Staging is the process whereby a medical team assesses the patient for the spread and growth of any known cancer within the body. If it is apparent that a cancerous mass has not spread throughout the body, then there is an expectation that radiation or chemotherapy could be useful in halting any potential spread or even removing the cancer from the body completely.
Cancerous tumors are examined for three specific characteristics in order to classify: are classified according to three characteristics:
- Location within the body:
- Carcinoma: Cancer appearing on the surface of the skin, located in body cavities or glands.
- Leukemia, Lymphoma, and Myeloma:.:Cancer found in lymphatic tissue, bone marrow, or the blood
- Grading (relationship between the size of regular and cancerous cells)
- Grade I: Slight difference in the size of comparable cells.
- Grade II: Slightly more abnormal than cells considered Grade I
- Grade III: Extreme irregularity of the cell differences, and perhaps even difficulty in determining which are healthy and which are cancerous.
- Grade IV: Cells are completely different, perhaps small, immature or rapidly spreading in comparison to the healthy normal cells.
- Staging (the spread of the cancer within the body)
- Stage O: Tumor is located on the surface of the skin or organ without actually infiltrating the tissue,
- Stage I: Cancer affects only the initial organ where the tumor was discovered
- Stage II: Small amount of localized spreading of affected cells.
- Stage III: Large amount of spreading throughout the same region of the body as the originating tumor was discovered
- Stage IV: Metastasis, where the cancer has spread to a completely unrelated region within the body.
The TRM system for the classification of cancer stages is detailed below. This system is frequently implemented as one way of determining a patient’s cancer stage.
Tumors, Lymph Nodes and Metastases are evaluated and assigned a stage. The numbers assigned represent T, N and M in the TNM system. A typical resulting evaluation will be T1M1N1. This means that the tumor, node and metastases are all rated as stage 1. A zero is assigned where there is no evidence of a particular item. In most cases, M is equal to zero, as there are no metastases present. If the patient’s lymphatic system is unaffected, N will also be equal to zero. The specific ways in which numbers are assigned, and the meaning of the composite truly differ from patient to patient and depend on the exact type of cancer being staged at that time. Moreover, this system is designed to give an overview assessment of the patient’s cancer stage.
The tumor is evaluated and assigned a number between 0 and 4. If 0 is the assigned number, the patient shows no signs of tumor growth in the body. A grading of 4 represents significant infiltration of the surrounding tissues by the original tumor being classified. Generally, a T4 is an inoperable tumor that has spread in the body via direct extension of the tumor.
N: Lymph Nodes
The lymph nodes that are evaluated for grading include only those glands secreting near the actual cancer location. If lymph nodes in a completely separate region of the body are assessed, there is definite suspicion of metastasis. If no lymph nodes are located in close proximity to the tumor, then a 0 is assigned as the N value. However, if there is tremendous lymphatic activity in the area, then a 4 could be designated for the N number. Unfortunately, there is no cut and dry explanation for which lymph glands are considered close, or what close is. When it comes to this evaluation everything depends on the specific cancer being evaluated. The assignment of the N value may also take into account significant swelling, or increased/decreased output. Again it all depends on the specific diagnosis of a patient.
Assigning the M value is a fairly simple process. If there are no metastases, the number is 0. If there are many, then the answer is 4. 2 and 3 are assigned depending on the amount and size of the metastases located.
As we described earlier, many of the considerations and evaluations are very specific depending on the type of cancer located in the body.
How do these two systems for rating the grade of cancer relate? The Level system is often used after an TNM evaluation has taken place. The TNM analysis is much more detailed and precise because it looks at more than a general overview of the cancer. It goes into specific details according to the type of cancer diagnosed in a particular patient.
Here’s an example: Lung cancer – small cell variety – may be assigned level II grading when there are tumors ranking T1 or T2, and there are low numbers of lymph nodes in the area (N1) and no metastases present (M0).