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Stages of Cancer

Stages of cancer of the lip and oral cavity

After it has been determined that an actual cancer exists, the degree to which the cancer has developed is determined. This is done for several reasons, the most important of which is providing a universally understood definition of a particular cancers progress. It aids in planning the treatment protocol for that particular cancer, determining prognosis, and also allows accurate end-results reporting. Treating physicians can speak to each other in a common language about something which might otherwise be discussed in subjective terms. Defining clear-cut descriptions of the disease at certain levels of development is called staging. A doctor, or treatment planning team, needs to know the stage of the disease to plan appropriate treatments. It is important to understand that while certain generalities can be drawn from these stages and the TNM system, each individual and each cancer are unique in many respects. While it is certainly true that individuals who are diagnosed with advanced stages (higher numbers) have a poorer prognosis of both cure and survival, that does not mean that people with these advanced stages will have a poorer outcome. We are all individuals and there is no hard rule or absolutes about survivability as it relates to staging.

Personal/editorial note from Brian Hill: I have avoided, in almost all of the web site, putting personal observations and comments into the content of the site, keeping it factual and not opinionated. But I get so many emails about this topic that I have to alter form here and make some personal and subjective observations.... if only to lighten my email load. You are likely on this page because someone has told you that you are a certain stage cancer. Staging and statistics can throw a newly diagnosed patient into confusion. The first rule of thumb is that no doctor can tell you ABSOLUTLY what your chances are of being cured or dying no matter what stage you are. Neither can they tell you how long you will live. Do not inquire about these things unless your doctor tells you that death is imminent and you must get your affairs in order. Even then, do not assume he can tell you for sure. He may speak from a statistical perspective, but that may not apply to you. You may be different in many ways from the population of individuals from which those statistics are derived. For instance, they may all be older than you, or all male, or many other possible variables. He may speak from his history of personal observations, but again, that may not apply to you, and his personal experience may not reflect accurately what is happening at another institution, in other patient populations, etc.

These three following links may be of value as you contemplate your situation as a newly diagnosed cancer patient. The first is a commentary on statistics and the value of them, or perhaps the lack of value. The second is on the importance of getting a second opinion, which everyone should get as soon as possible, and is something that any quality doctor will not object to you doing. In the latter, remember that time is of the essence when it comes to cancer, and don’t spend too much time before entering into a treatment plan specifically designed for you by a TEAM of doctors, ideally representing those from a variety of disciplines. (i.e. surgery, radiation, chemotherapy, dental oncology, etc.).

The old adage that if all you have is a hammer, everything looks like a nail, can apply to doctors as well. Surgeons may tend to view solutions only from a surgical perspective, radiation oncologists from a radiation perspective etc. The best of all possible worlds is some type of combined therapies, and this treatment plan is best arrived at by a TUMOR BOARD at a comprehensive cancer center, or at minimum from a group of regional doctors from different disciplines, if it can be done in a timely fashion. Please do not accept an appointment for a second consultation with another type of doctor weeks down the road. Be your own advocate. If you can’t get a timely appointment with the doctor that is recommended, get on the phone and find another. Do not wait for someone that is on vacation, do not be afraid to get on the phone and fight for your own appointments if you have to, if your current doctors staff isn’t on this immediately. We all tend to view doctors with admiration and wonder, and most of the time we unconditionally trust their opinions. But even the best doctors can be wrong. That being said, two opinions are certainly better than one. That is why my preference is to seek out treatment in a hospital facility that has a cancer center and staff of all the different types of doctors in one place. Go to this link on our resources page for a list of the top 50 cancer hospitals in the US.

Do not let geography, as in the facility or doctor is close to home, determine your choice. You have been diagnosed with a very serious illness. You want to be in the best facility, with the best doctors, and the most current equipment and treatment options that you can possible get yourself into, and you have ONE chance to make the best decision possible. Cancer is very unforgiving of "half-measures", and it seldom offers patients a chance to change their minds mid-stream. And lastly in this personal, and subjective opinion that I am offering you here, remember that while we all think that doctors are an incredible group of individuals, some think that they have THE answer. There is no single doctor out there with THE ONLY ANSWER. Here I will leave you with a lighter thought. There is a distinct difference between God and a doctor, and that is that God knows he is not a doctor.

The following stages are used to describe cancer of the lip and oral cavity:

Stage I

The cancer is less than 2 centimeters in size (about 1 inch), and has not spread to lymph nodes in the area (lymph nodes are small almond shaped structures that are found throughout the body which produce and store infection-fighting cells).

Stage II

The cancer is more than 2 centimeters in size, but less than 4 centimeters (less than 2 inches), and has not spread to lymph nodes in the area.

Stage III

Either of the following may be true: The cancer is more than 4 centimeters in size. The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch).

Stage IV

Any of the following may be true: The cancer has spread to tissues around the lip and oral cavity. The lymph nodes in the area may or may not contain cancer. The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches). The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lip and oral cavity or in another part of the body.

The TNM staging system

Another method of staging oral carcinomas is referred to as the TNM method. In this method T describes the tumor, N describes the lymph nodes, and M describes distant metastasis.

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor 2 cm or less in greatest dimension

T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension

T3 Tumor more than 4 cm in greatest dimension. (Lip) Tumor invades adjacent structures (e.g., through cortical bone, into deep [extrinsic] muscle of tongue, maxillary sinus, skin)

T4 (Oral cavity) Tumor invades adjacent structures (e.g., through cortical bone, into deep [extrinsic] muscle of tongue, maxillary sinus, skin)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension

N2 Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than
6 cm in greatest dimension; in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension

N2a Metastasis in single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension

N2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension

N2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension

N3 Metastasis in a lymph node more than 6 cm in greatest dimension

MX Presence of distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis

For example a patient described as a T2N1M0, has a primary tumor of between 2 and 4 cm, that has metastasized to a single node on one side, and that node is less than 3cm in size, and there are no distant metastases present.

Grade

The definitions of the G categories apply to all head and neck sites except thyroid. These are:

G -    Histopathological Grading

GX - Grade of differentiation cannot be assessed
G1 - Well differentiated
G2 - Moderately differentiated
G3 - Poorly differentiated
G4 - Undifferentiated

Differentiation: In cancer, refers to how mature (developed) the cancer cells are in a tumor. Differentiated tumor cells resemble normal cells and tend to grow and spread at a slower rate than undifferentiated or poorly differentiated tumor cells, which lack the structure and function of normal cells and grow uncontrollably.

In other words, poorly differentiated tumors are able to cross all boundaries of tissue types (muscle, soft tissue, etc.), even into bone.

Invasive:  Another term comonly used when descirbing disease state is  invasive. The lesion is "focally invasive" for instance. In terms of cancer, the term focal means limited to a specific area.

All of these factors are taken into consideration for your treatment plan.