|Understanding Gyn Cancer Staging|
by Laura Dolson
When the answer to the first question, "Is it cancer?", is an unfortunate "yes", the second most important question is "What stage is it?". This is because the choice of which treatment to use rests very much on the cancer's stage. Whereas the grade of the tumor, which we discussed in Part 4, has to do with the behavior of the individual malignant cells, the stage has to do with how large the tumor is and how far it has spread.
It is crucial for the cancer stage to be accurately assessed, because only then can the treatment be most tailored to the individual patient. Unfortunately, especially when it comes to surgical staging in the pelvic and abdominal area, many cancers are still not accurately staged. For this reason, it is absolutely vital for the most trained and experienced professional to perform the staging. Where available, gynecologic oncologists are the preferred professional for this job.
How is the stage of the cancer determined? There are a variety of methods used to determine cancer stage. Some of them can only be done during surgery, while scans and other exploratory and imaging techniques round out the picture.
Surgical Staging - Cancers of the "upper" female reproductive system - the body of the uterus (not counting the cervix), the ovaries, and the fallopian tubes - can only be properly assessed during surgery, usually either laparotomy or hysterectomy/oophorectomy. The removed tissue is examined carefully, often local lymph nodes are removed, peritoneal washing is done to detect malignant cells in the abdominal fluids, and the abdominal area is carefully examined for signs of cancer.
Other Staging Methods - In the "lower" female reproductive system, the tumors can be examined and biopsied more directly. Lymph nodes can sometimes be biopsied via fine needle without removing them. In addition, the bladder and rectum can be assessed via cystoscopy, protoscopy, and urography. Scans such as CT scans and MRIs, and occasionally PET scans are commonly used during all cancer staging these days.
What are the cancer stages, and what do they mean?
There are several classification systems for cancer staging, and subvarieties depending upon the cancer type. Often, more than one system is used to get a full picture, as different systems have different strengths and weaknesses. For gynecologic cancers, the most common system is the FIGO system, because it is accepted worldwide and promotes an international standard where professionals can speak with each other and be sure they can understand and compare each other's research.
These are the stages of the FIGO system, generally speaking. Each cancer, however, is different in the particulars. To view the stages of a particular cancer, click on the cancer type in the violet sidebar.
Stage 0 - This stage isn't really cancer at all, but is "precancer". It is common in the cervical, vaginal, and vulvar cancer spectra, and is variously called carcinoma in situ, severe dysplasia, intraepithelial neoplasia 3, and various other terms.
Stage I - Cancer is confined to the organ where is originated.
Stage II - Cancer has invaded nearby tissues or organs.
Stage III - Cancer has spread to lymph nodes or other tissues, but remains in the pelvic region (or, in the case of ovarian and tubal cancers, the outsides of abdominal organs such as the intestines).
Stage IV - Cancer has metastasized to more distant locations, such as the lungs.
How does stage relate to prognosis?
In general, cancer stage has a direct relationship with prognosis. Stage 0, by definition, has a 100% survival rate. Stage 1 cancer has a high probability of cure. The higher the stage, the worse the prognosis in general, although no staging should be taken as a death sentence. There are plenty of women around who can tell you stories of their late-stage cancer which was diagnosed many years ago. The higher the stage, in general, the more aggressively the cancer wil be treated.
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