The Stages of Cancer: Why Delays Can be Deadly

When giving an initial cancer diagnosis, the treating oncologist will often also determine the seriousness of the cancer by assessing which stage a patient’s cancer has progressed to.  

Staging is dependent on a number of factors. If there is a tumor, what is its size and location? Have cells moved out of the tissue or organ of origin and into any lymph nodes? Has it found its way into other tissues and organs? Has it traveled to the bloodstream? How quickly is it growing or spreading? 

These are just a few of the considerations an oncology team must make when deciding the best course of treatment for patients. 

As a patient’s cancer grows more severe, the treatments become more aggressive and serious. A delay in diagnosis, at any point, can cause a patient to move from a relatively easy and treatable cancer to something more sinister and deadly.

Not only will the course of treatment be affected, the length of time it takes for a physician to diagnose a patient with cancer will directly determine the overall survival rate and lifespan of the patient. 

How Cancer Staging Is Determined

The clinical stage is an estimate of the extent of the cancer based on results of physical exams, lab tests, imaging (x-rays, CT scans, etc.), endoscopies, surgeries, or any biopsies that are done before treatment begins. 

Tests performed will be based on the suspected type of disease, as each type of cancer presents differently. For example, diagnostic imaging would not be useful in detecting cancers of the blood, but work well to diagnose tumors.

The TNM Staging System

The TNM system is the most widely used cancer staging and classification system and is employed to stage many different types of cancer based on common standards.

The severity of the top five most common occurring cancers in the United states—skin cancer, lung cancer, prostate cancer, breast cancer, and colorectal cancer—are determined by the TNM staging system. 

In the TNM system, the overall stage is determined after the cancer is assigned a letter or number to describe the tumor (T), node (N), and metastasis (M) categories.

• T describes the original, or primary, tumor.
• N tells whether the cancer has spread to nearby lymph nodes.
• M tells whether the cancer has spread, or metastasized, to other parts of the body

These letter assignments are then broken down into hyper detailed descriptions of the cancer by combining them further with numbers referring to specific information about the tumor, lymph nodes, or metastasis. 

While the TNM gives providers easy access to the information they need about a patient, very quickly, most patients will be communicated about their cancer via one of five stage groupings that simply have a numerical value.

These are often called  stages I (1) to IV (4). Some cancers also have a stage 0 (zero).

• Stage 0. This stage describes cancer in situ, which means “in place.” These cancers are still located in the place they started and have not spread to nearby tissues. This stage of cancer is often highly curable.

• Stage I. This stage is usually a small cancer or tumor that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.

• Stage II and Stage III. In general, these 2 stages indicate larger cancers or tumors that have grown more deeply into nearby tissue. They may have also spread to lymph nodes but not to other parts of the body.
• Stage IV. This stage means that the cancer has spread to other organs or tissues of the body via the lymph nodes or bloodstream. It may also be called advanced or metastatic cancer.

Survival Outcomes as Stage Increases

As cancer spreads through the body, the staging of the cancer increases. And though each type of cancer has specific survival rates, if a cancer is left untreated due to negligent diagnosis, the survival rate of the cancer worsens, dramatically, regardless of the specific disease. 

The time it takes for a cancer to be diagnosed and for treatment to begin, directly determines a patient’s outcome. If a physician or healthcare worker acts negligently, and diagnosis and subsequent treatment was delayed, you may have a medical malpractice case.