Staging describes not only where a cancer is located, but whether it is affecting other parts of the body. Sometimes cancer cells stay contained to the primary tumor, while other times the cancer spreads to other areas of the body (metastasizes). Your medical team may use blood tests, imaging scans, and/or surgeries to determine whether your cancer is contained to the tumor (noted as “T”); has spread to the lymph nodes (noted as “N”); or metastasized, or spread, to other parts of the body (noted as “M”). In the pathology report, additional letters and numbers
may be assigned to the T, N, and M score to provide even more detail on the specific cancer. Doctors will use the TNM results to determine what stage a person is in:
Stage 0: Cancer in situ (“in place”). Stage 0 cancers are still located in the place they started and have not spread to nearby tissues.
Stage I: A small cancer or tumor that has not grown deeply into nearby tissues, spread to the lymph nodes, or metastasized to other parts of the body.
Stage II: The cancer or tumor is larger, but has not spread to lymph nodes and/or surrounding tissues.
Stage III: The cancer or tumor is larger and may have spread to the lymph nodes and/or surrounding tissues.
Stage IV: The cancer has spread from where it started to at least one other body organ; this is also known as “secondary” or “metastatic” cancer. When a cancer metastasizes to a different part of the body, it is still defined by its original location. For example, if colon cancer metastasizes to the lungs, it is still referred to as colon cancer, not lung cancer.
Typically, blood cancers (other than lymphomas) are not staged, because by nature your blood circulates throughout your body, so staging is not useful to your doctor.
Tumor grades are assigned based on how fast biopsied tissue from the tumor appears to grow under a microscope. Unlike stages, which provide a snapshot of where the cancer is in the body, tumor grades indicate how quickly a tumor is likely to grow and spread:
Grade 1: Tumor cells and the organization of the tumor tissue appear close to normal, indicating slow growth.
Grade 2: Cells are somewhat abnormal and will grow faster than normal cells.
Grade 3: Cells and tissue look abnormal and are disorganized, indicating they will grow rapidly.
Grade 4: The most abnormal-looking cells with a high level of disorganization, indicating they will grow and spread aggressively.
For some cancers, doctors will include a risk group designation as part of a cancer diagnosis. Typically, these groups are labeled low, medium, and high, and correspond with how likely it is that the cancer will come back. These designations can help guide treatment selection.
, also known as biomarkers, are substances found in the blood, urine, or tissues of some people with cancer. These substances are usually proteins made by the tumor itself, or made by healthy cells in response to the tumor. Your doctor may order tests to see if you have these substances in your body, and if so, what amounts are present.
Tumor markers or genetic tests, like FISH (fluorescence in-situ hybridization)
testing, flow cytometry
, or genomic sequencing (Sanger or Next Generation Sequencing)
can provide your doctor with important information about your cancer and how to treat it. These tests also provide a baseline for your medical team to refer to during treatment to determine how your cancer is responding.