Staging of Cancer

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Cancer staging explained

If you have a cancer diagnosis, your doctors may conduct tests to find out how big your cancer (or tumour) is, where it is in your body and how far it has spread. This is called staging.

The information on this website should be discussed with your healthcare professional and does not replace their advice.

Why staging is important

The staging of your cancer helps your doctors work out your treatment options and what the outlook or prognosis is likely to be. In addition, knowing the stage may help you understand what to expect. It may also empower you to have meaningful conversations with your doctor and loved ones.

If you have early-stage cancer you may not have treatment straight away. Some early-stage cancers may simply require monitoring by your doctor as part of a ‘Watch & Wait’ strategy. For other early-stage cancers, treatment can involve an operation to remove the tumour. This may be the only treatment you need.

If your cancer is more advanced, you may need treatments that work throughout the body. These may include chemotherapy, targeted drug therapy or immunotherapy.

How staging is done

Your doctors may perform a physical examination, request imaging scans, take a biopsy and use other information to work out the stage of your cancer.

There are different types of staging systems used to stage cancer. The most widely used system is the TNM staging system.

The TNM system is used for most cancers but not all. Some types of cancer have their own staging systems. See below for information about staging of endometrial cancer, cervical cancer and classical Hodgkin lymphoma.

Ask your doctor about the staging system used for your cancer type.

TNM staging system

The TNM staging system uses a combination of letters and numbers to describe a person’s cancer.

T stands for ‘tumour’ and measures the tumour’s size and location.

N stands for ‘node’ and shows if lymph nodes are involved.

M stands for metastasis. It shows if the cancer has spread elsewhere in the body.

Cancer stage grouping

The TNM system is then used to assign your cancer a number from 1 to 4. Some cancers also have a stage 0, which is when abnormal cells are detected, although they have not spread. This stage is often called in-situ cancer.

What the numbers mean

Stage 1: At this stage, the cancer is small and localised, which means it is limited to the organ it started in.

Stage 2: Cancer at this stage may have grown larger than in Stage 1 but the cancer has not started to spread into nearby tissue. Sometimes the cancer may have spread to lymph nodes near the tumour.

Stage 3: At this stage, the cancer is generally larger and may have spread to nearby lymph nodes and surrounding tissues.

Stage 4: This stage, also known as metastatic or advanced cancer, indicates that the cancer has spread to other organs or other parts of the body.

Letters may be added to the stage number to give more precise staging information.

Everyone’s situation is unique, so your doctor will explain your specific cancer stage and what it means to you.

Endometrial and cervical cancers

The International Federation of Gynecology and Obstetrics (FIGO) staging system is often used for cancers of the female reproductive organs.

This system splits cancers into stages from 1 to 4. Your doctor may also give your cancer a sub-stage, such as A, B or C.

Endometrial cancer stages

Stage 1A: Cancer that is only in the uterus (womb) and may have grown into the muscle wall, but it has not spread further than halfway.

Stage 1B: Cancer that is only in the uterus, and it has grown halfway or more into the muscle wall.

Stage 2: Cancer that has spread to the cervix.

Stage 3A: Cancer that has spread to the ovaries.

Stage 3B: Cancer that has spread into the vagina or the tissues surrounding your uterus.

Stage 3C: Cancer that has spread to lymph glands nearby the uterus.

Stage 4A: Cancer that has spread to the bladder or bowel.

Stage 4B: Cancer that has spread to other parts of the body.

Cervical cancer stages

Stage 1: Early cancer that has not spread out of the cervix.

Stage 2: Cancer that has spread outside of the cervix to the top two-thirds of the vagina or to other tissue close to the cervix.

Stage 3: Cancer that has spread to the lowest part of the vagina and/or to the tissue of the pelvic wall. It may have also reached nearby lymph nodes or caused kidney problems.

Stage 4A: Cancer that has spread to the bladder or rectum.

Stage 4B: Cancer that has spread to other parts of the body.

Classical Hodgkin lymphoma

The Lugano classification system is used to stage classical Hodgkin lymphoma. This system splits lymphoma into stages from 1 to 4.

Depending on your symptoms, your doctor will add the letter A or B to your stage number. The letter B means you are experiencing fever, night sweats and/or unexplained weight loss. An A means you are not experiencing these symptoms.

Stage 1: A single lymph node area is affected, either below or above the diaphragm. The diaphragm is a thin sheet of muscle between the chest and abdomen.

Stage 2: More than one lymph node area is affected on the same side of the diaphragm.

Stage 3: One or more lymph node areas above and below the diaphragm are affected.

Stage 4: Many lymph nodes are affected and the lymphoma has spread to body parts such as the liver, bone or lungs.

