Diagnosis and Staging of Cancer
Cancer can cause many different symptoms. Most often these symptoms are not caused by cancer, but by benign tumors or other problems. If you have symptoms that last for a couple of weeks, your doctor will do a physical exam and order tests or other procedures to find out what is causing your symptoms.
If you do find out you have cancer, your doctor will order another set of tests or procedures to figure out its stage. Stage refers to the extent of your cancer and is based on factors such as how large the tumor is and if it has spread. Once your doctor knows the stage of your cancer, he will be able to suggest treatment and discuss your prognosis with you. Understanding your cancer and knowing what to expect can help you and your loved ones feel more in control and cope with your diagnosis.
Some of the symptoms that cancer may cause include:
- Lump or firm feeling in your breast or under your arm
- Nipple changes or discharge
- Skin that is itchy, red, scaly, dimpled, or puckered
- Trouble urinating
- Pain when urinating
- Blood in the urine
Bleeding or bruising, for no known reason
- Blood in the stools
- Changes in bowel habits
Cough or hoarseness that does not go away
- Pain after eating (heartburn or indigestion that doesn’t go away)
- Trouble swallowing
- Belly pain
- Nausea and vomiting
- Appetite changes
Fatigue that is severe and lasts
Fever or night sweats for no known reason
- A white or red patch on the tongue or in your mouth
- Bleeding, pain, or numbness in the lip or mouth
- Vision changes
- Hearing changes
- Drooping of the face
- A flesh-colored lump that bleeds or turns scaly
- A new mole or a change in an existing mole
- A sore that does not heal
- Jaundice (yellowing of the skin and whites of the eyes)
Swelling or lumps anywhere such as in the neck, underarm, stomach, and groin
Weight gain or weight loss for no known reason
Lab tests: High or low levels of certain substances in your body can be a sign of cancer. So, lab tests of your blood, urine, or other body fluids that measure these substances can help doctors make a diagnosis. However, abnormal lab results are not a sure sign of cancer.
Some lab tests involve testing blood or tissue samples for tumor markers. Tumor markers are substances that are produced by cancer cells or by other cells of the body in response to cancer. Most tumor markers are made by normal cells and cancer cells but are produced at much higher levels by cancer cells.
CT scan: A CT scan uses an x-ray machine linked to a computer to take a series of pictures of your organs from different angles. These pictures are used to create detailed 3-D images of the inside of your body.
Sometimes, you may receive a dye or other contrast material before you have the scan. You might swallow the dye, or it may be given by a needle into a vein. Contrast material helps make the pictures easier to read by highlighting certain areas in the body.
During the CT scan, you will lie still on a table that slides into a donut-shaped scanner. The CT machine moves around you, taking pictures.
MRI: An MRI uses a powerful magnet and radio waves to take pictures of your body in slices. These slices are used to create detailed images of the inside of your body, which can show the difference between healthy and unhealthy tissue.
When you have an MRI, you lie still on a table that is pushed into a long, round chamber. The MRI machine makes loud thumping noises and rhythmic beats.
Sometimes, you might have a special dye injected into your vein before or during your MRI exam. This dye, called a contrast agent, can make tumors show up brighter in the pictures.
Nuclear scan: A nuclear scan uses radioactive material to take pictures of the inside of the body. This type of scan may also be called radionuclide scan.
Before this scan, you receive an injection of a small amount of radioactive material, which is sometimes called a tracer. It flows through your bloodstream and collects in certain bones or organs.
During the scan, you lie still on a table while a machine called a scanner detects and measures the radioactivity in your body, creating pictures of bones or organs on a computer screen or on film.
After the scan, the radioactive material in your body will lose its radioactivity over time. It may also leave your body through your urine or stool.
Bone scan: Bone scans are a type of nuclear scan that check for abnormal areas or damage in the bones. They may be used to diagnose bone cancer or cancer that has spread to the bones (also called metastatic bone tumors).
Before this test, a very small amount of radioactive material is injected into your vein. As it travels through the blood, the material collects in abnormal areas in the bone. Areas where the material collects show up on pictures taken by a special scanner. These areas are called “hot spots.”
PET scan: A PET scan is a type of nuclear scan that makes detailed 3-D pictures of areas inside your body where glucose is taken up. Because cancer cells often take up more glucose than healthy cells, the pictures can be used to find cancer in the body.
Before the scan, you receive an injection of a tracer called radioactive glucose. During the scan, you will lie still on a table that moves back and forth through a scanner.
Ultrasound: An ultrasound exam uses high-energy sound waves that people cannot hear. The sound waves echo off tissues inside your body. A computer uses these echoes to create pictures of areas inside your body. This picture is called a sonogram.
During an ultrasound exam, you will lie on a table while a tech slowly moves a device called a transducer on the skin over the part of the body that is being examined. The transducer is covered with a warm gel that makes it easier to glide over the skin.
