What does cancer “Stage” mean?
The stage of a cancer is a classification system that in general terms reports the degree of spread of a cancer in the body, from the site or organ it originated in. There are many different staging systems for different cancers types, and often different systems can exist for the same cancer.
The information that we feed into a staging system to define what stage a cancer is can come from different sources. For example, what we see on imaging, what we note on clinical examination, or pathology results we obtain from surgery. This is usually clearly defined by the staging system.
For Gynaecological cancers in Australia we use a staging system defined by FIGO (The International Federation of Gynaecology and Obstetrics). Each type of gynaecological cancer has its own staging classification with specific sub-stages. However, broadly the FIGO stages can be generalised as follows:
Stage 1: confined to the organ the cancer arose from
Stage 2: spread to an adjacent organ
Stage 3: spread to the region the organ is located (e.g. pelvic area)
Stage 4: spread outside the region the organ is located (e.g. to the upper abdomen or distant organs)
What does cancer “Grade” mean?
The grade of a cancer is a classification provided by an Anatomical Pathologist (a specialist doctor expert in diagnosing disease by examining tissues and cells). It is based on how abnormal tumour cells appear compared to normal healthy cells and can help in determining the potential aggressiveness of a cancer. Commonly it is either a binary classification of Low grade / High grade, or of Grade 1 through to Grade 3, with grade 3 representing the highest grade.
What is “Pre-cancer”?
A “Pre-cancer” is growth or change within tissues/cells that has the potential to progress to an invasive cancer over time if untreated. Pre-cancers may also have an associated risk of recurrence after treatment, either again as a pre-cancer or as a cancer.
Pre-cancerous changes can occur in all of the gynaecological organs (Whilst not strictly accurate, I conceptualise borderline ovarian tumours as pre-cancerous changes within the ovaries).
- Endometrium (Uterus) – endometrial hyperplasia with atypia
- Myometrium (Uterus) – smooth muscle tumour of uncertain malignant potential (STUMP)
- Cervix (Uterus) – cervical intra-epithelial neoplasia (CIN) or high grade squamous intra-epithelial lesion (HSIL)
- Vagina – vaginal intra-epithelial neoplasia (VAIN)
- Vulva – vulval intra-epithelial neoplasia (VIN)
- Fallopian tube – serous tubal intra-epithelial carcinoma (STIC), the precursor to high grade serous carcinoma (“Ovarian cancer”)
- Ovary – borderline ovarian tumours