It’s just as important to know how far your disease has spread and if it can be treated or simply contained and stabilised as it is to know its potential course and prognosis. The same can be said about understanding your chosen therapy’s goal – is it to cure the disease, to slow its progress or to provide relief for debilitating symptoms without actually effecting the course of the illness? If you don’t receive an honest answer to these questions, you and your loved ones will become easy targets for all manner of people promising miracle cures, including conventional or traditional treatment methods. As we’ve seen lately in Latvia, donations are collected with great pomp to purchase modern, innovative cancer drugs, but after a while the publicity often dies with the hopeful patients leaving behind deep scars in the hearts and wallets of their family and friends. By receiving honest information, you’ll at least have the opportunity to make an informed decision on your own in the late stages of your illness. When your remaining life can be defined as a finite period of time, it’s only logical that you should be able to spend what’s left the way you want to. You can make the most of your time with your loved ones or you can suffer from the side effects of toxic drugs, be permanently hooked up to machines or make frequent visits to the hospital. The situation is not unlike the fairy tale about the boy at a crossroads: ride to the right and you meet the princess and live happily ever after or ride to the left and meet the dragon, whose heads grow back every time you cut one off.
Non-invasive (in situ) tumours or Stage 0
These are tumours, which, morphologically speaking, resemble cancer cells, yet haven’t spread beyond the area in which they were first formed. This term is only applied to epithelial tumours (cells that cover the inside or outside of organs such as the skin, the mucous membrane of the intestines, etc.). A natural barrier called the basal membrane separates these cells from the surrounding tissue. A pathologist will pay special attention to this when examining tumour specimens, because both the prognosis and the treatment method will be largely dependent on these results. All of these tumours are considered pre-cancerous diseases, because if left alone there’s a significant risk that they could become invasive tumours. That’s why these tumours are often called in situ (from the Latin – in the original place) tumours and are traditionally classified as Stage 0 tumours.
You may find that the lab results regarding your tumour may reveal signs of both invasive and in situ tumours. This can happen. It means that the biopsied sample included hotbeds of genuinely invasive as well as non-invasive cells. The treatment strategy will be adapted to the invasive tumour, which is the more serious diagnosis.
Depending on the location of the tumour, therapy could be limited to the removal of the tumour or could be followed by more therapy such as hormone therapy, if the tumour was hormone-dependent, which is often the case with in situ breast cancer. After therapy, patients with in situ tumours are considered to be cured. However, they must carefully look after their health and receive regular check-ups, because we can never guarantee that this scenario will not repeat itself.
Small tumours or Stage I
By this we mean a tumour, which, at the moment, is still confined within an organ and has only minimally invaded surrounding tissues, but which hasn’t penetrated the barriers of the organ and hasn’t spread to the closest lymph nodes. Breast cancer, for example, which hasn’t spread to the skin or chest muscles or an intestinal tumour, which hasn’t penetrated the wall of the intestine and, in both cases, haven’t metastasised to the lymph nodes. These tumours are classified as Stage I tumours. They belong to the early-stage group of cancers.
Most Stage I tumours can be treated surgically or with radiation. In many cases, additional drug therapy isn’t required.
Localised tumours or Stage II
A localised tumour is slightly larger than a Stage I tumour and will probably have spread to neighbouring tissues and/or the closest lymph nodes. It should be mentioned that the term Stage II can differ quite significantly for different localised tumours. This sorting into stages is also in large part reliant on accumulated information regarding the prognosis of the spread of a tumour. In many cases, it’s also possible to completely cure Stage II tumours, which is why they’re also included in the group of early-stage cancers.
However, the size of a tumour and how far it has spread is not always indicative of its nature. Tumours that have supposedly advanced in the same fashion can behave differently in individual patients. In one case, they may have a positive prognosis and respond well to treatment, yet in another – the opposite. Therefore, in addition to the stage of a tumour, we now also consider a number of other biological indicators, which allow us to determine a tumour’s aggressiveness in an individual patient and to choose the most appropriate therapy.
