When a cancer diagnosis is made, the next step is for the doctor to get more detailed information about the cancer. This information is used for staging the cancer, a process in which your specific cancer type is grouped or categorised according to its size and spread. Stage 2 cancer is not considered to be advanced, but is more serious than stage 1.
What is cancer staging?
Staging is a grouping process that is done after a cancer diagnosis, before treatment begins. Staging describes the cancer in terms of its progression and location, information for which your doctor may need to do further assessments such as imaging and lab tests. Cancer is generally referred to by the stage allocated at diagnosis, regardless of changes over time (although new information could be added to the original stage).
There are many methods and systems for staging. One of the most common ways to stage a cancer is using the TNM system, which uses a combination of numbers and letters in various ways depending on the type of cancer. The three basic categories assessed are:
- Tumour (T): The size and extent of the primary tumour (where the cancer started). Usually described by a number between 1-4.
- Nodes (N): Lymph nodes near the primary tumour that have cancer. Usually described by a number between 0-3 (0 meaning none of the nodes are positive for cancer, 3 indicating that many are). Lymph nodes are small immune cell collections, often the first place that a nearby cancer will spread to before branching out to other parts of the body.
- Metastasis (M): Metastasis refers to how far the cancer has spread from the primary tumour to other parts of the body. It is usually described by the number 0 or 1 (0 indicating no spread).
Number staging is the system referred to when we use the phrase ‘stage 2’. While the TNM system gives important details, the combinations can be grouped into broader categories as described below.
- 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 (in situ).
There is another staging system used to group all types of cancer into main categories, which is used more often by registries.
This system refers to a cancer as: ‘in situ’ (abnormal cells present, however they haven’t spread to nearby tissue); ‘localised’ (no sign of spread, cancer remains where it started); ‘regional’ (cancer has spread to nearby lymph nodes, tissues, or organs); ‘distant’ (cancer has spread to an outlying body part); ‘unknown’ (not enough information to allocate a stage).
The staging process can involve more or less categories than described here, or use systems in different ways depending on cancer details. Some cancers are graded instead of staged, such as brain cancer. The grade refers to the appearance of the cancer cell in comparison to normal tissue. If the cancer cells are very unusual, it could indicate quick growth.
What could stage 2 mean in the context of common cancers?
- Breast cancer: Stage 2 breast cancer could indicate a tumour between 2-5 cm, or a tumour that has spread beyond its original location into surrounding tissue or to nearby nodes under the arm.
- Lung cancer: Cancer may have spread to nearby nodes or into the chest wall.
- Prostate: Cancer is likely confined to the prostate (although could grow faster if cells are abnormal).
- Colorectal: Cancer has grown through the outer colon or rectum layer, possibly into nearby organs or tissue. However, it has not spread to lymph nodes or distant organs.
- Melanoma: Cancer may have spread deeper into the skin or it has more high risk features. Nevertheless, it has not spread to nearby lymph nodes.
What is a cancer prognosis?
A prognosis is a prediction of how your cancer is likely to develop, the effects it will have, and how treatment may go for you. A prognosis speaks to the seriousness of the disease and chances of survival. Your doctor will use statistics and research in order to estimate a prognosis, along with your general medical information and details of your cancer such as stage and grade.
Prognosis depends on the type of cancer, but generally speaking stage 2 cancers are less advanced (although more advanced than stage 1) and have a better prognosis than later stage cancers. Statistics such as survival rates, which are established from research on groups of people with the same type of cancer, are useful in determining prognosis.
How is stage 2 cancer treated?
All of the information that we have covered here helps to plan the best treatment and identify any possible clinical trials. Generally speaking, stage 2 cancers are treated similarly to stage 1 cancers. This treatment is usually local, with medication used in some cases. Treatment options for common cancers may include the following:
Breast cancer: Generally treated surgically by way of a lumpectomy or mastectomy, during which nearby lymph nodes will be examined for cancer. This is followed by radiation, and medication such as chemotherapy, targeted therapy, or hormone therapy (or a combination) is often included in the treatment plan.
Lung cancer: Generally treated surgically, sometimes followed by chemotherapy. If the patient is unable to have surgery, radiation may be considered.
Prostate cancer: Treatment depends on symptoms, age, and general health. In some cases the tumour may just be monitored and only treated if there is a change (although stage 2 cancers are more likely to spread than stage 1 if not treated). Treatment could include surgery, radiation and/or hormone therapy, in varying combinations.
Colorectal cancer: Generally treated surgically by taking out the affected part of the colon. The treatment plan could also include chemotherapy (although this treatment post-surgery is still being studied) and radiation, usually including various steps in different orders depending on the patient
Melanoma: Generally treated surgically. Nearby lymph nodes may also be assessed, and treated via immunotherapy or targeted therapy if positive (another option is monitoring nodes before treating).
Once the grade, stage, location and other health information is assessed, speak to your medical team or ours about the specifics for your cancer type.