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A Beginner's Guide To Understanding Cancer Stages & Grades

Ann Schreiber

One of the first questions many newly diagnosed cancer patients have is how advanced their disease is.

With 1.9 million new cancer cases diagnosed each year in the United States, understanding cancer stages and grades can better inform your treatment decisions.

Whether you or a loved one faces this alarming diagnosis, this beginner's guide is designed to help you better understand how many stages of cancer there are and what they mean, so that you can make more informed decisions and find clarity during a challenging time.

Cancer staging is a critical component in determining the extent and severity of the disease, helping health care professionals chart an effective treatment plan. Most cancers, including solid tumors, adhere to the TNM (Tumor, Node, Metastasis) system, which evaluates the size and location of the tumor, lymph node involvement and whether the cancer has spread to distant organs.

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Cancer staging and grading offer essential information to cancer care teams while formulating a patient's treatment strategy. Dr. Ajaz Khan, enterprise chair of medical oncology at Cancer Treatment Centers of America (CTCA), pointed out in a recent article that staging can influence a patient's prognosis. Generally, cancers detected in stages 0 to 2 often lead to more favorable long-term outcomes than those diagnosed in stages 3 or 4.

However, it's important to note that not all cancers follow this staging pattern, such as blood cancers like leukemia or multiple myeloma. The Cleveland Clinic provides a simplified breakdown of the four primary cancer stages. While these four stages are the most common, there's also a Stage 0. This stage is usually easily treatable and is considered precancerous by most experts.

Stage I: In this phase, cancer is limited to a small area and hasn't spread to adjacent lymph nodes or other tissues. Early detection and intervention can lead to favorable outcomes.

Stage II: Cancer has progressed, but it is still localized and has not spread beyond its initial site. While it's more advanced than Stage I, it remains treatable with various therapeutic approaches.

Stage III: The cancer has grown further and might have invaded nearby lymph nodes or surrounding tissues. Treatment plans may involve a combination of surgery, radiation and chemotherapy.

Stage IV: Also known as metastatic or advanced cancer, Stage IV signifies that cancer has spread to distant organs or regions of the body. It is often the most challenging stage to treat, requiring advanced therapies tailored to each patient's unique circumstances.

Leukemia, a form of blood cancer, and the 10th most common form of cancer, according to the Cleveland Clinic, develops in the blood and bone marrow. It differs from solid tumors in its nature and staging process. This cancer arises from the excessive production of abnormal white blood cells, impairing the immune system's ability to combat infections and affecting red blood cell and platelet production.

Staging leukemia follows a unique system, often using the Rai system for chronic leukemia, as described by the Moffitt Cancer Center:

Stage 0: Patients have elevated white blood cell counts but no other symptoms.

Stage 1: Patients display increased white blood cell counts and enlarged lymph nodes.

Stage 2: In this phase, patients have elevated white blood cell counts, may be anemic and often present with enlarged lymph nodes.

Stage 3: Similar to Stage 2, patients have high white blood cell counts, anemia and may also have enlarged lymph nodes or an enlarged liver or spleen.

Stage 4: At this advanced stage, patients have high white blood cell counts, low platelet levels, anemia, enlarged lymph nodes and an enlarged liver or spleen.

The MD Anderson Cancer Center explains that cancer's grade refers to the degree of abnormality observed in cancer cells and tissues under a microscope compared to their healthy counterparts.

Tumors with cancer cells closely resembling normal tissue are classified as low-grade, often termed "well-differentiated" by physicians. These lower-grade cancers are less aggressive and offer a more favorable prognosis.

Conversely, the cancer's grade rises as cells become increasingly abnormal in appearance and organization. Cancer cells with high grades are generally more aggressive and are referred to as "poorly differentiated" or "undifferentiated."

While some cancer centers employ unique grading systems, many adopt a standard scale:

Grade 1: Tumor cells and tissue closely resemble healthy counterparts, termed "well-differentiated" and considered low grade.

Grade 2: Cells and tissue display moderate abnormalities, referred to as "moderately differentiated," marking intermediate-grade tumors.

Grade 3: Cancer cells and tissue exhibit pronounced abnormalities, losing their architectural structure or pattern, categorizing them as "poorly differentiated" and signifying high grades.

Grade 4: These cancers, known as undifferentiated, showcase the most extreme abnormalities in cell appearance. They represent the highest grade and typically grow and spread faster than lower-grade tumors.

Providing critical guidance for cancer care teams

Cancer care is advancing, with cancer mortality rates progressively declining over the years. From the late 1990s to 2019, the pace of decline in cancer mortality has accelerated, largely driven by advancements in lung cancer detection and treatment.

