Staging is the process of describing the extent or progression of the disease. In solid tumors like anal cancer, staging is important in determining the treatment plan, monitoring the patient’s response to the treatment and to assess its prognosis.
The most commonly known staging system utilized today is the TNM (Tumor/Node/Metastasis) System, established by the American Joint Committee on Cancer (AJCC). It assesses tumors based on the size or extent of primary tumor (T), the absence or presence of lymph nodes involvement (N) and the absence or presence of metastasis or spread of cancer cells to distant parts of the body.
Interpreting The Meanings
As described by The American Cancer Society, each factor is numbered from 0-4 or the letter X representing the severity of the condition. For example, in primary tumor, Tx is used, and this means a primary tumor cannot be assessed; T0 means no evidence of primary tumor; Tis reading would mean that the cancer is only in the mucosa or top layer of cells lining the anus; T1 the tumor is 2cm in dimension; T2 means the tumor is more than 2cm but not more than 5cm; T3 is a tumor that is larger than 5cm; and T4 where the tumor is any size and is growing into nearby organs.
For the lymph nodes involvement, the following are used:
- NX – Regional lymph nodes cannot be assessed
- N0 – No regional lymph nodes metastasis
- N1 – Involvement in perirectal lymph nodes
- N2 – Involvement in unilateral internal iliac and inguinal lymph nodes
- N3 – Metastasis in perirectal and inguinal lymph nodes and bilateral internal iliac and inguinal lymph nodes.
Lastly, for the metastasis, there are only two categories involved:
- M0 – For no distant metastasis
- M1 – With distant metastasis.
After TNM scores have been assigned, it is then grouped into stages. It ranges from stage I to IV, Stage I being the early stage and IV being the advanced stage.
Stages Of Anal Cancer
According to AJCC system effective January 2018, the following are the staging of anal cancer (Source: American Joint Committee on Cancer).
Stage 0 – Tis, N0, M0. The cancer is only in the mucosa, no lymph nodes and metastasis involve.
Stage I – T1, N0, M0. The tumor size is merely 2cm, has not spread to nearby lymph nodes or to distant sites.
Stage IIA – T2, N0, M0. The tumor can range from 2cm, but not more than 5cm has not spread to nearby lymph nodes or to distant sites.
Stage IIB – T3, N0, M0. The tumor is larger than 5cm but has not spread to nearby lymph nodes or to distant sites.
Stage IIIA – T1, N1, M0. The tumor is 2 cm, has spread to lymph nodes near the rectum but no distant sites involve. Another interpretation is T2, N1, M0 which means the tumor is more than 2cm but not more than 5cm in greatest dimension, has spread to lymph nodes near the rectum but no metastasis.
Stage IIIB – T4, N0, M0. At this stage, the tumor is of any size and is growing into nearby organs such as vagina, urethra, prostate gland or bladder, but no lymph nodes or metastasis involve.
Stage IIIC – T3, N1, M0. The tumor is larger than 5cm, has spread to lymph nodes but no metastasis) or T4, N1, M0 wherein the tumor is any size and growing into nearby organs, has spread to lymph nodes but no metastasis.
Stage IV. This is when any T, any N, M1 tumor can be any size may or may not grow into nearby organs or spread to nearby lymph nodes and it has spread to distant organs such as liver or lungs.
Helping Through The Stages
Getting a diagnosis of cancer can be a life-altering situation. There is no degree of putting the icing on the cake when cancer is the main topic. Relationship problems can occur as deterioration of physical and psychological dimension progress. Family members and significant others should be there with the person when this happens. A person diagnosed with cancer needs all the love and support they can need during this ordeal. Whatever stage they are in, continuous physical, emotional, psychological, and spiritual support is highly encouraged.