Introduction:
The most common question a cancer patient or their family asks an oncologist is What is the stage of my cancer? The fear of the word ‘cancer’ is such that the patient assumes they are in the last stage if they have cancer. But for treatment and management of any type of cancer, staging is very important. It helps the oncologist determine the best course of treatment.
Patients usually assume that biopsy will determine the stage of cancer. But biopsy just confirms and determines the type of cancer. It usually doesn’t help determine stage. Cancer staging requires radiological and nuclear investigations like CECT, MRI, or PET-CT. A CECT scan of the chest, abdomen, or pelvis is sufficient for staging in most solid cancers. MRI is commonly used for pelvic cancers such as cancers of the ovary, uterus, cervix, prostate, as well as urinary bladder.
A triphasic MRI of the liver is done for the staging of hepatocellular cancers. A whole-body PET-CT is often done for staging and to determine whether a localized cancer visible on CECT or MRI is truly localized before determining the intent of treatment. The drawback of PET-CT is that the brain imaging is poor, so an MRI of the brain is required to rule out brain metastasis.
Dr. Dhruv Mehta, a senior medical oncologist at SGHOC, a leading cancer hospital in Surat, explains the various stages of cancer and the importance of accurate staging for the right treatment in this blog.
Cancer Stages:
For most solid cancers, there are 4 stages:
Stage I
Stage I cancer is localized and can usually be treated with surgery or radiation therapy. Chemotherapy plays a limited role in most Stage I cancers.
Stage II
Stage II cancers are also localized, but they are more invasive and bigger in size than Stage I cancers. Like Stage I cancers, they can often be treated with surgery and radiation therapy. Many, though not all, patients may require adjuvant chemotherapy after surgery. Stage I and stage II cancers are classified as early-stage cancers in almost all solid cancers and have the best prognosis.
Stage III
Stage III cancers are called locoregional cancers. They have spread to lymph nodes draining the affected region. Depending on the number of lymph nodes affected, stage III is usually subdivided into three categories — A, B, and C. This stage usually requires multimodality therapy involving chemotherapy, surgery, and radiation. Depending on the site of cancer, chemotherapy may be given before surgery or after it. Immunotherapy is also given in certain cancers with specific conditions like MSI-high by IHC or PDL1 positive. Chances of recurrence remain high despite administration of all modalities of therapy.
Stage IV
In Stage IV, the cancer spreads from the primary site to surrounding organs in the body. It is called metastatic cancer. In this stage, local treatments like surgery and radiation have a minimal role. Molecular analysis is required for precision treatment like immunotherapy, targeted therapy, adoptive cell therapies, as well as chemotherapy. The intent of treatment in this stage is palliative care, which is aimed at symptomatic relief, prolonging life expectancy while preserving a good quality of life (QOL). A complete cure is very difficult, as only 5% of stage IV cancers are cured completely.
Conclusion:
Staging of cancer is vital for the best treatment planning. Without appropriate staging, a medical oncologist wouldn’t be able to determine the best course of action. Staging helps determine survival rates, treatment duration, and the line of therapy. Screening guidelines for cancer by the U.S. Preventive Services Task Force are aimed at detecting specific cancers in early stages. Consult Dr. Dhruv Mehta at SGHOC, a trusted cancer hospital in Surat, to learn about your cancer stage and start the treatment.
