This PPT includes details of Cancer Staging

1. PRESENTED BY
Prof.VIJAYREDDY.V
PhD SCHOLAR, M.Sc(N), PGDHA,PGCDE,.
FACULTY
ESIC CON KALABURGI.

2. Cancer is a generic term for a large group of diseases
that can affect any part of the body. Other terms used
are malignant tumours and neoplasm’s.
One defining feature of cancer is the rapid creation of
abnormal cells that grow beyond their usual
boundaries, and which can then invade adjoining parts
of the body and spread to other organs, the latter
process is referred to as metastasizing. Metastases are a
major cause of death from cancer.

3.  Cancer is the second leading cause of death globally, and is responsible for an
estimated 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer.
 Approximately 70% of deaths from cancer occur in low- and middle-income
countries.
 Around one third of deaths from cancer are due to the 5 leading behavioral and
dietary risks: high body mass index, low fruit and vegetable intake, lack of physical
activity, tobacco use, and alcohol use.
 Tobacco use is the most important risk factor for cancer and is responsible for
approximately 22% of cancer deaths (2).
 Cancer causing infections, such as hepatitis and human papilloma virus (HPV), are
responsible for up to 25% of cancer cases in low- and middle-income countries (3).
 Late-stage presentation and inaccessible diagnosis and treatment are common. In
2017, only 26% of low-income countries reported having pathology services
generally available in the public sector. More than 90% of high-income countries
reported treatment services are available compared to less than 30% of low-income
countries.
 The economic impact of cancer is significant and is increasing. The total annual
economic cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion
(4).
 Only 1 in 5 low- and middle-income countries have the necessary data to drive
cancer policy (5).

5.  Cancer arises from the transformation of normal cells into tumour cells
in a multistage process that generally progresses from a pre-cancerous
lesion to a malignant tumour. These changes are the result of the
interaction between a person's genetic factors and 3 categories of
external agents, including:
 physical carcinogens, such as ultraviolet and ionizing radiation;
 chemical carcinogens, such as asbestos, components of tobacco smoke,
aflatoxin (a food contaminant), and arsenic (a drinking water
contaminant); and
 biological carcinogens, such as infections from certain viruses,
bacteria, or parasites.
 WHO, through its cancer research agency, International Agency for
Research on Cancer (IARC), maintains a classification of cancer-
causing agents.

6.  Tobacco use, alcohol use, unhealthy diet, and physical
inactivity are major cancer risk factors worldwide and are
also the 4 shared risk factors for other noncommunicable
diseases.
 Some chronic infections are risk factors for cancer and have
major relevance in low- and middle-income countries.
Approximately 15% of cancers diagnosed in 2012 were
attributed to carcinogenic infections, including Helicobacter
pylori, Human papillomavirus (HPV), Hepatitis B virus,
Hepatitis C virus, and Epstein-Barr virus3.
 Hepatitis B and C virus and some types of HPV increase the
risk for liver and cervical cancer, respectively. Infection
with HIV substantially increases the risk of cancers such as
cervical cancer.

7.  Signs and symptoms caused by cancer will vary depending on what part of the body is
affected.
 Some general signs and symptoms associated with, but not specific to, cancer, include:
 Fatigue
 Lump or area of thickening that can be felt under the skin
 Weight changes, including unintended loss or gain
 Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal, or
changes to existing moles
 Changes in bowel or bladder habits
 Persistent cough or trouble breathing
 Difficulty swallowing
 Hoarseness
 Persistent indigestion or discomfort after eating
 Persistent, unexplained muscle or joint pain
 Persistent, unexplained fevers or night sweats
 Unexplained bleeding or bruising

8.  Staging is the process of finding out how much cancer is in
a person’s body and where it’s located. It’s how the doctor
determines the stage of a person’s cancer.
 Why is cancer staging needed?
 For most types of cancer, doctors need to know how much
cancer there is and where it is (among other things) to help
determine the best treatment options. For example, the best
treatment for an early-stage cancer may
be surgery or radiation, while a more advanced-stage cancer
may need treatments that reach all parts of the body, such
as chemotherapy, targeted drug therapy, or immunotherapy.

9.  Aid treatment planning,
 Provide an indication of prognosis,
 Assist in the evaluation of treatment results,
 Facilitate the exchange of information between
treatment centres,
 Contribute to continuing investigations of human
malignancies,
 Support cancer control activities, including through
cancer registries.

10.  What goes into the stage: The TNM system
 There are different types of systems used to stage cancer,
but the most common and useful staging system for most
types of cancer is the TNM system.
 The American Joint Committee on Cancer (AJCC) and the
Union for International Cancer Control (UICC) maintain
the TNM classification system as a way for doctors to stage
many different types of cancer based on certain common
standards.
 In the TNM system, the overall stage is determined after the
cancer is assigned a letter or number to describe the tumor
(T), node (N), and metastasis (M) categories.

