What do the different stages of cancer mean?
As a gynaecological oncologist, I see patients with gynaecological cancers including ovarian, cervical, endometrial (uterine), vulval and vaginal cancer.
If you are diagnosed with cancer, you will normally be given a cancer ‘stage’. The stage of a cancer describes how far it has grown and spread in the body at the time of diagnoses. To determine the stage this will involve having scans, biopsies and possibly further tests. The stage of the cancer will help us work out the most efficient and least harmful treatment options for patients.
All cancers are staged at the time of diagnosis. Stage is used to describe the spread of cancerous growths, like gynaecological, breast, bowel or lung cancers. Blood cancers are staged in different ways.
Typically, a numbered staging system is used. Most types of cancer have 4 stages, numbered from 1 to 4. You may also see roman numerals used.
Stage 0 cancer (in-situ)
Stage 0 or ‘carcinoma in situ’ means that there is a group of abnormal cells in one area of the body but these cells do not constitute cancer yet. Untreated, these cells could progress into cancer. In situ means ‘in place’. These pre-cancerous cells are still in the same place where they started and have not spread. Prognosis of cancer at this stage is highly curable, and typically involves surgery to remove the cells or tumour.
Stage 1 cancer
The cells now have features consistent with cancer but the cancer is still small and contained in the organ it originally developed in. It has not spread to any lymph nodes, organs, or body areas. This is often called early stage cancer. Based on additional risk factors, some patients might still need further treatment to reduce the risk of a cancer recurrence.
Stage 2 and 3 cancer
Stage 2 or 3 cancer means that the cancer is larger or has spread into nearby tissues or lymph nodes (metastases). Many of stage 2 and 3 cancers are still curable, depending on the location of the metastases, the cell type and whether the cancer responds to chemotherapy, radiation treatment or hormone intervention.
Stage 4 cancer
Stage 4 cancer means that the cancer has spread to other areas of the body. The treatment of stage 4 gynaecological cancer may be curative (aiming for cure) or palliative (aiming for symptom control).
For example, ovarian cancer is staged by FIGO (International Federation of Gynecology and Obstetrics) as follows:
Stage 1 – the cancer is in 1 or both ovaries and has not spread to other organs or tissues.
Stage 2 – the cancer is in 1 or both ovaries and has spread to other organs in the pelvis, such as the uterus, fallopian tubes, bladder or colon.
Stage 3 – the cancer is in 1 or both ovaries and has spread outside the pelvis to other parts of the abdomen or nearby lymph nodes.
Stage 4 – the cancer has spread to other parts of the body beyond the pelvis and abdomen, such as the lungs or liver.
Some cancer require surgery to determine a stage (uterine, ovarian and vulval cancer) whereas other cancers (cervical and vaginal cancer) do not require surgery to obtain staging information.
This means that sometimes staging information is not readily available initially; histopathology reports may take a few days and provide important information in ovarian, uterine and vulval cancer.
In a specialised gynaecological oncology practice, surgeons tend to use the FIGO staging system.
Sometimes, the TNM staging system may also be used to determine cancer spread:
T (Tumour) indicates the depth of the tumour invasion – the higher the number (between 1 and 4), the further the cancer has spread.
N (Nodes) indicates whether the lymph nodes are affected – a number between 0 and 3 describes how much the cancer has spread to lymph nodes near the bladder.
M (Metastasis) indicates whether the cancer has spread to other parts of the body – M1 means the cancer has spread to other organs or lymph nodes that are not near the bladder; M0 means there is no sign of the cancer spreading to other parts of the body.
Cancer can also be referred to as ‘localized’ where the cancer is limited to the place it originated (no spread), ‘regional’ where the cancer has spread to lymph nodes, tissues, or organs, and ‘distant’ where the cancer has spread throughout the body.
Our patients are 100% entitled to know what their cancer stage is. In our practice, we are very forthcoming with information about our patients’ cancer stage (once it is known) and other relevant factors.
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