Once a diagnosis of cancer is made, it is important to understand the extent or stage of the cancer in order to develop the most appropriate treatment plan.
The surgical specimen is carefully reviewed under a microscope and special stains are done to the tissues in order to identify the cancer and determine characteristics about the tumour such as type, size, depth and possible lymph involvement.
This information helps guide your oncologist in developing your treatment plan. This whole process can take many weeks to analyze. While waiting for results can be frustrating, it is vital to ensure that we have the correct diagnosis as treatment varies depending on these results.
Terms You May Hear
Grade refers to the appearance of the cancer cells when they are examined under the microscope. There are typically three grades of cancer when examined by pathology, grades 1-3. A grade one cancer is also called well differentiated. This means that, when the pathologist examines it under the microscope, it looks very similar to the organ where it started. A grade two tumour is called moderately differentiated. This means that, while it may look like a specific cell, it is becoming more abnormal in appearance. A grade three cancer is known as poorly differentiated; this means that the cells least resemble the original tissue where it started.
Stage defines where the cancer is located. There are two different systems that can be used to determine stage.
One is the TNM classification, the other is the Spread of Cancer Scale. Both are relatively the same in terms of what they measure.
TNM (this rating scale is not routinely used in gynecologic oncology)
T(Tumour) describes site and size of primary tumour
N(Node) describes the involvement of any lymph nodes
M(Metastasis) describes the areas where the cancer may have spread
Spread of Cancer Scale
Pecorelli S: Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105 (2): 103-4, 2009.FIGO Committee on Gynecologic Oncology: Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet 105 (1): 3-4, 2009.
Here are some of the topics your oncology team may talk about and some questions you might wish to ask about your pathology report when you are ready for the information.
• What type of cancer do I have?
• What grade is my cancer or how aggressive is it?
• What stage is my cancer?
• Has the cancer spread to lymph nodes?
• Has the cancer spread to other areas of my body (metastasized)?
• Do I need any further tests before I start treatment?
• What are my chances for recovery and survival?
Chance of Recovery/Survival
Chance of recovery and survival are ways to discuss prognosis, an expert estimation developed by your health care professional based on survival statistics of patients in similar circumstances. Survival rates are based on past outcomes of large numbers of people who have faced similar circumstances, but they cannot tell how you will respond to treatment. Some patients wish to know this information as soon as a cancer has been diagnosed; others choose not to know right away. It is completely up to you when you wish to hear these statistics.