BY JIM HOWE
Before a patient starts treatment at the Upstate Cancer Center, a medical team evaluates the cancer in a process called staging.
Staging determines the extent of cancer in the body, based on the tumor’s size and depth and whether it has spread to other areas, such as lymph nodes or organs.
“It allows us to plan treatment and determine whether the patient can be cured, using a standardized language to talk to other doctors,” explains Ajay Jain, MD, Upstate’s associate director of liver, pancreas and gallbladder surgery.
Under the system used in the United States and Europe, the higher the stage, the worse the prognosis. Generally speaking:
- stages I and II mean the cancer has not spread to lymph nodes.
- stage III means lymph nodes are involved.
- stage IV means the cancer has spread, or metastasized, widely, and the prognosis is poor.
Clinical and pathologic are the two main types of staging.
Clinical staging is done before treatment starts, to assess how far along a tumor is and where doctors and other health care providers can make a difference, Jain told an audience at the annual Upstate Cancer Symposium.
Clinical staging aims to predict whether a cure is possible and the likelihood of the cancer’s nearby or distant recurrence in the body. It also helps to plan a surgical strategy, which might include attempts to shrink the tumor before operating, known as neoadjuvant therapy.
Pathologic staging is done after surgery by looking at the cancer cells under a microscope to give the true stage. This also helps determine whether radiation or chemotherapy is needed to lessen the risk of cancer returning, known as adjuvant therapy, and what sort of monitoring, or surveillance, might be called for.
Staging can be done surgically or with medical imaging.
“It’s a lot like hunting” Jain explains. “It’s based on how the beast behaves,” demanding intimate knowledge of the way various cancers grow and spread.
When staging tumors that arise in the bone or muscle, called sarcomas, doctors look at the lungs because that’s the most common site where sarcomas spread. For the skin cancer, melanoma, patients may require a full-body scan because melanomas are liable to spread anywhere.
Certain cancers are likely to spread to bones. Health care providers use the first letters of the phrase “BLT with a kosher pickle” to recall those cancers, of the breast, lung, thyroid, kidney and prostate.
Staging criteria evolve as new information arises and as factors like the thickness and ulceration of the tumor are considered. As staging changes, so do treatments.
Jain stresses that staging is critical to cancer treatment and notes that it must be documented in the patient’s record before treatment starts.
The National Comprehensive Cancer Network, an alliance of the world’s 27 leading cancer centers, provides the latest and best staging guidelines. Upstate and other cancer centers are audited by the American College of Surgeons’ Commission on Cancer to ensure that the guidelines are followed – so that patients receive the best available care.
This article appears in the winter 2017 issue of Cancer Care magazine.