What Is Stage 1 Cancer?

We often hear people talking about “stage-something” cancer, and perhaps you have been wondering what this means. Stage 1 generally refers to cancer that has not grown much, and can sometimes be referred to as an ‘early stage’. Your best bet would be to discuss the type and staging process with a professional team.

What is a ‘stage’ when we talk about cancer?

Staging is a system in which cancer is described and categorised. The stage of specific cancer gives you more information about it, such as the size and spread. A stage helps to communicate details about the cancer that could inform treatment and prognosis.

How is cancer staging done?

Staging is done after diagnosis, before any treatment action is taken. A medical practitioner will collect relevant information about the cancer, from tests, scans, physical exams or other sources, and use it to categorise the cancer according to a staging system. There are several staging systems, and these vary depending on the type of cancers. Common information that will be used in staging include the size, location and spread.

What staging system does ‘stage 1 cancer’ fall under?

There are many different systems for staging. One of the more common staging systems is number staging, which uses the TNM staging system to assess information about the tumour (T), nodes (N), and metastasis (M), along with any other relevant information, and places the cancer in one of 4 broader categories. Generally speaking, lower numbers indicate less advanced cancer and have a better prognosis.

• Stage 1 (I): Generally indicates that the cancer is small and contained within the organ where it started (no spread).
• Stage 2 (II): Generally indicates a larger tumour (compared to stage 1), but that the cancer has not spread into surrounding tissue. However, depending on the type of cancer, Stage 2 could also refer to cancerous cells having spread to the nearby lymph nodes. 
• Stage 3 (III): Generally indicates a larger cancer, possibly one which has spread into nearby lymph nodes as well as surrounding tissues.
• Stage 4 (IV):  Also called secondary, advanced, or metastatic cancer. Generally indicates that the cancer has spread from where it began to at least one other organ.
• Stage 0: Some cancers have the option of a stage 0. This stage indicates that abnormal cells are present, but have not spread from the layer of cells where they started. 

Below are some common cancer types and what stage 1 could mean for each.

Stage 1 breast cancer 

The cancer is small but noticeable, contained to the breast tissue in which it began to develop or found in the nearest nodes.  Stage 1 breast cancer can further be divided into Stage 1A and Stage 1B, each stage determined by tumour size and positive lymph nodes (cancer present in nodes). Stage 1A would indicate a tumour 2cm or smaller, with no cancer in the nodes. Stage 1B would indicate cancer found in the lymph nodes, and either a small tumour (2cm or less) or no tumour found in the breast.

Stage 1 lung cancer

Stage 1 means the cancer is small and hasn't spread. Stage 1 can further be divided into 1A (cancer is 3cm or smaller) and 1B (cancer is between 3-4cm, and/or is smaller than 4cm and has grown into the main lung airway, and/or has grown into the membrane around the lung and is smaller than 4cm, and/or is smaller than 4cm and has caused a partial or complete lung collapse via pneumonitis or a blocked airway).

Stage 1 bowel cancer

Stage 1 indicates that the cancer has grown into the muscle wall or through the inner bowel lining, but no further (and nothing in the lymph nodes). Using the TNM system could be written as T1, N0, M0 or T2, N0, M0.

What is the prognosis for stage 1 cancer? 

Stage 1 cancer is usually not considered serious or severe, as it generally indicates that the cancer is not very large or spread out over the body. Prognosis very much depends on the type of cancer, but generally speaking stage 1 cancers have the best prognosis (i.e. they are very survivable) and curative treatment options. 

When determining prognosis, your doctor will be informed by research on groups of people with the same type of cancer. Combined with your personal information, it allows for a comparison and educated guess as to how the cancer and treatment may unfold for you.

Survival rates are not always categorised by stage, and when they are it may be a different staging system to the numbered system discussed here. For example, the CDC categorises survival statistics by a staging system called Summary Stage (localised, regional, distant, or unknown). Nevertheless, here are some survival statistics for common cancers, grouped by the numbered stage:

• In England, over 55% of people with stage 1 lung cancer will survive for 5 or more years after they’re diagnosed.
• In England, most women (98%) with stage 1 breast cancer will survive their cancer for 5 years or more after diagnosis.
• When diagnosed at its earliest stage, over 92% of  people with bowel cancer will survive their disease for five years or more.

How is stage 1 cancer treated?

While there are common or frequently used cancer treatments, each cancer type would have different treatment options depending on individual factors and the stage and grade of the cancer.  Below are some treatment possibilities for stage 1 common cancers:

• In breast cancer, stage 1 is considered highly treatable. Treatment usually consists of surgery and/or radiation (chemotherapy is not generally part of an early stage cancer regimen). Depending on the type of cancer cells and risk factors, hormone therapy may also be considered. 
• Amongst bowl cancers, for Stage 1 colon cancer surgery would be the main treatment. As with breast cancer, this early stage is unlikely to require chemotherapy, however surgery provides a closer look and may highlight a more advanced situation, in which case further treatment could be needed. 

For stage 1 rectal cancer, the main treatment would be surgical. Possible options are a trans anal endoscopic microsurgery (TEM) if the cancer is very low risk, or a total mesorectal excision (TME). If surgery is not an option, you may be offered brachytherapy or chemo-radiotherapy.