Stages of Cancer: Learn about the different phases
We’ve all heard “She has stage III breast cancer” or “Thank goodness it’s only stage I!” What are the stages of cancer? What do each of the stages of cancer mean? What are the symptoms, cognitive issues, and life expectancy for each stage? What are the stages of cancer treatment?
What are the stages of cancer?
Each cancer is in its own stage of development. Staging cancer helps to explain and describe where the cancer is located if it has spread, and to where the spreading extends, as well as if the cancer is affecting other parts of the body. In short, the stages of cancer tell us how much “real estate” cancer has within the body.
Doctors use a series of tests in order to diagnose the stage of cancer. Determining the stage of cancer isn’t complete until all tests are done. By knowing the stages of cancer, a doctor is able to:
- Predict the chance of recovery.
- Find a treatment plan such as chemotherapy, hormone therapy, or radiation therapy as well as surgery.
- Determine how well the treatment will work.
- Be able to predict the chance that cancer can come back after the first-time treatment.
- The effects cancer can have on the patient.
Doctors often use the TNM System (tumor, node, metastasis) from the American Joint Committee on Cancer (AJCC) to diagnose the stages of cancer. Doctors try to answer the following questions using a series of imaging scans, diagnostic tests, and surgery to get a sample of or remove the tumor:
- How large in the tumor and where is it located? (“T” for “tumor”)
- Did the tumor spread to the lymph nodes? If yes, how many and where? (“N” for “node”)
- Has cancer spread to any other parts of the body? If yes, how much and where? (“M” for “metastasis”)
Stages of Cancer- Staging
There are two types of cancer staging- clinical or pathological. Clinical staging is based on the results done by and given before surgery using tests like imaging scans and physical examinations. This stage is often indicated in the TNM classification with a lowercase “c”. Pathological staging is based on what is found during surgery. It provides, in general, most information in order to determine the patient’s progress and gives as many details as possible. This stage is often indicated in the TNM classification with a lowercase “p”. There is a third type of staging known as post-therapy staging, which is done after the patient has already undergone other cancer treatments before surgery such as hormone therapy, radiation therapy, immunotherapy, or chemotherapy. This type of staging is often used when the tumor is too big or intricate to take out with only surgery- the other therapies shrink and make the tumor easier to extract. The post-therapy stage is indicated in the TNM classification with a lowercase “y”.
It’s important to know that the stages of cancer don’t change once diagnosed, even if cancer has metastasized or the tumor shrinks. Doctors always will refer to cancer as the stage in which it was diagnosed in the first place, such as Stage II, and will then label and describe any changes to cancer by changing the numbers in the TNM system.
Stages of cancer- Stage 0
Stage 0 cancer is the stage used to describe carcinoma in situ, which means “in place”. It can also be called pre-cancerous cells. When a cancer is at stage 0, it means that the cancer was identified by the location where it initially emerged and began to multiply. That said, a stage 0 cancer won’t have spread to nearby tissue yet. It’s the most basic stage of all cancers.
For instance, with breast cancer in stage 0, the cells may have ductal carcinoma in situ which means that abnormal cells have developed within the lining of the breast duct. This means that the cells haven’t yet spread to other parts of the surrounding breast tissue, but that the cells could at any time.
Due to the fact that stage 0 cancer isn’t as life-threatening of a stage at more advanced cancers, the prognosis is quite high. Some people believe that natural treatments along with clean eating (aka no eating processed food) and making sure that your immune system is at its best is all one needs in order to help reverse stage 0 cancer.
One study has shown that overall, women who were diagnosed with Stage 0 breast cancer have the same chance of dying (from the breast cancer) as women with no breast issues. That’s only about 3.3% according to the study.
Stages of cancer- Stage I
Some doctors call this stage the “early stage cancer” and some insist on starting treatment immediately because this stage has a high prognosis with it while using traditional care. Stage I cancer describes a small tumor that is cancerous and that has spread to the nearby tissue but hasn’t spread far beyond that, such as to the lymph system or to the bloodstream. For example, women who stage I breast cancer have a tumor that hasn’t left the breast area, though it may have invested the nearby areas such as the lymph nodes by the armpit. That said, this stage of cancer is easier to treat than other cancers where the tumor is more advanced. The treatment options for stage I cancer include chemotherapy and surgery- often in conjunction with each other.
Stages of cancer- Stage II, Stage III
Stages II and III are often lumped together because they are both considered to be regionally spread cancers which mean that cancer has spread beyond its initial place (such as the breast) and, in some cases, deeply embedded itself into the surrounding tissues. Stage II cancers have only gotten to the nearby lymph nodes, but haven’t gotten yet to the far-off lymph nodes. Stage II is known as a more localized cancer, but it’s more threatening than a stage I cancer. Stage III cancers have spread to the surrounding and far-off lymph nodes. That said, Stage III cancers haven’t metastasized in the distant areas of the body. For a woman with Stage III breast cancer, that means that the cancer is in the chest wall and nearby lymph nodes, but not the bones or brain. In the II and III stages of cancer, the cancerous cells have entered the bloodstream which the lymph system should be able to detect since the cells can get caught in the lymph nodes while they travel throughout the body. While both of these stages are serious, cancer hasn’t yet spread to other organs which are good.
