treatment that is used after, or in addition to, surgery. "Adjuvant therapy" is usually radiation oncology and/or chemotherapy.

A number of terms are used to describe the clinical benefits of treatment. For cancers of the blood, generally the term "remission" is used to indicate that the cancer (for example, leukemia) has improved or is no longer evident. For solid tumors, the term "response" is used to indicate clinical improvement. The response can be objective (or measurable, for example an x-ray), or subjective (an improvement in symptoms). Responses can also be called partial or complete with specific criteria that are tumor-specific and generally accepted by physicians.

"Recurrent disease" refers to the clinical situation when, after a period of time there has been no apparent disease, disease becomes apparent either through blood tests or physical exam and/or scans. "Progressive disease" refers to the clinical situation when there is evidence that the tumor is getting larger and/or spreading to new metastatic sites.

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