11.  In the TNM system, the overall stage is determined
after the cancer is assigned a letter or number to
describe the tumor (T), node (N), and metastasis (M)
categories.
 T describes the original (primary) tumor.
 N tells whether the cancer has spread to the nearby
lymph nodes.
 M tells whether the cancer has spread (metastasized)
to distant parts of the body

12.  Different types of exams and tests can be used to figure out a
cancer’s stage.
 Depending on where the cancer is located, a physical exam may
give some idea as to how much cancer there is.
 A biopsy often is needed to confirm a cancer diagnosis. Biopsies
might also be needed to find out if a lump felt on an exam or if
something seen on an imaging test in another part of the body is
really from the spread of cancer. During a biopsy, the doctor
removes a tumor or pieces of a tumor to be looked at in the lab.
Some biopsies are done during surgery. But biopsies can also be
done using a thin, hollow needle or through an endoscope. For
more on biopsies, see Testing Biopsy and Cytology Specimens
for Cancer.
 Lab tests of cancer cells (from a biopsy or surgery) and blood
tests can also be used to help stage some types of cancer.

13.  Imaging tests like x-rays, CT scans, MRIs, ultrasound,
and PET scans may also give information about how
much and where cancer is in the body.
 Endoscopy exams are sometimes used to look for
cancer. For these exams, an endoscope, which is a thin,
lighted tube (usually with a small video camera on the
end) is put inside the body to look for cancer.

14.  When trying to determine how much and where the cancer is in
the body, doctors first look at the primary (main) tumor, which
is where the cancer started. The tumor’s size, location, and
whether it has grown into nearby areas can all be important.
Doctors also check for other nearby tumors.
 The T category can be assigned a letter or a number:
 TX means there’s no information about the primary tumor, or it
can’t be measured.
 T0 means there is no evidence of a primary tumor (it cannot be
found).
 Tis means that the cancer cells are only growing in the layer of
cells where they started, without growing into deeper layers. This
may also be called in situ cancer or pre-cancer.

15.  Lymph nodes near the primary tumor are usually are
checked to find out if cancer has spread into them. Lymph
nodes are small, bean-shaped collections of immune cells.
Many types of cancer often spread to nearby lymph nodes
before they reach other parts of the body.
 The N category can be assigned a letter or a number:
 NX means there’s no information about the nearby lymph
nodes, or they can’t be assessed.
 N0 means nearby lymph nodes do not contain cancer.
 A number after the N (such as N1, N2, or N3) might
describe the size, location, and/or the number of nearby
lymph nodes affected by cancer. The higher the N number,
the greater the cancer spread to nearby lymph nodes.

16.  Doctors might also look at other parts of the body to see if the
cancer has spread. Cancer spread to parts of the body far from
the primary tumor is known as metastasis.
 The M category is assigned a number:
 M0 means that no distant cancer spread has been found.
 M1 means that the cancer has been found to have spread
to distant organs or tissues.
 Each cancer type has its own version of the TNM categories, so
letters and numbers don’t mean the same thing for every type of
cancer. For example, for some types of cancer, the T categories
describe the size of the main tumor, while for others they
describe how deeply the tumor has grown into the organ it started
in, or whether the tumor has grown into nearby structures
(regardless of its size).

17.  Tumour, node and metastasis (TNM) staging is the
most common way that doctors stage stomach cancer.
 Doctors may also use the number staging system.
 The stage of a cancer tells you how big it is and how
far it’s spread. It helps your doctor decide which
treatment you need.
 Your scans will give some information about the stage
of your cancer, but your doctor may not be able to tell
you the exact stage until you have surgery.

18.  Tumour describes the size of the tumour.
 There are 4 main stages of tumour size in stomach cancer.
 T1 means the tumour has started to grow into the wall of the stomach. It’s
divided into T1a and T1b:
 T1a means the tumour is within the inner layers of the stomach (the mucosa)
 T1b means the tumour has grown through the mucosa and into a layer of
supportive tissue called the submucosa
 T2 means the tumour has grown into the muscle layer of the stomach
 T3 means the tumour has grown into the outer lining of the stomach
 T4 means that the tumour has grown through the outer lining of the stomach.
It’s divided into T4a and T4b:
 T4a means the tumour has broken through the outer lining of the stomach wall
 T4b means the tumour has grown through the stomach wall and into other
organs or body structures nearby such as the liver, food pipe (oeosphagus) or
abdominal wall

19.  Node (N) describes whether the cancer has spread to the lymph nodes.
Lymph nodes are a network of glands throughout the body, for
example in your armpits, neck and groins. They drain away waste fluid,
waste products and damaged cells, and contain cells that fight
infection.
 There are 4 possible stages describing whether cancer cells are in the
lymph nodes – N0, N1, N2 and N3:
 N0 means there are no lymph nodes containing cancer cells.
 N1 means there are cancer cells in 1 to 2 lymph nodes near to the
stomach.
 N2 means there are cancer cells in 3 to 6 nearby lymph nodes.
 N3 is split into N3a and N3b:
 N3a means there are cancer cells in 7 to 15 nearby lymph nodes
 N3b means there are cancer cells in 16 or more nearby lymph nodes

20.  Metastasis describes whether the cancer has spread to a
different part of the body.
 There are 2 stages of metastasis:
 M0 means the cancer has not spread to other organs
 M1 means the cancer has spread to other parts of the
body

21.  https://www.who.int/
 https://www.nccn.org
 https://www.cancer.org/
 https://www.cancerresearchuk.org/
 https://www.uicc.org/
 https://www.mayoclinic.org/

22. Thank you