Localised tumours that have spread or Stage III
Usually these are large tumours, which have grown into the surrounding tissue and have metastasised in a number of regional (nearby) lymph nodes. These tumours are conditionally called late diagnosis tumours. The metastasis in the lymph nodes is usually a sign of its aggressive nature. While it was once believed that our lymph nodes protected us and served as checkpoints, which prevented the further spread of cancer cells in the body, we now know that metastases in the lymph nodes are one of the most significant indicators for creating a prognosis and understanding how the illness will advance. This frequently also means that if metastases are discovered in the regional lymph nodes, that there is a significant risk the tumour will also spread to other lymph nodes and even more distant organs. This is why Stage III tumours are treated more aggressively often using a combination of various methods.
If you have a Stage III tumour, that doesn’t mean that you can’t be treated or that you’re condemned to a bleak fate. That said, the chance of a complete cure is unlikely. However, in most cases it’s possible to considerably prolong a good quality of life. It’s important to have a good relationship with your doctor, because you’ll have lots of questions that need answering.
Stage III tumours are most commonly treated with a multipronged approach using a variety of therapy methods. It’s also important to simultaneously strengthen your health – this includes your nutritional intake, physical activity and avoiding harmful lifestyle choices.
This is a tumour of any size growing at the site where the progression began, but which has also metastasised in other tissue and organs near or farther away from the original site. These cases are considered to be Stage IV. These tumours are also considered to be late diagnoses and they can’t always be blamed on a patient’s lack of vigilance. Some tumours are so aggressive, that it’s not uncommon for the metastasis to be discovered before the actual tumour.
Treatment of a Stage IV tumour is especially complicated and requires a doctor with an open mind. Patients usually exhibit not only a variety of symptoms, but also specific organ damage, which can further hamper treatment with drugs. To do no harm is the main principle, which should be followed so as not to make a patient’s already grave situation even worse. It’s important to understand that the main goal of therapy isn’t to cure the patient, but to stabilise the illness as much as possible and to alleviate painful symptoms. However, these patients are often cynically deceived with offers of miracle cures with new and revolutionary methods. You must understand the goal of your therapy and you shouldn’t hesitate to ask your doctor the same question. The goal for a Stage IV patient should be to hinder the progress of the disease, to alleviate symptoms and to prolong life. Even if you consider this unacceptable and devoid of hope, it is at least an honest approach. Unfortunately, no one is immortal and people, including the rich and famous, die of cancer all over the world. In this situation, it’s very important to recognise the limits of your existence and to find the motivation to live, if only for a limited period of time.
A metastatic tumour is a tumour of any stage that has spread to other tissue and organs. For example, it’s revealed after 12 years that a patient’s Stage I tumour has metastasised in his bones. His stage doesn’t officially change in his chart, but an indication of metastasis is noted. It has been observed that roughly one third of cases develop into local and/or regional metastases such as the closest lymph nodes or in the scars left after surgery. Approximately one third of metastases develop distally, in other organs, and in one third of cases, metastases can be local, regional and distal all at once.
The prognosis is largely dependent on the location of the metastasis and the number of damaged organs. Metastases in the lymph nodes, bones, skin and the dermis are easier to treat (with surgery, radiation or drugs) and often have a better prognosis. Metastases of the inner organs (liver, lungs) and the brain are harder to treat, but aren’t untreatable and I have experienced many cases where patients with several organs damaged by metastases have responded well to therapy and lived productive lives (without painful symptoms) for several years.
Currently, it’s widely believed that metastases are a completely separate illness. Tumours change over time, so, when possible, it’s best to examine a sample of the metastasis. This can help your doctor choose the best therapy strategy. It’s also been observed that the shorter the period of time between the discovery of a tumour and the development of the metastasis, the worse the prognosis. However, this differs from case to case, and every once in a while someone in this situation pulls a rabbit out of a hat. This is why you can’t lose hope and why you should fight in every way possible, even if that means trying less traditional methods of therapy. The key to your success will be faith, hope and love, even if you have limited resources or treatment opportunities.