Ask your doctor to explain

Cancer staging can be complicated and confusing. Ask your doctor to explain your specific cancer stage and what it means for you.

Immunotherapy

KEYTRUDA® (pembrolizumab) 100 mg/4 mL concentrate solution for infusion is a Prescription Medicine. KEYTRUDA has risks and benefits. The KEYTRUDA Consumer Medicine Information (CMI) is available at www.medsafe.govt.nz or by clicking the 'Consumer Medicine Information' button at the top of this page.

IMPORTANT SAFETY INFORMATION

You should not be given KEYTRUDA if you are allergic to pembrolizumab or to any of the following inactive ingredients: histidine, histidine monohydrochloride monohydrate, sucrose, polysorbate-80, water for injection.

Tell your doctor if you have a disease of your immune system such as Crohn’s disease, ulcerative colitis, or lupus; have had an organ transplant or have had a bone marrow (stem cell) transplant that used donor stem cells (allogeneic); have pneumonia or swelling of your lungs (called pneumonitis); or have liver problems.

If you are pregnant, think you may be pregnant or are planning to have a baby, tell your doctor. KEYTRUDA can cause harm or death to your unborn baby. Effective contraception must be used during treatment with KEYTRUDA and for at least 4 months after the last dose of KEYTRUDA for woman who could become pregnant.

If you are breastfeeding, tell your doctor. Do not breastfeed while taking KEYTRUDA.

Tell your doctor if you are taking any other medicines, including medicines that can be bought without a prescription from a pharmacy, supermarket or health food shop, or other medicines that make the immune system weak. Examples of these may include steroids, such as prednisone.

What are the possible side effects of KEYTRUDA?

KEYTRUDA can have some serious side effects. These side effects can sometimes become life-threatening and can lead to death. These side effects may happen any time during treatment or even after treatment has ended. More than one side effect can be experienced at the same time.

Call or see your doctor right away if you develop any of the following symptoms:

Lung problems:
Signs and symptoms of lung problems may include shortness of breath, chest pain, or coughing.

Intestinal problems:
Signs and symptoms of problems with your intestines may include diarrhoea or more bowel movements than usual, stools that are black, tarry, sticky, or have blood or mucus, or severe stomach pain or tenderness.

Liver problems:
Signs and symptoms of liver problems may include nausea or vomiting, feeling less hungry, pain on the right side of your stomach, your skin looks yellow, the whites of your eyes look yellow, dark urine or you bleed or bruise more easily than normal.

Hormone gland problems (especially the thyroid, pituitary, adrenal glands):
Signs and symptoms of hormone gland problems may include rapid heartbeat, weight loss or weight gain, increased sweating, hair loss, feeling cold, constipation, your voice gets deeper, muscle aches, dizziness or fainting, or headaches that will not go away or unusual headache.

Kidney problems:
Signs and symptoms of kidney problems may include change in the amount or colour of your urine.

Blood sugar problems:
Signs and symptoms of blood sugar problems may include feeling more hungry or thirsty, needing to urinate more often or weight loss.

Skin problems:
Signs and symptoms of skin problems may include rash, itching, blisters, peeling or skin sores, or ulcers in mouth or in lining of nose, throat, or genital area.

Problems in other organs:
Signs and symptoms of problems in other organs may include muscle pain or weakness; changes in eyesight; stomach area pain with nausea and vomiting (pancreatitis); shortness of breath, irregular heartbeat, feeling tired, or chest pain (myocarditis, pericarditis); confusion, fever, memory problems, or seizures (encephalitis); swollen lymph nodes, rash or tender lumps on skin, cough, or eye pain (sarcoidosis); pain, numbness, tingling, or weakness in the arms or legs, bladder or bowel problems including needing to urinate more frequently, urinary incontinence, difficulty urinating and constipation (myelitis); inflammation of the blood vessels (vasculitis); decreased function of the parathyroid gland, which may include muscle cramps or spasms, fatigue and weakness (hypoparathyroidism); inflammation of the stomach lining, which may include severe stomach pain or tenderness, nausea or vomiting (gastritis); destruction of red blood cells, which may include dark urine, pale or yellow skin/eyes, lightheadedness, feeling tired, rapid heartbeat, or shortness of breath (haemolytic anaemia), or pain in the upper right part of the stomach, swelling of the liver or spleen, fatigue, itching or yellowing of the skin or whites of eyes (sclerosing cholangitis) ; or decreased ability of the pancreas to make digestive enzymes, which may include diarrhoea with loose and oily stools, weight loss, metabolic bone disease, and vitamin or mineral deficiencies (exocrine pancreatic insufficiency).