Understanding cancer stages and grades is vital in this progress, guiding treatment decisions and providing hope for improved outcomes in the fight against cancer.

Cleveland Clinic: Leukemia

Moffitt Cancer Center: Staging Leukemia

American Society of Hematology: Blood Cancers

American Cancer Society Journals: Cancer Statistics, 2022

Raising Lymphoma Awareness During Blood Cancer Awareness Month

While much progress has been made in treating blood cancers like lymphoma, I know that there is still far more work to be done.

Steven Eichberg was diagnosed with lymphoma in 2012.

September is Blood Cancer Awareness Month — a month that has grown particularly meaningful to me. That's because on June 6, 2012, I was first diagnosed with the blood cancer lymphoma. I soon learned that more than 100,000 Americans are diagnosed with lymphoma each year.

Lymphoma is the most common type of blood cancer in adults and the third most common cancer type in children. It affects lymphocytes (a type of white blood cell that travel through the blood and lymphatic system to defend the body against foreign invaders, such as bacteria and viruses). Typically, lymphomas develop when a change or mutation takes place within a lymphocyte, causing the cell to replicate faster or live longer than normal. Cancerous lymphocytes also travel through the blood and lymphatic system and can spread and grow throughout the body.

Upon my lymphoma diagnosis, I joined the growing ranks of cancer survivors. Thanks to better diagnostic tools, more effective treatments and diligent researchers who are advancing the understanding of the more than 100 different subtypes of lymphoma, more people like me are able to live long and fulfilling lives after lymphoma. However, one challenge for many cancer survivors remains and that's living a life free from long-term side effects and adverse effects post treatment.

In the grand scheme of things, this is a welcome challenge to have. However, the main reason that Blood Cancer Awareness Month exists is to raise awareness of the disease, the need for additional research for a cure and the wide range of unique challenges that blood cancer survivors face post diagnosis.

In my case, for example, my biggest challenge was maintaining my everyday activities. I can remember my various treatment protocols and wondering, "How am I going to feel? And will I be able to do all the things I enjoy?" There was so much I didn't know and so much to learn about living with a lymphoma diagnosis.

After receiving my initial diagnosis, I plowed headfirst into gathering solid and reliable information about my specific lymphoma. Having a trusted source is more than half the battle as I did not want to go down a rabbit hole. My search led me right to the Lymphoma Research Foundation's Helpline, where I received current and verifiable information on my disease and my options going forward. Even after my initial treatment, three years after diagnosis, I always came back to the Lymphoma Research Foundation for up-to-date information on new advances in treatment protocols. That has served me well as my initial treatment failed and my lymphoma transformed to a more aggressive variety, but the research and trials done in the few years prior, allowed me to be treated with better, less-toxic agents.

Today, I am now four years in remission and plan on staying there for many years to come.

We still have a way to go in supporting blood cancer survivors and their unique needs. Balancing career and family obligations with cancer treatment requires the support of many, and despite recent treatment advances, we're only just beginning to understand the mental health challenges survivors face beyond their physical challenges. Those with supportive employers, families and friends have an advantage, but not all are as fortunate.

The good news is that a blood cancer diagnosis — much like many other cancers these days — is not a death sentence, and more researchers are focusing on the unique issues surrounding survivorship. Today's cancer researchers are getting better at identifying longer-term health risks connected to cancer treatments, and that can help shape the screening and follow-up care that survivors receive. Their continued research breakthroughs make this a time of promise for the long-term health of lymphoma survivors like me.

To navigate diagnosis, treatment and beyond, cancer survivors and their families need to be armed with quality information provided by their healthcare providers and non-profit foundations like the Lymphoma Research Foundation (LRF), for which I volunteer my time as their Board Chair and assist in fundraising efforts. LRF's only mission is to eradicate lymphoma and to serve those impacted by this blood cancer. They are founded in research and committed to community. And as I noted before, the foundation publishes valuable information on the issues survivors face and how we may all better support survivors here.

I've found considerable, life-affirming support through my involvement with the lymphoma community here in Massachusetts and through the simple act of talking about what we're going through with other cancer survivors on similar journeys.

This post was written and submitted by a CURE reader. The article reflects the views the author and not of CURE®. This is also not supposed to be intended as medical advice.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

Healthy Headlines: Blood Cancer Awareness Month

CHARLOTTE, NC — September is Blood Cancer Awareness Month. Acute leukemia and MDS are two types of blood cancers that we will be learning more about today. Joining us in this week's Healthy Headlines segment is Dr. Patricia Kropf, a hematologist oncologist at Novant Health.

For more information and stories on your health, visit novanthealth.Org/healthyheadlines.

Watch the full interview below:

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