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Cancer Staging

Staging of cancers is used to describe the severity of the patient’s cancer based on the extent of the primary tumor and whether the cancer has spread elsewhere in the body (1). This is useful to help the doctor determine the appropriate treatment and can be used to estimate the prognosis (1).

The elements considered in the staging system are the site of the primary tumor, tumor size and number of tumors, lymph node involvement (spread of cancer into lymph nodes), cell type and tumor grade (how closely the cancer cells resemble normal tissue cells) and the presence or absence of metastasis (1).

The TNM system is the most commonly used staging system (1). It is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N) and the presence of a distant metastasis (M) (1,2). A number is indicated next to the letters to indicate the severity of the parameter (1). Stage 0 means that the carcinoma is in situ (abnormal cells are present only in the layer of the cells in which they are developed) (1). Higher numbers (Stage I, II and III) indicate a disease that is more extensive (1). This can be a larger tumor size and or spread of the cancer beyond the organ in which it is first developed to lymph nodes and or organs that are adjacent to the location of the primary tumor (1). Stage IV is when the cancer has spread to another organ (1).

Stave IV non small cell lung cancer includes cancers that have spread to areas that are beyond the chest (3). It also includes patients who have fluid collection around the lung (malignant pleural effusion) due to the cancer (3). This specific type of cancer that our patient has cannot be cured at all (3). Unresectable refers to tumors that are not removable by surgery (3). Treatment options only reduce pain, ease the breathing and extend and improve the quality of life (3). The ultimate outcome from this disease is death and the global estimated median survival time was 29 weeks, with a 95% confidence interval of 27 to 30 weeks in an analysis of 1,052 patients (3). A possible mechanism for non small cell cancer is due to the loss of the short arm of chromosome 3(3). This loss of the 3p alleles is in 50% of non small cell lung cancers (3). This is of significant importance because there is believed to be several different tumour suppressor genes present in the 3p region (3). It appears that tobacco smoke induced DMA damage and an early age of smoking initiate induces this chromosome 3p loss (3).

References

  1. Lung. In: American Joint Committee on Cancer Staging Manual, 7th, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010. p.253.
  2. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, Postmus PE, Rusch V, Sobin L, International Association for the Study of Lung Cancer International Staging Committee, Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2(8):706.
  3. Brundage MD, Davies D, Mackillop WJ. Prognostic factors in non-small cell lung cancer. Chest. 2000;122(3):1037-1057.

Disclaimer

This information is presented for informational purposes only and is not meant to be a substitute for advice provided by qualified health care professionals. You should contact your qualified health care provider if you have or suspect any health problems. This article is not intended to provide medical advice for its readers


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