How do doctors determine what stage of cancer you have? - Hyunsoo Joshua No and Trudy Wu

Summary

The video script explains cancer staging, which uses T, N, and M to denote tumor size, lymph node involvement, and metastasis. It clarifies how these variables determine a cancer's overall stage, affecting treatment and prognosis, and highlights advancements in staging and treatment that offer hope.

Takeaways

• 🧪 Each year, approximately 20 million people worldwide receive a cancer diagnosis.
• 🔢 Cancer staging ranges from 1 to 4 and helps patients understand their condition, though it can be confusing.
• 🧬 Staging is determined by three variables: T (tumor size), N (lymph node involvement), and M (metastasis).
• 🔍 T stages typically range from 1 to 4 and are often based on tumor size, but criteria vary by cancer type.
• 🔎 N stages assess cancer spread to lymph nodes, with higher stages indicating more extensive spread.
• ⚖️ M stages involve assessing metastasis, historically a binary yes/no but now seen as a continuum.
• 🔗 TNM combinations create different overall stages, each reflecting treatment difficulty.
• 📊 Each cancer type has unique staging criteria and survival rates, even for the same TNM combinations.
• 🔄 Staging systems are constantly evolving with new research and treatment advancements.
• 🌟 Early detection and improved treatments are increasing survival rates and offering more hope.

Q & A

How many people are diagnosed with cancer each year worldwide?

Approximately 20 million people receive a cancer diagnosis each year.

What is the purpose of cancer staging?

Cancer staging is designed to help patients better understand what they are facing by categorizing the extent of their disease.

What are the three variables used in the cancer staging system?

The three variables used in the staging system are T (tumor size), N (presence in lymph nodes), and M (metastasis to other organs).

What does the T designation in cancer staging represent?

The T designation represents the size of the tumor, with different criteria for different types of cancer.

How does the size of a tumor affect its T stage in different cancers?

For example, a five-centimeter-wide tumor is labeled as T3 in oral cancers but T2 in breast cancers.

What is the role of lymph nodes in cancer staging?

Lymph nodes are evaluated for cancer staging to determine if cancer cells have spread from the initial tumor through the lymphatic system.

How does the N stage in cancer staging reflect the spread of cancer?

Cancers that spread to larger, more distant, or a greater number of lymph nodes typically have higher N stages.

What does the M stage in cancer staging indicate?

The M stage indicates whether the cancer has metastasized to other organs or bones, which is a more threatening category of cancer spread.

How does the combination of TNM stages correlate to an overall cancer stage?

Each TNM combination correlates to a different overall stage, ordered by how difficult the cancer is to treat, with definitions specific to each type of cancer.

Why might the same TNM combination result in different overall stages for different types of cancer?

The same TNM combination might result in different overall stages because the behavior and response to treatment of cancers with different spreads and characteristics vary.

How have advances in treatment and genetic testing affected cancer staging?

Advances in treatment and genetic testing have prompted the medical community to rethink and refine cancer staging, leading to more accurate and targeted treatment approaches.

What impact do improvements in cancer screening have on the staging and treatment of cancer?

Improvements in cancer screening lead to more cancers being discovered at early stages, which can result in better treatment outcomes and higher survival rates.

Outlines

00:00

🏥 Understanding Cancer Staging

Cancer staging is a critical component in the diagnosis and treatment process, helping patients comprehend their condition. Each year, about 20 million people receive a cancer diagnosis and are informed of their cancer's stage, typically a number from 1 to 4. The TNM system is used by doctors to describe a tumor's characteristics: T for tumor size, N for lymph node involvement, and M for metastasis. This system requires thorough investigation, including symptoms assessment, health evaluation, tissue biopsy, medical scans, and blood tests. Tumor size is generally indicated by a number from 1 to 4, but criteria vary by cancer type. Lymph node evaluation (N stage) considers the spread of cancer cells through the lymphatic system, with higher stages indicating more extensive spread. Metastasis (M stage) involves the spread to other organs or bones, historically a binary 'yes' or 'no' but now considered on a continuum due to treatment advances. The combination of TNM stages correlates to an overall cancer stage, which varies by cancer type and is based on research into cancer behavior and treatment response. For example, a T3N1M0 stage in breast cancer is stage 3 with an 85% five-year survival rate, while the same TNM combination in pancreatic cancer is stage 2 with a 15% survival rate. The staging system is dynamic, with changes reflecting advances in treatment and genetic testing, leading to more accurate and hopeful prognoses.

