Writing In The Dust: Cervical Cancer Blog Six aka Staging

Interrupting my regular scheduled blog post with a… well, a regular scheduled blog post.

The next post I do will be entitled ‘How to Tell Friends and Family that You Have Cancer Whilst Making It Sound Like You Have Nothing More than a Common Cold so that You Keep Their Spirits Up While Somehow Simultaneously Convincing Yourself that You Have Cured Your Cancer via the Power of Positive Thinking Because the Brain Gets Weird When it’s in Denial.’

This week’s post is more simply entitled ‘Staging’ and is another ‘biology lesson’ of sorts except this time it’s on the staging process of cervical cancer and what each of those stages mean.

Yes, if this were a TV show it would be described as a ‘filler’ episode!

Are you ready? Anyone got an apple for teacher? Well my subtle little hint a few posts ago to SEND ME PIZZA has been ignored so I’m not holding out much hope.

Now I don’t know how staging works for other cancers so this is solely focused on what happens when they stage you for cervical cancer. Sorry!

What I always thought is that they would need to run the diagnostic tests before they staged you and maybe in other cancer cases they do but it seems that with cervical cancer they have a good indication of what your stage is at the very beginning. The diagnostic tests seem to be confirmation that their initial diagnosis is correct and they need to run a whole bunch just to make sure the pesky bastard hasn’t gone off and done more damage.

From the sounds of it, it is very unusual and uncommon for an initial staging to differ once they’ve done the tests. It does appear, based on the Jo’s Trust forums, that this can happen on occasion but can swing either way. The staging may have been initially high and after tests it’s found to be lower or the staging was lower but something unexpected was found in the tests and so the cancer has been restaged higher. Rest assured that when the medical team give you your initial stage they are confident that it is the stage of cancer you have. Their goal is not to cause any unnecessary worry and they wouldn’t give you your stage to change it arbitrarily.

I won’t get into diagnostic testing in this post because that is yet to come. But I have already had them done…. ooh Twilight Zone, Gerry is both in the past and present… do do do do do do….

Ahem. S’cuse me.

When staging it appears hospitals go off a ‘TNM’ system. This will now sound like a weird Sesame Street episode called ‘T is for Tumour.’

Pipe down guys, I got this.

Well the TNM looks like this: -

T – Tumour (told you!) – describes the size of the tumour

N – Lymph Node – indicates whether any cancer is present in the lymph nodes (turns out the lymphatic system is very important in the human body and so I will be doing a section on these little beauties at some point)

M – Metastasis – this refers to whether cancer has spread to other parts of the body. Apparently if cervical cancer has metastasized it will spread to regional lymph nodes, lungs, liver, bladder, vagina and the rectum. For such a small area to get cancer it can cause some big problems.

Lymph Node staging is either: -

· NX (can’t be assessed)

· N0 (no lymph node involvement)

· N1 (lymph node involvement)

I now have no pelvic lymph nodes because they needed to take them out and have a peek for cancer. Luckily, I was N0. If you find yourself with lymph node involvement (regardless of tumour size) it means that your treatment plan will move beyond surgery.

Metastasis staging is either: -

· M0 (no spread)

· M1 (spread)

Again, I was lucky and had M0. For those with M1 it will again mean that your treatment plan will move beyond surgery.

I don’t know a great deal about what happens to patients if they have N1 or M1 and so I won’t speculate as to the treatment plans.

Tumour staging is far wordier which is why I have left it until the end. This bit gets medical (thank you to the various sites I have borrowed this from) and I have included handy diagrams as well (I have not drawn this via paint you will be pleased to know).

Staging: -

Stage 0

This is not considered cancer. Any cancerous cells that have been found are confined to the surface area and are not invasive. Some sexy words used to describe this are carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN) grade 3 (CINIII) – try saying that three times when drunk!

Although not cancerous it is important to understand that these stage 0 calls can become cancerous if left untreated. This is where those smear tests and LLETZ procedures come in handy. Remember these guys: -

Yeah you do.

