Oncology: understand cancer, stage and grade
Oncology refers to both the disease of cancer and the treatment of people who have cancer or are at high risk of developing it. There are many cancers with similarities and differences in their characteristics and treatments; understanding the cancer can be made easier if we consider each type of question on an individual basis. The first type of questions involves what the cancer is; the second type of questions involve where the cancer is located; and the third type of questions concerns how the cancerous cells operate. These three forms of questions will produce varying degrees of evidence so they cannot be used interchangeably.
Distinguish the terms
Cancer involves unregulated cell growth with the ability to invade tissue or spread. Many cancers form solid tumours; blood cancers such as leukaemia generally do not. A tumour may be benign or malignant. It should be noted that simply because a tumor is classified as benign it does not mean it will not negatively affect you.
The place where a cancer starts is important to its description. Spread to another location does not make every cancer in that organ the same disease. A learning account should distinguish the original cancer type from the places it involves. This also helps explain why a general label such as tumour is not enough to describe the biological problem or the person's care needs.
Ask what evidence establishes the finding
Investigation can be prompted by symptoms or scans; neither alone provides a complete diagnosis. Assessment may involve physical examination, laboratory tests, imaging and examination of tissues or cells. A pathologist examines samples and reports relevant features. The investigation depends on the suspected cancer and circumstances. Identify the evidence available in a teaching case and the conclusions it can reasonably support.
Different investigations contribute different kinds of evidence. An image can help describe an area of concern, while analysis of cells or tissue can provide other information about its nature. A report should be read in the context of the question being investigated. Distinguish a finding that prompts further assessment from a conclusion that has been established through the appropriate diagnostic process.
Describe extent separately from cell appearance
Stage describes the extent of a cancer, including features such as its size and spread. Grade describes how abnormal tumour cells look under a microscope. Stage and grade answer different questions. There are various staging and grading classifications depending on what type of cancer it is. Therefore, be cautious using a number classification system developed for one type of cancer for all cancers.
Stage and grade should not be read as two versions of the same scale. A description of extent and a description of microscopic appearance provide different information. The meaning of each category depends on the cancer and reporting system. Keep the terms attached to their definitions when comparing teaching cases, rather than assuming that a particular number predicts the same course in every cancer.
Connect several kinds of information
A care plan considers the cancer type, extent, biological characteristics and the person’s circumstances and preferences. Treatments can include surgery, radiotherapy, medicines or combinations of approaches. Treatment objectives vary from case to case. A general overview cannot select an individual regimen or predict a person’s outcome. For revision, identify what information the care team would need before discussing options.
Treatment planning can involve several disciplines because the relevant information is not confined to one test. The person's general health, goals and practical circumstances also matter alongside cancer features. An educational comparison of treatment types explains their roles; it does not decide which option someone should receive. Questions about an individual plan need discussion with the team who can interpret the complete clinical picture.
Check your understanding
A short quiz, with an explanation after each answer.
What does cancer stage mainly describe?
For a teaching case, make separate notes headed type, extent and cell features. Place each available finding under the appropriate heading, then list what remains unknown. Use the quiz to check the distinction between stage and grade before moving to a cancer-specific topic.