Why doctors must do cancer staging before commencing treatment

Jailet Ninsiima, a nurse at Uganda Cancer Institute explains cancer of the cervix to women in Mulago: COURTESY PHOTO


Surviving cancer is three times more likely to happen when the disease is diagnosed early, statistics have shown.

Data from Uganda Cancer Institute between 1999 and 2005 indicates that, over 80% of those with cancer survive for at least 10 years, only if they were diagnosed at stage one or two. For those diagnosed at stage three or four, only a quarter of them may get the chance to live and tell the tale.

Those diagnosed at stage one are the real champions whose 10-year survival is 90% and above close to the 100% percentile while their counterparts whose cancers are diagnosed in the fourth stage only get a 5% share of the survival rate. Early Cancer screening may save your life.

Severity is the basis upon which cancer stages are based as indicated by the size of tumours and how far they have spread throughout the body.

Many a times, a friend, relative or a loved one is diagnosed with cancer and it is at that point that we are informed of the cancer stage.

If it is not stage one, we are left with alarming curiosity, regrets and fear. Why wasn’t it discovered at stage one? We often ask.

When trying to determine the extent of the cancer in the body, doctors first look at the primary (main) tumour for its size, location, and whether it has grown into nearby areas.

Doctors also check for other nearby tumours. They might also look at nearby lymph nodes to find out if cancer has spread into them. Lymph nodes are small, bean-shaped collections of immune cells.

Many types of cancer often spread to nearby lymph nodes before they reach other parts of the body.

Your doctor is most likely to look at other parts of the body to see if the cancer has spread there. When cancer spreads to parts of the body far from the primary tumour, it is known as metastasis.

In some kinds of cancer, other factors are used to help determine the stage. Factors such as the cancer cell type and grade (how abnormal the cancer cells look under a microscope), or the results of certain blood tests. Different types of exams and tests are used to figure out a person’s cancer stage.

Depending on where the cancer is located, the physical exam may inform the clinician as to how much cancer there is. Also tests like x-rays, CT scans, MRIs, ultrasound may also give information about where and how much cancer is in the body.

For some time now, I have felt the obligation of informing the public about cancer staging and its usefulness. Unaware, many people get to the Uganda Cancer Institute only to discover that cancer has stages. Overwhelmed, they ask, “What is staging and of what use it to my treatment?”

Staging is the process of finding out how much cancer is in a person’s body and where it is located. It can also be explained as, how the doctor determines the stage of a person’s cancer.

For most types of cancer, doctors use staging information to help plan treatment and to predict a person’s outlook (prognosis). Although each person’s situation is different, cancers with the same stage tend to have similar outlooks and are often treated the same way.

The cancer stage is also a way for doctors to describe the extent of the cancer when they talk with each other about a patient. It is a requirement in cancer treatment as doctors need to know the amount of cancer and where it is in the body in order for them to choose the best treatment options in administering and during study.

For example, the treatment for an early-stage cancer may be surgery or radiation, while a more advanced-stage cancer may need to be treated with chemotherapy.

Doctors also use cancer staging to aid in their predictions of the most likely course the cancer is about to take. Staging also allows researchers to make sure study groups are actually similar when they test cancer treatments against one another, measure outcomes, and more.

A biopsy is often needed to confirm a cancer diagnosis and to find out if an abnormal spot seen on an imaging test is really cancer spread. During a biopsy, the doctor removes a tumour or pieces of a tumour to be looked at under a microscope.

Some biopsies are done during surgery. However, common practice suggests that the doctor removes small pieces of the tumour through a thin needle or through a flexible lighted tube called an endoscope.

It is important to know that not all cancers are staged. Leukemias are cancers of the blood cells and therefore spread throughout the body. Most types of leukemias aren’t staged the way cancers that form tumours are.

Cancer staging had its first hallmark in 1932 London with the publication of an article by Cuthbert E.Dukes, pathologist to St Mark’s hospital. The article was entitled, The Classification of Cancer of the Rectum.

Since then, the technique has not faltered, for it is more than befitting to finally say that staging is one of the best practices in cancer care today and it has been so for a very long time.

The UCI-Fred Hutch Cancer Centre in Mulago



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