What is Cancer Staging? 

Cancer staging is a process your oncologist uses to determine the extent of your disease. Staging considers factors such as your cancer type, where the cancer is located, and its size. While many solid tumors follow the TNM system (tumor, lymph nodes, metastasis/spread), blood cancers (hematologic cancers) are staged differently.

The language used to describe your staging may vary from someone who has a different cancer type than you. Cancer staging is important in helping your oncologist determine treatment options, as well as prognosis. 

How is Cancer Staged? 

There are many different exams that are used in determining a patient's cancer stage. Some of those exams can include: 

• Lab tests  

• Imaging such as PET (Positron Emission Tomography), MRI (Magnetic Resonance Imaging), and CT (Computed Tomography) scans 

• Biopsy  

• Physical examination 

Should Staging Always Occur Before Treatment? 

The short answer is maybe. Before starting any treatment, your oncologist will want to make sure they are giving you the appropriate treatment based on the size and location of your cancer. However, there may be times when all diagnostic testing has not been performed and treatment needs to be initiated.  

Hematological Cancer Staging by Cancer Type 

Lymphoma uses the Lugano Classification:

• Stage 1: Only one lymph node area/organ within the lymphatic system (spleen, thymus, Waldeyer's ring) is affected by the cancer, or the cancer is noted in one organ outside of the lymphatic system. 

• Stage 2: Two or more groups of lymph nodes are noted above or below the diaphragm (must be on the same side), or cancer is noted in one group of lymph nodes and an organ nearby. 

• Stage 3: Cancer is noted on lymph nodes of both sides of the diaphragm (above and below), or the spleen and lymph nodes above the diaphragm are affected. 

• Stage 4: Cancer has spread to an organ that is not part of the lymphatic system.

Chronic Lymphocytic Leukemia uses both the Rai system and Binet system:

1. The Rai system is broken down into stage 0- 4:  

   • Stage 0: Lymphocytosis is noted in either the blood or bone marrow. 

   • Stage 1: Lymphocytosis is noted in either the blood or bone marrow with enlarging of the lymph nodes. 

   • Stage 2: Lymphocytosis is noted in either the blood or bone marrow with enlarging of the spleen and/or liver noted. 

   • Stage 3: Lymphocytosis is noted in either the blood or bone marrow with anemia. Enlarging of lymph nodes, liver, and/or spleen may or may not be present. 

   • Stage 4: Lymphocytosis is noted in either the blood or bone marrow with platelet counts below 100,000. Anemia may or may not be present. Enlarging of lymph nodes, liver, and/or spleen may or may not be present. 

2. The Binet staging system is divided into three groups:

   • Stage A: Fewer than three areas of lymph tissue are noted to be enlarged. Low platelet count or anemia is not present. 

   • Stage B: At least three areas of lymph tissue are noted to be enlarged. Low platelet count or anemia is not present. 

   • Stage C: Multiple areas of lymph tissues are noted to be enlarged in conjunction with low platelet count and/or anemia. 

Good to Know

Acute Lymphocytic Leukemia and Chronic Myelogenous Leukemia are not staged.  

Multiple Myeloma uses RISS:

• Stage I: Normal LDH in labs. No evidence of high-risk gene markers. Albumin level greater than 3.5 g/dl and microglobulin less than 3.5mg/L on labs. 

• Stage II: Not stage I or stage III 

• Stage III: Microglobulin level at or greater than 5.5mg/L in combination with elevated LDH levels and/or high-risk genetic markers. 

Why is This Important?

Understanding your cancer stage is a crucial factor in advocating for your needs. This allows you to ask the appropriate questions regarding what to expect.

Questions to consider asking are: 

• How does my cancer stage affect my prognosis? 

• Are there any clinical trials available for my cancer type and stage? 

• What treatment options are available for my cancer?