{"id":1356,"date":"2020-11-17T16:01:28","date_gmt":"2020-11-17T15:01:28","guid":{"rendered":"http:\/\/youtumor.org\/a-tumor-has-just-been-found\/understanding-the-gravity-what-stage-is-it\/"},"modified":"2021-01-14T13:20:39","modified_gmt":"2021-01-14T12:20:39","slug":"understanding-the-gravity-what-stage-is-it","status":"publish","type":"page","link":"https:\/\/youtumor.org\/en\/there-is-or-there-was-a-tumor\/a-tumor-has-just-been-found\/understanding-the-gravity-what-stage-is-it\/","title":{"rendered":"UNDERSTANDING THE GRAVITY: WHAT STAGE IS IT?"},"content":{"rendered":"\n<p><span style=\"text-decoration: underline;\"><strong>Once the diagnosis has been made, we need to know how far the cancer extends<\/strong><\/span> in the organ where it is located and whether it has spread to other organs (metastasis). This means &#8220;staging&#8221; the tumor by means of instrumental examinations: CT, PET, magnetic resonance, scintigraphy, echography, etc. <span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p><span style=\"text-decoration: underline;\"><strong>Depending on the stage of the tumor, the first important decision regarding treatment will be taken.<\/strong><\/span> The options are:<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<ul>\n<li>operate immediately (or administer local therapies instead of operating);<\/li>\n<li>administer treatment first, and then operate;<\/li>\n<li>administer treatment without operating, as surgery is no longer possible because the disease is already at an advanced stage.\u00a0<\/li>\n<\/ul>\n<p>\u00a0<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>The first step in staging is to find out whether there are any distant metastases<\/strong><\/span> (<a href=\"https:\/\/youtumor.org\/en\/id-like-to-know-more\/what-are-metastases\/\">WHAT ARE METASTASES?<\/a>). <span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Metastases are groups of cells that have detached from the tumor and spread to other organs, where they have begun to grow and to form other nodules.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p><strong><span style=\"text-decoration: underline;\">The question of whether or not there are distant metastases is of enormous importance<\/span> <\/strong>(<a href=\"https:\/\/youtumor.org\/en\/ce-o-ce-stato-un-tumore\/a-tumor-has-just-been-found\/understanding-the-gravity-what-stage-is-it\/why-is-staging-so-important\/\">WHY STAGING IS SO IMPORTANT<\/a>). If there are already metastases, the disease is generally no longer curable; if, by contrast, the tumor has not yet given rise to metastases, the disease can generally be cured by removing the tumor surgically.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>With regard to distant metastases, staging can have 3 possible outcome<\/strong><\/span>s (FIGURES 2 and 3):<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<ol>\n<li>positive for the presence of metastases;<\/li>\n<li>negative, because there are no metastases;<\/li>\n<li>negative, because metastases are present but are still too small to be seen (less than 0.5 \u2013 1 cm). In this last case, the disease is actually at an advanced stage, though neither the patient nor the doctor can know this.\u00a0<\/li>\n<\/ol>\n<p>\u00a0<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-style-default\"><img fetchpriority=\"high\" decoding=\"async\" width=\"841\" height=\"525\" src=\"http:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/2_tumor_staging.png\" alt=\"\" class=\"wp-image-1254\" srcset=\"https:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/2_tumor_staging.png 841w, https:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/2_tumor_staging-300x187.png 300w, https:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/2_tumor_staging-768x479.png 768w\" sizes=\"(max-width: 841px) 100vw, 841px\" \/><figcaption><strong class=\"caption-title\">Fig 2. Possible results of tumor staging: metastases may be microscopic and therefore invisible on the common imaging tests <\/strong> There are 3 possible outcomes of staging, which is the assessment of whether the tumor has spread to distant organs. In the first case, the staging result is truly negative because the primary tumor has not spread outside the local site of origin as evidenced by negative CT, PET scan and magnetic resonance tests ( =no tumor in other organs). After the primary tumor is removed, the patient is cured.<br>\nIn the second case, the staging result is falsely negative because although the CT, PET scan and magnetic resonance tests are negative (=no tumor in other organs) the primary tumor has already spread outside the local origin, but these small nodules are too small to be revealed by the imaging tests. These tests usually disclose nodules of at least 0.5-1 cm ( the dotted line in the figure). After the primary tumor is removed, the patient is not cured. A relapse will become known when these small nodules have grown above that threshold.<br>\nIn the third case, the staging result is positive (= presence of cancer in other organs ) because metastases are already seen by the staging tests: they are already large enough at the time the primary cancer is discovered.