cancer staging

what does staging of cancer implicate

assessment of the severity of the disease

what are the 3 factors that determine the stage of cancer (important to know!)

• size of primary tumour

• whether it has invaded to surrounding tissues

• whether it has metastasised (spread to other areas of body)

why are treatment plans influenced by stage of cancer

• late stage of cancer is less intensively treated, especially when it is not possible to cure it - higher chance that pallative care is used for late stage of cancer

spread of cancer - local invasion
what is local invasion

infiltrates, invades and destroys surrounding tissue but it is localised to its primary site

true or false: localised invasion is not a metastatic disease

true

e.g. colorectal cancer perforates colon wall

what is metastasis

• primary cancer can spread to other areas of the body

• metastases - secondary involvement

true or false: cells within the metastasis are different from cells within the secondary involvment

false - cells within the metastasis resemble the primary cancer

e.g. even though cancer can metastasised in brain, it still resembles the cells of breast cancer which are the primary cancer site

what are the routes of metastatic spread

• lymphatic spread to lymph nodes

• haematoagenous spread (via blood)

• through body walls into abdominal or chest cavities

what are the preferential sites of metastases

what is the TNM system for staging

• Tumour

• Node

• Metastasis

the cancer is given a numerical score for each of these categories

what is TNM based on

• size of primary tumour

• number of lymph nodes

• whether it has metastasised

what values do TNM vary between

what is the highest TNM score for which a primary tumour has not metastasised

T-4

N-3

M-0

note that M only takes value 0 or 1 because it does not tell you extend of metastasis, only if it has occurred or not

what is the numerical staging system

• stage 1

• stage 1: primary tumour is small and contained within one area

what is the numerical staging system

• stage 2

• stage 2: tumour larger than stage 1 - may have infiltrated local lymphs

what is the numerical staging system

• stage 3

• stage 3: tumour larger than stage 2 - at least one lymph node has been infiltrated

what is the numerical staging system

• stage 4

• cancer has spread to another part of body

how do the alphabet subtypes of numerical staging system work

e.g. 3a or 3b

associated with cancers that can have many permutations in terms or size and spread

describe the NHS cancer pathway and talk about timing targets

• target to be seen by specialist after referal in 2 weeks

• additional target to determine if patient has cancer within 28 days

• first treatment should aim to be within 31 days of patient consenting to treatment

• whole process (GP to first treatment) should be within 62 days

• however GPs and NHS are struggling to meet these targets

what is the biggest hurdle on the NHS cancer pathway

relies on patients actually making an appointment with the GP to be assessed