X-rays: X-rays use low doses of radiation to create pictures inside your body. An x-ray tech will put you in position and direct the x-ray beam to the correct part of your body. While the images are taken, you will need to stay very still and may need to hold your breath for a second or two.
Biopsy: In most cases, doctors need to do a biopsy to diagnose cancer. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist looks at the tissue under a microscope and runs other tests to see if the tissue is cancer. The pathologist describes the findings in a pathology report, which contains details about your diagnosis. Pathology reports play an important role in diagnosing cancer and helping decide treatment options. Learn more about pathology reports and the type of information they contain.
The biopsy sample may be obtained in several ways.
With a needle: The doctor uses a needle to withdraw tissue or fluid. This method is used for bone marrow aspirations, spinal taps, and some breast, prostate, and liver biopsies.
With endoscopy: The doctor uses a thin, lighted tube called an endoscope to examine areas inside the body. Endoscopes go into natural body openings, such as the mouth or anus. If the doctor sees abnormal tissue during the exam, he will remove the abnormal tissue along with some of the surrounding normal tissue through the endoscope.
Examples of endoscopy exams include
- Colonoscopy, which is an exam of the colon and rectum. In this type of exam, an endoscope goes through the anus, allowing the doctor to examine the rectum and colon. If the doctor sees polyps, she will remove them and send them to a lab for testing.
- Bronchoscopy, which is an exam of the trachea, bronchi, and lungs. In this type of exam, an endoscope goes through the mouth or nose and down the throat.
With surgery: A surgeon removes an area of abnormal cells during an operation. Surgery may be excisional or incisional.
In an excisional biopsy, the surgeon removes the entire area of abnormal cells. Often some of the normal tissue around these cells is also removed.
In an incisional biopsy, the surgeon removes just part of the abnormal area.
Some biopsies may require a sedative or anesthesia.
Sedatives are medicine that help you relax and stay very still or sleep during a biopsy.
Anesthesia keeps you from feeling pain. It refers to drugs or other substances that cause you to lose feeling or awareness. There are three types of anesthesia.
- local anesthesia, which causes loss of feeling in one small area of the body
- regional anesthesia, which causes loss of feeling in a part of the body, such as an arm or leg
- general anesthesia, which causes loss of feeling and a complete loss of awareness that seems like a very deep sleep
Stage refers to the extent of your cancer, such as how large the tumor is, and if it has spread. Knowing the stage of your cancer helps your doctor:
- Understand how serious your cancer is and your chances of survival
- Plan the best treatment for you
- Identify clinical trials that may be treatment options for you
A cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads. New information about how a cancer has changed over time gets added on to the original stage. So, the stage doesn’t change, even though the cancer might.
How Stage Is Determined
To learn the stage of your disease, your doctor may order x-rays, lab tests, and other tests or procedures. See the section on Diagnosis to learn more about these tests.
Systems that Describe Stage
There are many staging systems. Some, such as the TNM staging system, are used for many types of cancer. Others are specific to a particular type of cancer. Most staging systems include information about:
- Where the tumor is located in the body
- The cell type (such as, adenocarcinoma or squamous cell carcinoma)
- The size of the tumor
- Whether the cancer has spread to nearby lymph nodes
- Whether the cancer has spread to a different part of the body
- Tumor grade, which refers to how abnormal the cancer cells look and how likely the tumor is to grow and spread
The TNM Staging System
The TNM system is the most widely used cancer staging system. Most hospitals and medical centers use the TNM system as their main method for cancer reporting. You are likely to see your cancer described by this staging system in your pathology report, unless you have a cancer for which a different staging system is used. Examples of cancers with different staging systems include brain and spinal cord tumors and blood cancers.
In the TNM system:
- The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.
- The N refers to the the number of nearby lymph nodes that have cancer.
- The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.
When your cancer is described by the TNM system, there will be numbers after each letter that give more details about the cancer—for example, T1N0MX or T3N1M0.
Other Ways to Describe Stage
The TNM system helps describe cancer in great detail. But, for many cancers, the TNM combinations are grouped into five less-detailed stages. When talking about your cancer, your doctor or nurse may describe it as one of these stages:
|Stage||What it means|
|Stage 0||Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer.|
|Stage I, Stage II, and Stage III||Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.|
|Stage IV||The cancer has spread to distant parts of the body.|
Another staging system that is used for all types of cancer groups the cancer into one of five main categories. This staging system is more often used by cancer registries than by doctors. But, you may still hear your doctor or nurse describe your cancer in one of the following ways:
- In situ—abnormal cells are present but have not spread to nearby tissue.
- Localized—Cancer is limited to the place where it started, with no sign that it has spread.
- Regional—Cancer has spread to nearby lymph nodes, tissues, or organs.
- Distant—Cancer has spread to distant parts of the body.
- Unknown—there is not enough information to figure out the stage.