A diagnosis of cancer, then what? You will be staged. From test results the doctor will stage you; I [one], II [two], III [three] or IV [four]. Once you are staged no matter if you go into remission or not the doctor will refer to you as in whatever the last stage he staged you; unless of course, they re-stage you.
Sounds a bit confusing, doesn’t it?
But is all this necessary? And is staging an accurate statement to give to a patient?
A patient presents with a small tumor in her breast. The test result shows it is a primary tumor and there are no significant changes in nearby lymph nodes so the doctor stages her at stage one. Another patient he sees has some lymph node involvement and stages her at stage two. Another shows enlarged lymph nodes a lesion nearby the primary tumor, he stages her at Stage three. The fourth patient has a large tumor in her breast, enlarge lymph nodes and a lesion now on her liver, the doctor has given this patient the bad news she is Stage IV [four].
So how did he stage? Doctors use what is called the TNM Stage System. It was developed by the AJCC [American Joint Committee on Cancer] and UICC [Union for International Cancer Control ] and used by doctors worldwide. TNM stands for the extent of the tumor [T], the extent of lymph node involvement [N] and the presence of Metastases [M]. To easily understand it remember: T= tumor, N= lymph Nodes, and M= metastases.
Staging is based on if cancer is present, then how large is the tumor, has it spread to lymph nodes? If so, the stage will be I, II, or III depending on the advancement locally; however, if it has been found in a distant body part then there are metastases and the stage is IV [four].
In looking at the patient examples above, the doctor saw Stages one, two and three patients, they are worried since they have cancer, but the doctor has given them a boost of hope telling them, ‘don’t worry cancer hasn’t spread.’ It is as he says: still localized. But is this an accurate statement? If not, is the doctor doing a disservice by giving them a false sense of security?
Cancer is stage IV [four] out the door. Stage IV is defined as having accumulated cancer cells in a distant part of the body from the primary tumor. Long before accumulated cells can be found on a conventional type test, CT scan, MRI, PET scan, etc., they are there, somewhere growing. By the time such a test finds them there are billions and billions of cells, only then are they detected. But a million-cell grouping is still significant because it is a small tumor on its way to becoming a larger tumor ready to invade or debilitate the individual. This is significant enough to warrant a doctor’s concern.
Normal healthy cells live on nutrients and oxygen brought to them by blood supply; cancer cells need a lot of energy to grow thereby needing more blood supply to accommodate their growing needs. This process of new blood vessel growth is called angiogenesis. Without added blood supply the tumor could not grow beyond a tiny grouping and we would not have cancer progression. When the tiny grouping of cells reaches more than about 10 million [ about the size of the pin head] it needs to have blood vessels sprouting into the tumor giving it the nutrients for further growth. At this point, the tumor begins to release VEGF [vascular endothelial growth factor], an angiogenic factor causing new blood vessel growth. Because we all have such cancer cell groupings, it takes phytonutrients that have VEGF suppressors to stop tiny cell groups [less than 10 million] to fade away. Those not killed off continue to grow.
When we are looking at staging, we need to consider what is happening to the primary tumor and how has that caused it to be Stage IV out the door. There are two major causative reasons.
One is cancer cells may be part of the blood vessel walls. This theory was discussed as early as 1948 and again in the 1960s by Warren and Shubik, others still studied this idea in the 1980s to the present; all theorizing that tumor cells were part of, adhered to or lined the blood vessels feeding into the tumor. This idea would explain the reason how tumor cells could be in the bloodstream. Furthermore, other studies have shown cancer cells can elongate and squeeze themselves through the tiny blood vessels thus causing distant metastases. As they get into the blood vessels they become trapped and even divide there, before their adaptation of the confinement allows them to elongate whereby they dislodge and move onward. They land in remote areas of the body and begin to grow further, once becoming larger than 10 million build their own blood supply; meanwhile, they remain small and undetectable by conventional testing.
Another method of spreading is called seeding. This is the method of spreading after a biopsy. Interstitial fluid surrounding all cells drain into the lymph system, the system is a series of lymph channels, feeding fluid into the upper left chest where the major lymphatic channel will drain into the blood. When a biopsy is done, the needle/scalpel cuts into the tissue [cancer tissue] as the tissue bleeds cancer cells flow into the blood vessels or they spill into the interstitial fluid. A small amount could mean a few billion cells quickly entering the bloodstream directly or through the lymph system; metastases are ready to begin somewhere in the body. This process is called ‘seeding’. Dr. Gammill at the Center of the Study of Natural Oncology in California said he rarely sees distant metastases until after a biopsy, then he sees it grows rapidly everywhere, especially in the bones. This is because a biopsy lets tens of billions of cancer cells into the blood and lymph system at one time whereas the cancer cells squeezing through the tumor blood vessels is done far slower.
A third method of creating new tumors can also be done during PET or CT scans whereby the high amounts of radiation around a suspicious growth can cause healthy normal cells to become damaged and turn malignant. One doctor studying patients after PET and CT scans noted that remote stray cancer cells that would otherwise never grow began to clump together. They are damaged and begin to attract each other, creating a remote tumor that would otherwise never occur.
Patients told they have Stage I, II or III and believe they are not in danger or that there is no concern of cancer growing in any remote area of the body is being misled. They have a false sense of security. Any doctor should know cancer cells are circulating in the blood if there is a tumor; if the doctor has ordered and had performed a biopsy to determine cancer type then he knows he has ordered ‘seeding’. Somewhere in the patient, there are metastases growing, whether they are detectable or not they are there. There is no Stage I, II or III – it is Stage IV out the door.
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