Infusion (IV) reactions:
Signs and symptoms of infusion reactions may include shortness of breath, itching or rash, dizziness or fever.

Rejection of a transplanted organ:
People who have had an organ transplant may have an increased risk of organ transplant rejection. Your doctor should tell you what signs and symptoms you should report and monitor you, depending on the type of organ transplant that you have had.

Graft-versus-host-disease (GVHD) in people with bone marrow (stem cell) transplant that uses donor stem cells (allogeneic):
GVHD may occur if you had this transplant in the past. Your doctor will monitor you for the following signs and symptoms: skin rash, liver inflammation, abdominal pain, and diarrhoea.

Common side effects:
Common side effects (may affect more than 1 in 10 people) include: diarrhoea, nausea, itching, rash, joint pain, back pain, feeling tired, cough, patches of skin which have lost colour, stomach pain, decreased sodium levels in the blood and low levels of thyroid hormone.

Common side effects (reported in more than 1 in 5 people) when KEYTRUDA was given in combination with chemotherapy include: hair loss, feeling tired, diarrhoea, vomiting, rash, fever, decrease in white blood cell count, decreased appetite, joint pain, swelling of the lining of the digestive system (for example mouth, intestines), mouth sores, decrease in number of red blood cells and decrease in number of platelets in the blood.

The most common side effects when KEYTRUDA is given in combination with axitinib are: diarrhoea, high blood pressure, fatigue, low levels of thyroid hormone, decreased appetite, blisters or rash on the palms of your hands or soles of your feet, nausea, increase in liver enzyme levels, hoarseness, cough and constipation.

The most common side effects when KEYTRUDA is given in combination with lenvatinib are: high blood pressure, diarrhoea, feeling tired, decreased appetite, low levels of thyroid hormone, nausea, vomiting, weight loss, joint pain, headache, constipation, hoarseness, urinary tract infection, stomach-area (abdominal) pain, blisters or rash on the palms of your hands and soles of your feet, rash, protein in your urine, increase in liver enzyme levels and feeling weak.

The most common side effects when KEYTRUDA is given alone to children are: fever, vomiting, headache, stomach pain, decrease in number of red blood cells, cough, and constipation.

Less common side effects can happen. KEYTRUDA may cause other side effects that are not listed. If you have any side effect that bothers you or that does not go away, tell your doctor.

For more information, please talk to your doctor.

KEYTRUDA may be used in adults to treat certain cancers when the cancer has spread (metastatic) or cannot be removed by surgery (unresectable), such as:

melanoma
non-small cell lung cancer
urothelial carcinoma
head and neck squamous cell carcinoma
renal cell carcinoma
oesophageal carcinoma
cervical cancer
endometrial carcinoma
gastric or gastroesophageal junction adenocarcinoma
triple-negative breast cancer
cutaneous squamous cell carcinoma
a kind of cancer that can occur in any part of the body and is shown by a laboratory test to be microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR)
colon or rectal cancer that is shown by a laboratory test to be MSI-H or dMMR

KEYTRUDA may also be used in adults:

after surgery to remove melanoma, non-small cell lung cancer, or renal cell carcinoma to help prevent the cancer from coming back
before surgery to treat triple-negative breast cancer and then continued after surgery to help prevent the cancer from coming back
to treat bladder cancer which has not spread to nearby tissues but is at high-risk of spreading and where bladder removal is not preferred
to treat classical Hodgkin Lymphoma (cHL) that has returned or when other treatments have not worked

KEYTRUDA may be used in children with cHL, MSI-H or dMMR cancer, or after surgery to remove melanoma. It is not known if KEYTRUDA is safe and effective in children with MSI-H or dMMR cancer of the brain or spinal cord (central nervous system cancers).

KEYTRUDA may sometimes be given in combination with other anti-cancer medicines.

Based on the KEYTRUDA Consumer Medicines Information and Data Sheet dated 6^th November 2024.

Ask your doctor if KEYTRUDA is right for you. If symptoms continue or you have side effects, see your doctor, pharmacist, or health professional.

KEYTRUDA is funded to treat certain patients with the following types of advanced cancers: melanoma, non-small cell lung cancer, MSI-H or dMMR colorectal cancer, triple-negative breast cancer, head and neck squamous cell carcinoma, urothelial carcinoma, and classical Hodgkin lymphoma - further restrictions apply. KEYTRUDA is not funded for the treatment of all other cancers listed above.

Ask your health professional about the cost of the medicine and any other medical fees that may apply.

Merck Sharp & Dohme (New Zealand) Limited, Level 3, 123 Carlton Gore Road, Newmarket, Auckland.

TAPS NP20132 TAPS DA 2419KN NZ-KEY-00885v11 Last updated December 2024