05:00

🌟 Advances in Cancer Treatment

The script concludes with a hopeful outlook on cancer treatment, acknowledging the significant strides made in recent years. Advances in therapy have transformed cancers once deemed untreatable into conditions with high remission rates. Improvements in screening have also led to earlier cancer detection, increasing the chances of successful treatment. This progress offers patients and their loved ones greater hope for the future, with better treatments and more targeted cures on the horizon.

Keywords

💡Cancer Diagnosis

A cancer diagnosis refers to the process of identifying cancer in a person. It is a critical moment in the video's narrative as it sets the stage for discussing the complexities of cancer staging. The script mentions that approximately 20 million people receive a cancer diagnosis each year, highlighting the prevalence and importance of understanding cancer stages to manage patient expectations and treatment plans.

💡Cancer Staging

Cancer staging is a system used by doctors to describe the extent of a cancer in the body. It is central to the video's theme, as it helps patients and healthcare providers understand the severity of the disease. The script explains that cancer stages are typically represented by numbers from 1 to 4, and understanding these stages is crucial for determining treatment options and prognosis.

💡TNM System

The TNM system is a method used to classify the size of the tumor (T), the involvement of lymph nodes (N), and the presence of metastasis (M). It is a key concept in the video, as it underpins the staging of cancers. The script details how doctors use this system to describe tumors and inform treatment decisions, emphasizing its importance in understanding the progression and severity of cancer.

💡Tumor Size

Tumor size is a critical factor in cancer staging, particularly in the T component of the TNM system. The video script explains that the T designation is usually a number between 1 to 4, based on the size of the tumor. This is significant as it helps in determining the cancer's stage and, consequently, the treatment approach. For example, a larger tumor might be labeled as T3, indicating a more advanced stage.

💡Lymph Nodes

Lymph nodes play a significant role in the N component of the TNM system. They are part of the immune system and can be affected by cancer cells. The script discusses how doctors evaluate lymph nodes through biopsies and imaging to determine the N stage. This is crucial in understanding how cancer might spread and the potential need for more aggressive treatment.

💡Metastasis

Metastasis refers to the spread of cancer cells from the original tumor to other parts of the body. It is a critical concept in the M component of the TNM system. The script highlights that historically, metastasis was a binary 'yes' or 'no' factor, but advances in treatment have led to a more nuanced understanding. This is significant as it affects the staging and treatment of cancers, particularly in terms of prognosis.

💡Survival Rate

Survival rate is a measure of the percentage of patients who survive a certain disease for a specified period. In the context of the video, it is used to illustrate the prognosis associated with different cancer stages. The script provides examples, such as a T3N1M0 breast cancer being considered stage 3 with an 85% five-year survival rate, which underscores the importance of staging in predicting outcomes.

💡Treatment Advances

Treatment advances refer to improvements in medical therapies and techniques that can change the prognosis and management of cancer. The video script mentions that these advances can lead to changes in cancer staging, reflecting better outcomes for patients. This is significant as it shows how the understanding and treatment of cancer evolve over time, offering hope for improved survival rates.

💡Genetic Testing

Genetic testing is the analysis of DNA to identify changes that may increase the risk of developing specific health conditions, including cancer. The script mentions that advancements in genetic testing are refining cancer staging, particularly in breast, prostate, and gynecological cancers. This is important as it can lead to more personalized and effective treatment plans based on the genetic characteristics of the tumor.

💡Screening

Screening refers to the process of checking for a disease or condition in people who have no symptoms. In the video, it is mentioned that improvements in cancer screenings are leading to more cancers being discovered at early stages. This is significant as early detection can greatly improve treatment outcomes and survival rates.

💡Remission

Remission is a term used to describe the disappearance of all signs of a disease, particularly cancer. The script highlights that many cancers that were once considered nearly impossible to treat are now associated with high rates of remission due to breakthroughs in therapies. This is a key point in the video, illustrating the progress made in cancer treatment and the potential for recovery.

Highlights

Approximately 20 million people receive a cancer diagnosis each year.

Cancer stages are typically a number ranging from 1 to 4, designed to help patients understand their condition.

Cancer staging involves the variables T (tumor size), N (lymph nodes), and M (metastasis).

Physicians use a system with T, N, and M to describe a tumor’s characteristics.

