Cancer Staging

Cancer doesn’t discriminate. It affects the young, the old and the in-between, and has likely touched all of our lives in some way. As nurses, we may see its presence more than most, and the impacts that it has, not only on the patient, but also their family. One of the most raised questions by patients with cancer seems to be about their cancer staging and prognosis.

What Is Cancer Staging?

When someone is diagnosed with cancer, they get a crash course in the terminology used to describe their diagnosis, and more importantly, their prognosis.  But sometimes they have trouble understanding what it all means.

Cancer staging relates to how much cancer is in the individual’s body and where it is located. This staging helps give the healthcare team information to help plan the individual’s treatment and to give them information regarding their long-term outlook.

Determining the Stage

Doctors stage cancers depending on many factors. They first look at the primary tumour for its size, location and whether it has spread to any nearby areas. They then look at nearby lymph nodes for spreading, and then move on to other parts of the body. This is otherwise known as metastasis (American Cancer Society 2015). It is this metastasis which is the cause of approximately ninety per cent of deaths from tumours (Gupta & Massagué 2006).

In different kinds of cancer, other factors are also taken into account to determine staging, such as the cancer cell type, the grade of the cancer cell and certain pathology tests (American Cancer Society 2015).

Tumours tend to be staged, however blood cancers such as leukemia are not staged as they are cancers of the blood cells and spread throughout the body (American Cancer Society 2015). Childhood cancers also have their own staging system which is often specific to the cancer type.

TNM System

The most common way to describe a cancer’s stage is by using the American Joint Committee on Cancer’s TNM system (2016). This system is used to describe cancers that are in the form of solid tumours.

• T – Tumour: The size and location of the primary tumour and how much it may have grown into tissues nearby
• N – Node: If the cancer has been found in the lymph nodes. If it has, then it also describes how many of the lymph nodes contain cancer
• M – Metastasis: Whether the cancer has metastasised

(Cancer.Net Editorial Board 2015).

When cancer is staged by the TNM system, there will often be letters and numbers which give more information regarding the cancer. This can look like T1N0M0 or T2N1MX. Each letter and number relates to the 3 sections of the system;

Tumour

• TX: Main tumour cannot be measured
• T0: Main tumour cannot be found
• T1, T2, T3, T4: The size and extent of the main tumour, the higher the number, the larger the tumour and the more it has grown into nearby tissues

Node

• NX: Cancer in nearby lymph nodes cannot be measured
• N0: There is no cancer in nearby lymph nodes
• N1, N2, N3: The number of lymph nodes that contain cancer – the higher the number, the higher the number of lymph nodes affected

Metastasis

• MX: Metastasis cannot be measured
• M0: Cancer has not spread to other body parts
• M1: Cancer has spread to other body parts

(National Cancer Institute 2015).

As brain tumours generally do not spread outside the central nervous system, they are described only using the T of the TNM system. There is no single staging system that is available for central nervous system tumours (Cancer.Net Editorial Board 2015).

Doctors use the results from the information gathered to determine the stage of cancer of the person. These stages range from stage zero to stage four.

Stage 0: These cancers have not spread to any nearby tissue and still located in the place they started. They can be described as cancer in situ. This stage of cancer is often highly curable and is usually treated by removing the entire tumour with surgery.

Stage 1: This stage can also be called an early stage cancer. It is usually a small cancer or tumour that has not grown deeply into nearby tissues and has not spread to any lymph nodes or other parts of the body

Stages 2 & 3: These cancers may have spread to lymph nodes but not to any other parts of the body. They are larger cancers then stage 1 and have grown more deeply into the nearby tissues.

Stage 4: This stage can also be described as advanced or metastatic cancer as the cancer has spread to other organs or body parts.

(Cancer.Net Editorial Board 2015)

Restaging

Once a cancer is staged, this stage does not change. If the cancer returns, it will have the same stage as the first cancer. Any information about the returning cancer will be added on to the stage.

Restaging is very uncommon and generally only done to determine how well a treatment may be working or to get more information about a cancer that has returned after treatment. When this restaging occurs, if a new stage is determined, it is always discussed and documented in conjunction with the old stage so people can see that it has been a restaged cancer (Cancer.Net Editorial Board 2015; National Cancer Institute 2015).

Nursing Implications and Support for the Patient

Because cancer has so many implications for the individual and can cause a variety of negative effects such as pain, fatigue and nausea (just to name a few), nursing care for patients with cancer will be as widely broad as the patients, cancers and side effects we are seeing.

Support of not only the individual with cancer, but also their family and loved ones, is essential. This support can assist them with alleviating anxiety and allow them to feel supported and empowered in their decision-making processes.

As well as support, nurses also need to monitor and assist with management of side effects not only from the cancer, but also from any treatments. We need to ensure adverse effects are promptly identified so management is carried out efficiently to increase the comfort of the patient.

Nurses are at the heart of cancer care and are with patients at each step of the way, therefore we can make a huge impact on the cancer experience of the patient and their family. We often give them support, as well as laugh with them, cry with them, and be there for them and their families during their journey. Sometimes nursing care of the individual with cancer can just involve giving support to someone through one of the hardest times of their life.

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References

• American Cancer Society 2015, Cancer Staging, Atlanta, GA, USA, viewed 1 August 2016, http://www.cancer.org/treatment/understandingyourdiagnosis/staging
• American Joint Committee on Cancer 2016, What is Cancer Staging?, AJCC, Chicago, IL, USA, viewed 29 July 2016, https://cancerstaging.org/references-tools/Pages/What-is-Cancer-Staging.aspx
• Cancer.Net Editorial Board 2015, Stages of Cancer, American Society of Clinical Oncology (ASCO), Alexandria, VA, USA, viewed 29 July 2016, http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/stages-cancer
• Gupta, GP, & Massagué, J 2006, ‘Cancer Metastasis: Building a Framework’, Cell, vol. 127, no. 4, pp. 679-95, viewed 29 July 2016, http://www.cell.com/cell/pdf/S0092-8674(06)01414-0.pdf
• National Cancer Institute 2015, Staging, NCI, Bethesda, MD, USA, viewed 29 July 2016, https://www.cancer.gov/about-cancer/diagnosis-staging/staging

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