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-style-default\"><img decoding=\"async\" width=\"846\" height=\"558\" src=\"http:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/3_metastases.png\" alt=\"\" class=\"wp-image-1257\" srcset=\"https:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/3_metastases.png 846w, https:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/3_metastases-300x198.png 300w, https:\/\/youtumor.org\/wp-content\/uploads\/2020\/11\/3_metastases-768x507.png 768w\" sizes=\"(max-width: 846px) 100vw, 846px\" \/><figcaption><strong class=\"caption-title\">Fig 3. Metastases may appear months or years after the primary tumor, or even at the same time as, or before, the primary<\/strong>\nFIG 3 Sometimes the metastases appear even before the primary tumor is found. This happens when 1) the primary tumor starts spreading metastases at a very early stage of development and 2) the metastases grow faster than the primary tumor. <\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p><span style=\"text-decoration: underline;\"><strong>There is, however, an important difference between the first and the third conditions described above<\/strong><\/span>. In general, the first situation is one of disseminated (widespread) disease that is no longer curable, while in the third situation, cure is still possible. Indeed, postsurgical therapy \u2013 so-called adjuvant therapy \u2013 is able to eliminate these tiny (less than 1 mm) deposits of tumor cells (micrometastases), precisely because they are microscopic. In the first situation (metastases of a few cm), by contrast, it is not. (<a href=\"https:\/\/youtumor.org\/en\/surgical-operation\/assessing-the-risk-of-relapse-after-surgery\/possible-adjuvant-preventive-therapy-after-surgery\/\">POSSIBLE PREVENTIVE THERAPY AFTER SURGERY<\/a>)<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>The second step in staging, when distant metastases have been ruled out, is to establish the local extension<\/strong><\/span> of the tumor, in order to determine how easy or difficult it will be to completely remove it by means of surgery.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n<p>Local staging depends on the size and local extension of the tumor and on whether the nearby lymph nodes are affected.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n<p><span style=\"text-decoration: underline;\"><strong>The table below shows the classic division of tumors into 4 stages.<\/strong><\/span> The differences are extremely important, as they enable us to clearly distinguish between conditions that are curable by means of surgery and other therapies (stages 1, 2 and 3) and those which are generally no longer curable owing to the advanced stage of the disease (stage 4).<\/p>\n<h4>CLASSIC STAGING: 4 LEVELS OR STAGES<\/h4>\n\n\n\n<figure class=\"wp-block-table\"><table><thead><tr><th class=\"has-text-align-left\" data-align=\"left\">STAGE<\/th><th class=\"has-text-align-left\" data-align=\"left\">TUMOR<\/th><th class=\"has-text-align-left\" data-align=\"left\">LOCAL LYMPH NODES<\/th><th class=\"has-text-align-left\" data-align=\"left\">METASTASES<\/th><\/tr><\/thead><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\">1<\/td><td class=\"has-text-align-left\" data-align=\"left\">small<\/td><td class=\"has-text-align-left\" data-align=\"left\">without tumor<\/td><td class=\"has-text-align-left\" data-align=\"left\">absent<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\">2<\/td><td class=\"has-text-align-left\" data-align=\"left\">larger<\/td><td class=\"has-text-align-left\" data-align=\"left\">without tumor<\/td><td class=\"has-text-align-left\" data-align=\"left\">absent<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\">3<\/td><td class=\"has-text-align-left\" data-align=\"left\">large or small<\/td><td class=\"has-text-align-left\" data-align=\"left\">with tumor<\/td><td class=\"has-text-align-left\" data-align=\"left\">absent<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\">4<\/td><td class=\"has-text-align-left\" data-align=\"left\">large or small<\/td><td class=\"has-text-align-left\" data-align=\"left\">with or without tumor <\/td><td class=\"has-text-align-left\" data-align=\"left\">present <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><span style=\"text-decoration: underline;\"><strong>In reality, however, things are much more complicated than this<\/strong><\/span>, as each type of tumor has its own variants. Nevertheless, this simple classification provides a general indication of the gravity of tumors.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p><span style=\"text-decoration: underline;\"><strong>Finally, it must be pointed out that the preoperative staging described above will be completed when surgery is performed.<\/strong> <\/span>Indeed, when the surgeon directly inspects the operating field and the entire surgical specimen is analyzed by the pathologist, the stage previously assigned to the tumor on the basis of imaging may be confirmed or modified.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Once the diagnosis has been made, we need to know how far the cancer extends in the organ where it is located and whether it has spread to other organs (metastasis). This means &#8220;staging&#8221; the tumor by means of instrumental examinations: CT, PET, magnetic resonance, scintigraphy, echography, etc. \u00a0 Depending on the stage of the [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":1342,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1356","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/pages\/1356","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/comments?post=1356"}],"version-history":[{"count":18,"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/pages\/1356\/revisions"}],"predecessor-version":[{"id":4749,"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/pages\/1356\/revisions\/4749"}],"up":[{"embeddable":true,"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/pages\/1342"}],"wp:attachment":[{"href":"https:\/\/youtumor.org\/en\/wp-json\/wp\/v2\/media?parent=1356"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}