Page 35 Complete Your CE Test Online - Click Here Cancer staging Treatment depends on diagnosis (primary site and type of cancer) and stage. For example, early stage solid tumors can often be treated by surgery alone, while later stage ones may require chemotherapy and/ or radiation. Staging Stage refers to the extent of the cancer, such as tumor size, invasion, and metastases. Cancer treatments and prognosis are based on the cancer type and stage, and clinical trials are often limited by stage. A cancer is always referred to by the stage at diagnosis, even if it later progresses or metastasizes. Information about how a cancer has progresses over time is added to the original stage. How stage is determined To learn the stage of disease, procedures typically include imaging studies, lab tests, and biopsy. The biopsy may be taken with a needle, endoscope, incision, or incision. A pathologist looks at the tissue sample and does further testing on it [195]. Systems that describe stage There are many staging systems. The TNM staging system (below) is used for many types of cancer, while others are specific to a particular type of cancer. The stage information typically appears on the pathology report. Most staging systems include information about: ● ● Tumor location. ● ● Cell type. ● ● Tumor size. ● ● Lymph node involvement. ● ● Metastases to other organs. ● ● Tumor grade (how abnormal the cells look, which is a marker for aggressiveness). The TNM staging system: Most hospitals and medical centers use the TNM system as their main method for cancer reporting. Different staging systems are often used for brain and spinal cord tumors and blood cancers [195]. In the TNM system: ● ● The T refers to the size and extent of the primary tumor. ● ● The N refers to the number of nearby lymph nodes that contain cancer. ● ● The M refers to whether the cancer has metastasized. When 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. The following explains what the letters and numbers mean: Primary tumor (T): ● ● TX: Main tumor cannot be measured. ● ● T0: Main tumor cannot be found. ● ● T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has invaded nearby tissues. T’s may be further divided to provide more detail, such as T3a and T3b, based on specific criteria for that cancer. Regional lymph nodes (N): ● ● NX: Cancer in nearby lymph nodes cannot be measured. ● ● N0: There is no cancer in nearby lymph nodes. ● ● N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. Distant metastasis (M): ● ● MX: Metastasis cannot be measured. ● ● M0: Cancer has not metastasized to other parts of the body. ● ● M1: Cancer has metastasized to other parts of the body. Stage grouping The TNM system describes the cancer in great detail. But the TNM information can also be grouped into five less-detailed stages, called stage groupings. The following summarizes the TNM information in a specific way that alludes to prognosis and treatment [195]. Table 4. The TNM system description of cancer. Stage Summary Stage 0 Abnormal cells are present but have not spread to nearby tissue (i.e.) It is not cancer, but might develop into cancer. Also called carcinoma in situ, or CIS. Stage I, II, or 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 metastasized to distant parts of the body. Another staging system that is used for many types of cancer groups the cancer into one of five main categories. This staging system is more often used by cancer registries than by oncologists. It is an alternate way to describe stages and may also be used informally [195]: ● ● In situ: Abnormal cells are present but have not spread to nearby tissue. ● ● Localized: Cancer is limited to where it started, no signs of metastasis. ● ● Regional: Cancer has metastasized to nearby lymph nodes, tissues, or organs. ● ● Distant: Cancer has metastasized to distant parts of the body. ● ● Unknown: Insufficient information to determine stage. Cancer treatment: Pretreatment assessment Health history, current illnesses, and future plans Health and family history: Before starting any cancer treatment, a full health history and summary of current medical conditions is required. This is important to review, even though the patient may have completed questionnaires and forms. Nurses report often that the patient does not always understand the terminology, and says different answers when the questions are asked in everyday language. This is a good time to ask if patients have had recent vaccines, surgery, dental problems, or other health issues. Follow up on details about any family history of cancer, especially in first-degree relatives (parent, sibling, child). It is especially important to know if the person has ever had cancer before and if so, when and what type it was, and how it was treated at that time; or if they have had radiation therapy. This may require getting release of information forms signed, since most patients cannot provide enough detail. A cancer history can affect treatment choices since radiation and medications with cumulative dose toxicity might not be available for use due to concerns about effects on certain organs from past drug or radiation treatment. Co-morbid conditions can also affect cancer treatment choices and drug doses. Given that many people with cancer are older, there is greater likelihood of co-morbidities. Problems like cardiac arrhythmias, prolonged QT interval, congestive heart failure, lung disease, hypertension, diabetes, kidney disease, HIV, hepatitis B or C, and frequent heartburn or reflux can affect treatment. Drug allergies and intolerances can indicate possible issues with future cancer treatments. Medications and drug use: This assessment must also include daily meds plus a listing of p.r.n. medications, herbs, supplements, and recreational drugs the patient takes must be elicited. Drinking habits