Patients who are diagnosed with cancer often receive a tremendous amount of information and it’s common for them to have questions, says gynecologic oncologist Dr. Kathleen Yang with Willamette Valley Cancer Institute.
“Patients want to know, ‘Is this cancer serious? Am I OK? Am I going to survive this?’ When I begin explaining a patient’s condition to them, I usually start with two things. First, I tell them what type of cancer they have. And second, what organ the cancer arises from.”
To answer a patient’s questions about the severity of their cancer, Dr. Yang and other involved physicians need to know more about an individual’s specific disease, including the stage and grade.
Cancer staging is a process by which oncology specialists figure out how advanced the cancer is, says pathologist Dr. Denis McCarthy with Pathology Consultants PC. “Is it localized? Has it been caught very early or has it spread widely?”
Doctors need to know the amount of cancer and where it’s located to choose the best treatment options, which may include surgery, chemotherapy or radiation, or a combination of treatments. Doctors also consider the cancer’s stage to predict the course it will likely take.
“We’ll look at the size of the tumor and what structures it invades through. For example, you can have a tumor located just at the surface of the colon, in the mucosa, that’s considered early cancer. But if it is invading into the muscular wall of the colon or invading through the wall and into the fat surrounding the colon, that’s more serious. That’s all part of the tumor stage,” says Dr. McCarthy.
In general, cancer has four stages. For most cancers, the stage is a Roman numeral from I to IV. Stage I cancers are least advanced and often result in a good prognosis. Stage IV (4) is the highest and means the cancer is more advanced. Sometimes stages are subdivided, using letters such as A and B. Learn more about staging here.
The term “grade” refers to the nature of the cancer. It describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread.
“The grade of a tumor is basically, how ugly does this tumor look? The closer it looks to normal tissues, the lower the grade,” says Dr. McCarthy. “Uglier tumors tend to be more aggressive, although that is not always the case.”
Working together on a patient’s behalf
Cancer patients will likely see multiple specialists from diagnosis through treatment. To help streamline that process, physicians from about a dozen specialty clinics in the Eugene-Springfield community work together through the Oregon Cancer Alliance, coordinating care and discussing specific cases as a group in what’s known as tumor boards.
“Cancer is a really complex and difficult problem to solve in many cases,” says Dr. Kristian Ferry, a surgeon with Avanté Surgical. “And success really comes from a multipronged approach of treatment of the cancer.”
While in-person tumor board gatherings have transitioned to virtual discussions, due to the current health crisis, the collaboration remains invaluable.
Oregon Medical Group radiologist Dr. Michael Milstein says, “There’s so much involved in diagnosis and treatment — one person can’t do it all. So, it’s really nice to have the expertise of other people to help you provide the best care for the patient.”
“At the very least, everyone takes a look at a patient’s information again. Pathologists look at the case again under the microscope, radiologists look at radiology again. It’s a second look and second looks are always good,” Dr. McCarthy says.
The type of treatment you choose to receive helps determine your prognosis, the likely outcome or course of your cancer and your chances for recovery or recurrence. It can be hard to understand what prognosis means and also hard to talk about, even for doctors.
“Prognosis is an educated guess based on statistical information,” says Dr. Yang. “It does not predict what will happen, so I always try to explain that upfront to the patient.”
You can ask your doctor about survival statistics or you may find statistics confusing and frightening, or too impersonal to be of value to you. It is up to you to decide how much information you want. If you decide you want to know more, the oncologist who knows the most about your situation is in the best position to discuss your prognosis and explain what the statistics may mean.
The Oregon Cancer Alliance encourages patients to learn as much as they can, or choose to, about their condition and to ask questions, so that they feel empowered to make the treatment decisions that are right for them.