trials and comparing results of different trials.
Staging is based on knowing how a particular cancer grows and progresses. As a tumor grows, it can invade nearby tissues and organs. Cancer cells can also break away from a tumor and enter the bloodstream or the lymphatic system (a part of the body’s immune system). By moving through either of these systems, the cells may move away from the site of origin (or primary site) to lymph nodes or other organs where they form new tumors. This spread of cancer is called metastasis. There are different staging systems and for each cancer there are key criteria that are used to properly stage the cancer. The most common staging system for solid tumor cancers is referred to as the TNM staging system. The system classifies cancers by:
T = size and extent of the tumor.
N = involvement of lymph nodes near the tumor.
M = whether or not the cancer has spread or metastasized.
The determination of what criteria make a stage is based on how the particular cancer usually behaves. This system was developed and is maintained by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). It is updated every six to eight years. The staging system is used by medical professionals around the world.
With the TNM staging system, there are typically four stages described. However, each of the four stages may be broken down further into sub-stages. You may hear a cancer described as a stage 1A or 3B. This number and letter combination does not mean the same thing for every cancer.
At the completion of the staging process, the surgeon or oncologist interprets the information gathered and will discuss prognosis and make recommendations for further treatment, if needed. The stage of cancer given at the completion of the staging process is always used to describe that individual’s cancer when communicating about their diagnosis in the future.
Prognosis
When diagnosed with cancer, the question patients ask most is “How serious is my cancer?” Or, “What are my chances of survival?” When the doctor evaluates how the disease will go for you, it is called your prognosis. A prognosis is not an exact prediction, but rather it is an estimate. The estimate is based on such pieces of information as type of cancer, stage of cancer, certain traits of cancer cells, and how this information compares to others with similar cancers. Such a comparison is generally discussed by use of statistics. Statistics are information that applies to a group or population of people from which the statistics were calculated. The group could be tens, hundreds, or thousands of people. However, you and your situation are unique. As there is no one else in the world quite like you, then no statistics are able to give you exact answers about the outcome of your particular cancer.
In a discussion of prognosis, your oncologist also takes into account the information that they know about you as an individual that is not found in the statistics of hundreds of others. They consider information such as your age, your overall health, how your cancer has been responding to treatment, and how you have been doing during treatment. While this additional information helps to personalize the statistics, a prognosis is still an estimate, not an exact prediction. Information about prognosis can be helpful as you are faced with many decisions, such as:
• What treatment is best for you
• Whether or not to have treatment
• Planning for care and assistance that you may need
• Dealing with financial and legal matters
Sources of Information
Your Healthcare Team
The most obvious place to start when seeking information about your cancer and treatment is with your healthcare team. It may be helpful to think of the health caregivers as part of your team, as all are there to play a part in helping you during your cancer experience. As you proceed with your cancer care, you may come into contact with different specialists, all of whom could be excellent sources of information for you.
Who Is Who?
Oncologist (or Medical Oncologist)—a doctor who specializes in treating people with cancer. A medical oncologist uses medications such as chemotherapy to treat cancer. You may be referred to an oncologist to help with the workup on your cancer, or you may see them when the diagnosis has been made following surgery or biopsy. Often, the medical oncologist becomes the “quarterback” of your cancer team. They will use the results from the workup and surgery and discuss with you the type of cancer, treatment plan, and prognosis.
Surgical Oncologist—specializes in removing tumors as treatment for cancer.
Radiation Oncologist—specializes in treating cancer using radiation.
Primary Care Physician (PCP)—works with your oncology team during your cancer treatment. They may be very involved advising on issues regarding other healthcare conditions you have, such as high blood pressure or diabetes. Or, they may take a back seat during your cancer care, resuming a more active role in your care once the cancer treatment is complete.
There are other doctors whom you may never see or talk to, but they influence your care through the interpretation of tests. These are:
Pathologist—specializes in interpreting laboratory tests and evaluating cells, tissue, and organs to diagnose disease.
Radiologist—specializes in interpreting imaging tests such as X-rays, scans, or MRIs.
Other specialists with whom you may come into contact because of special procedures they perform or advice and assistance they can provide due to their particular expertise include:
Interventional Radiologist—a doctor who does procedures such as biopsy or insertion of port-a-cath (used for giving chemotherapy infusions) under X-ray guidance.
Palliative Medicine Specialist—specializes in treatment of pain and other symptoms related to cancer and its treatment.
Fertility Specialist—Some cancer treatments may affect a person’s ability to have children in the future. A fertility specialist may be consulted after a discussion with your healthcare team about fertility and before you begin your cancer treatment. The fertility specialist will be able to discuss what fertility preservation steps you can take before you begin cancer treatment.
Other members of the healthcare team who have a very significant role in your cancer care include:
Nurses—You will encounter nurses in all settings of your cancer care—inpatient, outpatient, office, home care, or hospice. They provide care and are a valuable source of information about your cancer, treatment, side effects, side-effect management, as well as what to expect with your cancer treatment. Nurses may be providing bedside care, giving chemotherapy treatments, providing education about treatments, as well as assisting with coordination of care.
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