Stages of cancer- Stage IV
Stage IV cancer is when cancer has spread from the original “birth site”, such as the breast or testicles, to other areas of the body or to the organs. It’s also known as metastatic cancer, distant spread cancer, or advanced cancer. For instance, stage IV breast cancer means that the tumor may have spread from the chest to the lungs, liver, bones, and/or brain. It’s a difficult stage of cancer to treat, but that doesn’t mean it’s impossible. While different cancers, of course, have different survival rates, it’s hard to treat at this stage because cancer has become so developed. The common treatments for stage IV cancer include radiation therapy, chemotherapy, and surgery.
Stages of cancer- Recurrent
When cancer comes back after being treated, it’s known as recurrent cancer or as a recurrence. The recurrent cancers begin with cancer cells that weren’t fully destroyed or removed in the first round of treatments. However, it’s important to remember that just because you had recurrent cancer doesn’t mean that the treatment you had before was wrong. It simply means that a small small small amount of cancer cells were able to survive the treatment and were simply too small to show up in the follow-up tests during treatment. However, these small cells grow and become detectable in new cancer or in a tumor. There are three types of recurrent cancer.
- Local recurrence- the cancer is found in the same place and area as original cancer. For example, if the first cancer was found in the breast and the second one is, too.
- Regional recurrence– the tumor has grown into tissue or lymph nodes near where the original cancer was.
- Distant recurrence– cancer spread to tissues and/or organs far away from original cancer.
There is also the possibility of a new type of cancer occurring in someone who has a history with cancer. This is known as a second primary cancer. It’s important not to confuse a second primary cancer with reoccurring cancer.
In order to figure out the type of recurrent cancer you have, you will have the same tests you had during first cancer such as imaging procedures and lab tests. These assessments and process, when concerning recurrent cancer, are known as “restaging”.
Cognitive skills affected by stages of cancer
Having cancer can affect the brain in many ways and in all stages of cancer. It’s been proven that being diagnosed with cancer affects how the brain works. There are a number of cognitive issues associated with having cancer. One of the studies on the matter found that women who are diagnosed with breast cancer can have cognitive issues before they begin with cancer treatment… cognitive issues likely due to post-traumatic stress from their initial diagnosis (of cancer). One German study from 2013 took 166 women under 65 diagnosed with breast cancer recently and 60 women who hadn’t been diagnosed with cancer. The study found that 23% of women diagnosed with breast cancer patients who are newly diagnosed suffer from PTSD symptoms.
Another phenomenon known as chemo brain is a common cognitive side effect of the stages of cancer. While it’s unknown the true causes of chemo brain, and some doctors disregard its existence altogether, it’s theorized that chemo brain is a condition that is related to different cancer treatments such as hormone therapy and radiation therapy, as well as anxiety and depression rather than just a side effect of chemotherapy. Chemo brain can affect cognitive skills such as mental flexibility, differences in judgment, reaction time, attention, visual-spatial memory, the speed of information processing, and our motor and verbal functions. It’s also thought that chemotherapy and other cancer treatments can cause a reduction of gray matter in the brain as well as a reduction in the region of connective tissues within the brain.
Around 75% of cancer patients experience cognitive issues during cancer treatment while up to 35% have cognitive problems that continue for months to years after treatment is done. Of course, some of the factors for this are age, stress levels, length and severity of cancer treatment, history of anxiety or depression, and overall ability to cope. According to cancer.net, children who are younger than age five are more likely to have long-term cognitive issues after cancer treatments, such as chemo brain and learning disabilities.
What are the stages of cancer treatment?
While some worry we are overtreating stage 0 cancers, there are numerous clinical trials being studied on all stages of cancer. A 25-year long Australian study found that 8 in every 1,000 mammograms are “over-treated” or “over-diagnosed”. Fun fact: did you know that men can get breast cancer, too? There is a current clinical trial going on that is trying to find out how a caloric restriction in treating patients with Stage 0 or Stage I breast cancers while they undergo surgery or radiation therapy helps their treatment. You can see the most recent findings from the clinical trial here. Another study found that many breast cancer patients with a low stage, such as stage 0 or stage I, can actually forego chemotherapy altogether. A long-term study published in the Journal of Clinical Oncology looked at the survival rates for stage I and stage II breast carcinoma (breast cancers). They found survival rates, with treatment, to be 70% or higher!
All cancers and therapies have different side effects. One side effect that is common is chemo brain. While it may have to do with chemotherapy, many believe that the so-called chemo brain is actually an effect of cancer and the toll it takes on a person in addition to any treatment plan (not just chemotherapy). The stress of having cancer, the effects of having cancer, plus the side effects from any of the treatments and the drugs involved with the treatment plans combined can be catastrophic. Chemo brain can cause memory issues, concentration problems, and learning complications. It’s actually a rather common condition with 17-50% of breast cancer patients reporting the condition.
There are different stages of cancer treatment, too. Doctors often recommend a surgery first to remove the tumor or as much as cancer as possible. However, if the tumor is intertwined with lots of vessels or the surrounding area, some patients will have to undergo radiation therapy, chemotherapy, or hormone therapy to help reduce the size of the tumor before surgically removing it. After the tumor is removed, there is a second step/treatment to get rid of the cancer cells that are within the body still. This can be done with a number of methods such as chemotherapy, radiation therapy, hormone therapy, immunotherapy (a treatment that works in conjunction with the immune system), and targeted therapies among other treatments.
Have you ever gone through cancer and/or cancer treatment? What stage did you have? Let us know what you think in the comments below!
Anna is a freelance writer who is passionate about translation, psychology, and how the world works.