Exit stage left.
Exit stage right.
As a Stage IV head and cancer patient, I’m not interested in leaving the stage. I intend to stay on it for as long as I can.
Cancer patients know all about stages and when you are told you have Stage IV, you get stage fright.
The first time I was told I had cancer in 2009, I really took centre stage by momentarily fainting. How embarrassing.
This was Stage IV cancer but remarkably I staged a comeback.
Then ten years later, I was told I had advanced cancer again (hypopharyngeal carcinoma) and this time it was incurable. That was a stage in my life that deserved another fainting episode but this time I just cried my eyes out instead.
The clinical classification of cancer into stages was developed in the 1940s by a French surgical oncologist called Pierre Denoix.
It was initially an anatomical staging system relating to breast cancer and was dependent on the size of the tumour, nodal status, and metastatic findings.
The TNM (Tumour, Nodes, Metastases) cancer staging system is now a globally recognised standard and unified system for classifying the extent of spread of cancer. It serves as a common language so that oncology health professionals can communicate on the cancer extent and as a basis for decision making relating to treatment.
As a cancer patient, it’s useful to know what each individual aspect of TNM mean. It helps you looking up information about your cancer and your treatment options.
TNM are categories, not stages:
- T category describes the primary tumour site and size
- N category describes the regional lymph node involvement
- M category describes the presence or otherwise of distant metastatic spread
The classification of cancer by anatomic disease extent, i.e. stage, is something that hasn’t changed (in terms of a new stage) but perhaps it’s time to do just that.
Although staging is reviewed, overseen and published by the Union for International Cancer Control (UICC), does it reflect changes in diagnosis and treatment? The last review was in 2016.
Advances in some treatments such as immunotherapy are now rewriting longevity and prolonging life further than anyone dared dream of.
Do we therefore introduce a new stage or stages or subcategories? The ninth edition is scheduled for publication in 2024.
I am of course approaching this from a very simplistic view of things but it seems to me that some of us are at an advanced stage but living longer and creating new territory. We’ve reached a new level of survival and that to me is a different level.
Regardless of the stage you are at, getting the news that you have cancer is going to knock you sideways. It could, as in my case, make you light-headed and you end up on the floor.
Cancer staging is a cornerstone of patient care, cancer research and cancer control but if I was to introduce a new addition to the staging system, then I’d have that as the ‘Comeback Stage’ (CB).
If you are Stage IV and you are beating the odds, then you can be reclassified and downstaged as Stage IV (CB).
Why should the original stage have to ‘stick’? Stage at diagnosis does not change – but it could and it can!
If your tumour shrinks or you are NED (No Evidence of Disease) then why should the stage at diagnosis remain the patients clinical stage?
The TNM staging lacks impact of response and lumps patients together in ‘bins’ so it is not individualised. It therefore doesn’t meet the needs of patients or clinicians.
Set the stage for you own comeback and prove them all wrong.