Staging and Management

Abstract

When a diagnosis of cancer has been made, an evaluation of the extent of spread is needed. Different types of neoplasms have different effects. Hematological or “fluid” malignancies predominantly affect the bone marrow, spleen, liver, and lymph nodes, but can involve other sites such as the central nervous system or testes. “Solid” tumors, such as those of the lung, bowel, or breast, invade neighboring structures and spread via the lymphatics to regional nodes and via the blood stream to distant sites. Patterns of spread are reasonably predictable, and laboratory or radiologic investigations or studies for staging of site-specific neoplasms reflect this. The clinical examination and results of these investigations form the basis of classical staging, as shown in Table 1. If the clinical stage reflects the “true” pathological stage as, for example, carcinoma in situ of the uterine cervix or stage I laryngeal cancer, then the chances of cure following local treatment are high. If the investigations show evidence of distant spread, then local treatment, however radical, will not cure the patient. Staging provides part of the basis upon which rational treatment decisions are made.