Stage 1

It is now cancer and is now invasive. This stage means that the cancer is contained within the cervix and hasn’t spread anywhere else. This stage and stage 2 contain categories and subcategories just to throw people into more confusion. I’ve done the best I can here but I won’t be testing you so rest easy if none of it makes sense.

Though I am now tempted to throw a pop quiz in…

Stage 1A: Very small amounts of cancer, less than 5mm deep and less than 7mm wide and can only be seen under a microscope.

Stage 1A1: The cancer is equal to or less than 3mm deep and less than 7mm wide

Stage 1A2: The cancer is between 3 – 5 mm deep and less than 7mm wide

Stage 1B: Cancer can now be seen by the naked eye and measures 4cm or less or can only be seen under a microscope but is more than 5mm deep and more than 7mm wide

Stage 1B1: The cancer is not larger than 4cm

Stage 1B2: The cancer is larger than 4cm

Stage 2

Cancer has now grown beyond the cervix but hasn’t reached the lower part of the vagina or pelvic wall and hasn’t reached the lymph nodes: -

Stage 2A: Cancer has not spread into the tissues next to the cervix (this is called the parametria) but may have grown into the upper vagina

Stage 2A1: The tumour is not larger than 4cm

Stage 2A2: The tumour is larger than 4cm

Stage 2B: Cancer has spread into the parametria

Stage 3

Cancer has now spread into the lower part of the vagina or pelvic walls but not to the lymph nodes or any other areas.

Stage 3A: Has grown into the lower part of the vagina but not the pelvic walls

Stage 3B: Has grown into the pelvic walls and may have blocked both ureters but hasn’t spread to lymph nodes or other areas. Or, the cancer has spread to the lymph nodes but not to other areas.

Stage 4

Cancer has spread to other organs.

Stage 4A: Cancer has spread to bladder and/or rectum but nothing else.

Stage 4B: Cancer has spread beyond the pelvis to other organs such as the lungs or liver.

So there are the stages of cervical cancer. A shorthand version of saying what stage cancer you have/ had is: -

· 1A through to 1B1 Early Stage

· 1B2 through to 4A Locally Advanced

· 4B Advanced

How you are staged does impact on survival rates but I won’t go into that in detail here. Obviously the earlier you are staged and the more contained any cancer is the higher the number will be in front of the percent sign.

The stage you are given will also have an impact on the type of treatment that is given to you. As a rough rule of thumb (remember everyone is different and unique and these may vary) it commonly looks like this: -

Stage 1A1 – conisation or hysterectomy (the hysterectomy is often dependent on age and childbearing status so if you are done with having children they may well go for the hysterectomy)

Stage 1A2 – 2A – trachelectomy or hysterectomy (1B2 and 2A2 often have chemo-radiation as well as surgery. Trachelectomy's seem to be dependent on a few factors as well; namely whether you are done having children and sadly, whether the postcode lottery of the UK NHS allows you to ‘win.’)

Stage 2B – 4A – chemotherapy (usually no surgery at this stage)

Stage 4B – palliative therapy (this focuses on providing pain management and symptom relief and is not necessarily curative)

I was staged at 1B1 which meant that I was at the later stages of early stage cancer. I am fully aware of my luck and as I keep reiterating (because I know now how important it is to attend smear tests) if I had decided to ignore the symptoms that were presenting themselves for any more length of time the stage may have looked very different.

If we were to add all the staging components together mine would be classified as: -

T1b1, N0, M0

But because I’m so much more than a disease here are some other letters: -

BSc, MSc, CIPD

(Hey I worked hard for those. Fine, semi-hard).

Oh, and here’s one more: -

I have suggested that my brother get the above as a full back tattoo to honour me but so far he's not buying.

Oh ‘fun’ fact (I am aware that this is not, in actuality, fun):

The staging process was determined by an organisation called FIGO or the ‘Federation Internationale de Gynecologie et d’Obstetrique.’ This organisation was founded in Geneva, Switzerland. Switzerland have provided the world with some very special things: -