T staging is generally based on tumor size, but varies by cancer type.

N staging evaluates lymph nodes through biopsies and imaging.

M staging indicates whether cancer has spread to other organs or bones.

The TNM combination correlates to an overall cancer stage, indicating treatment difficulty.

Cancer stages vary in meaning across different types of cancer.

A T3N1M0 combination in breast cancer is considered stage 3 with an 85% five-year survival rate.

The same TNM combination in pancreatic cancer is stage 2 but has a lower survival rate.

The staging system is intricate and subject to change based on new research and treatment advancements.

Advancements in genetic testing and therapies are refining cancer staging.

Cancer stages can change over time as new treatments and understandings emerge.

More cancers are being discovered at early stages due to improvements in screenings.

Advances in cancer treatment offer better outcomes and hope for the future.

Transcripts

Each year, approximately 20 million people across the world

receive a cancer diagnosis.

At this overwhelming, and often scary time,

a patient usually learns their cancer’s stage,

which is typically a number, ranging from 1 to 4.

While staging is designed in part to help patients better understand

what they’re facing,

extracting this information from a simple number

can be confusing and less than straightforward.

So, what do cancer stages actually mean?

To understand stage numbers,

we first need to unpack the three variables that inform it.

Doctors utilize a system which uses the letters T, N, and M

to describe a tumor’s size,

its presence in the immune system’s lymph nodes,

and whether it has metastasized, or spread, to other organs.

Arriving at this letter staging takes thorough investigation—

physicians will consider a person’s symptoms and overall health,

and may sample, or biopsy, cancerous tissue,

order medical scans, and analyze blood tests.

The T designation is usually a number between 1 to 4,

and is, in most cases, based on tumor size.

But each type of cancer has its own T staging criteria.

Five-centimeter-wide tumors are labeled as T3 in oral cancers,

but T2 in breast cancers.

And some cancers use other staging criteria,

like esophageal cancers, which are staged based on how deeply

the tumor invades the layers of tissue.

To assign an N stage,

doctors evaluate the lymph nodes through biopsies and imaging.

Cancer cells tend to break off from the initial tumor and spread.

They often travel through the lymphatic system—

a network of vessels and nodes,

which filter waste and harbor cells that help fight infection.

Cancers that spread to larger, more distant,

or a greater number of lymph nodes typically file into higher N stages.

M staging involves a more threatening category of cancers’ spread—

when diseased cells scatter and then settle on other organs or on bones.

Historically, this stage has been a matter of just “yes” or “no,”

because once a cancer has metastasized, it’s considered to be much more lethal.

But advances in treatment have recently prompted the medical community

to rethink the M stage as a continuum.

Doctors now consider the number of organs in which the cancer has spread,

as well as the abundance and characteristics of the metastatic tumors.

All sorts of combinations of T, N, and M are possible,

and one letter doesn't always follow the other.

For example, some head and neck cancers will test positive in the lymph nodes N1

with no clear initial tumor, or T0.

So how do these three variables inform a cancer's stage number?

Each TNM combination correlates to a different overall stage,

ordered by how difficult the cancer is to treat.

This sorting is rigidly defined for each type of cancer,

based on generations of research looking at how cancers with different spreads

and characteristics tend to behave.

Importantly, what a certain overall stage means varies from cancer to cancer.

For example, a T3N1M0 combination for a breast cancer

is considered stage 3 and carries an 85% five-year survival rate.

A pancreatic cancer with this same TNM combination, however,

is sorted to stage 2, and yet is more difficult to treat

with a 15% survival rate.

The system is intricate— and ever-changing.

For instance, someone with a stage 4 throat tumor in 2017,

might be considered stage 1 just one year later.

The cancer didn’t improve; the staging system did.

Experts realized that a subset of these advanced cancers

responded to existing treatment better than others,

so their staging was downgraded.

Similar discoveries and advancements in the genetic testing of tumors

are refining staging in breast, prostate, and gynecological cancers.

Meanwhile, breakthroughs in therapies can change things seemingly overnight.

Many cancers one considered near impossible to treat

are now met with high rates of remission.

And thanks to improvements in screenings,

more and more cancers are being discovered at early stages.

So while many will deal with the reality of cancer,

either for themselves, or through the diagnosis of a loved one,

these advances offer better treatments, more targeted cures,

and greater hope for the years to come.