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Understanding your Cancer Diagnosis and Treatment

Knowing what Stage and Grade mean in the cancer report is the first step to dealing with it.

“Dealing with it is the operative word. I found myself at seven years not battling it. Not struggling with it. Not suffering from it. Not breaking under the burden of it, but dealing with it.”

-Michael J. Fox

Cancer diagnosis and treatment is directly related to 2 important pieces of information that have a direct bearing on your prognosis- stage and grade. It is easy to confuse the two terms but they each provide different information to your oncologist and affect your treatment plan. A cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads. The stage refers to the extent of your cancer, such as how large the tumor is, and if it has spread. Knowing the stage of your cancer helps your doctor understand the extent of your cancer and your chances of survival, determine the best cancer treatment for you and also suggest clinical trials that may be treatment options for you. New information about how a cancer has changed over time gets added on to the original stage. So, the stage doesn't change, even though the cancer might. There are many staging systems. The most commonly used system for many types of cancer is the TNM staging system which includes the following information:

  1. Where the tumor is located in the body

  2. Which cell type (such as, adenocarcinoma, lymphoma, melanoma or squamous cell carcinoma)

  3. The size of the tumor

  4. Whether the cancer has spread to nearby lymph nodes (local metastases)

  5. Whether the cancer has spread to a different part of the body (distant metastases)

  6. Tumor grade

In the TNM staging report, The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor. The N refers to the number of nearby lymph nodes that have cancer. The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.

Another common system that many people use ranks cancer on a scale of 0 to IV. The lower the number or the more localized the cancer, the better a person’s chances of benefiting from treatment.

  • Stage 0 is for abnormal cells that haven’t spread and are not considered cancer, though they could become cancerous in the future. This stage is also called “in-situ.”

  • Stage I through Stage III are for cancers that haven’t spread beyond the primary tumor site or have only spread to nearby tissue. The higher the stage number, the larger the tumor and the more it has spread.

  • Stage IV cancer has spread to distant areas of the body.

A cancer’s grade describes how abnormal the cancer cells and/or tissue look under a microscope when compared to healthy cells.

It is an indicator of how quickly a tumor is likely to grow and spread. A surgeon removes a small tissue sample during a biopsy and a pathologist examines it under a microscope for the presence of cancer cells. Cancer cells that look and are structured like most healthy cells and tissue are low grade tumors, also called well-differentiated tumors. Lower grade cancers are typically less aggressive, grow and spread at a slower rate and have a better prognosis. The more abnormal and disorganized the cells look, the higher the cancer’s grade. Cancer cells with high grades tend to be more aggressive. They are called poorly differentiated or undifferentiated. Based on how the cancer looks under a microscope, doctors assign a numerical “grade” to most cancers. The factors used to determine tumor grade can vary between different types of cancer. Tumor grade is not the same as the stage of a cancer. Grade provides information about how quickly the cancer is likely to grow and spread. Additional information at the time of diagnosis includes the genetic mutations or genetic profile of the tumor as well as any biomarkers that can help personalize the type of treatment.

Your cancer stage at diagnosis provides a general overview of what to expect. A thorough physical exam, your health history including prior medical conditions and prior surgeries, lab tests and staging scans such as CT and PET-CT are part of the staging process as well. Be sure to talk to your oncologist about your cancer stage and how it affects your treatment and prognosis. Based on your clinical and pathological stage and grade, your treatment plan may include biopsy, surgery, chemotherapy, radiation therapy, immunotherapy, targeted drug therapy or a combination of these modalities.

The stress and anxiety from a cancer diagnosis can turn your world upside down. It is important to have a support system that can help you get through the initial shock and provide the necessary aid to get you to survivorship. Our understanding of cancer is always improving. Cancer staging is one more tool to help your cancer care team treat you effectively and with the established standard of care. It is important for patients to understand their staging so that they can be knowledgeable, active participants in their cancer care.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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