The single most important question to ask your doctor when you are diagnosed with cancer in Kingston, New York

When you are first diagnosed with cancer, horrible thoughts come to mind: Will I live?  Will I live to see my children marry?  Why did this happen to me?

The single most important question to ask your doctor when diagnosed with cancer

Here's what you should be asking your doctor: What is the stage of my cancer?  Once you know the stage of your cancer, the rest is easy.  With the stage of the cancer, you can determine the statistical likelihood that you will survive for the next five years, known as the "five year survival rate".  Pretty important stuff to know, right?

What is the "stage" of your cancer?

The stage of your cancer is the most important predictor of survival.  The TNM system is the most widely used staging system and has been accepted by the American Joint Committee on Cancer (AJAC), and most doctors and hospitals use the TNM system as their main method of cancer reporting.

The TNM system is based on the extent of the tumor (T), the extent of spread to lymph nodes (N), and the presence of distant metastasis (M).  Based upon these three criteria, the stage of cancer can be determined.  One small caveat: most cancers have TNM designations, but some do not.  Cancers of the brain and spinal cord are staged according to their cell type and grade.  Different staging systems are also used for many cancers of the blood or bone marrow, such as lymphomas.

Once you know the stage of your cancer, you can determine the statistical likeihood of your survival five years from the date of your diagnosis. For example, papillary thyroid cancer has a 5-year survival rate of 100% for stages I and II, a 93% 5-year survival rate for stage III, and a 51% 5-year survival rate for stage IV.   The prognosis and five-year survival rate for thyroid cancer is directly related to the tumor size ("T"--less than 1.5 c.m. has a good prognosis), the presence of lymph node metastasis ("N") and whether the tumor of any size extends beyond the thyroid capsule to invade subcutaneous soft tissues ("M").  Overall the cure rate for thyroid cancer is very high (91% five year survival rate and higher) as long as the cancer is diagnosed before stage 4.

What is "summary staging" of cancer?

Some doctors and medical facilities use "summary staging".  This system is used for all types of cancer and it groups cancer into five main categories.  The first category is "in situ", where abnormal cells are present only in the layer of cells in which they developed.  "In situ" is the earliest stage of cancer and has the highest five year survival rate.

The second category of summary staging of cancer is "localized", where the cancer is limited to the organ in which it began without evidence of spread. An example of a localized cancer would be colon cancer in which the tumor has invaded the wall of the colon, but has not spread into the surrounding lymph nodes and tissues.  Localized tumors are associated with a good prognosis. 

The third category is "regional", where the cancer has spread beyond the primary site to nearly lymph nodes or organs and tissues.  Since cancer tends to spread to other parts of the body through the lymph nodes and blood vessels, a regional cancer is usually associated with a prognosis that is far from clear.  While regional cancers can be beaten, you will face extensive treatment, such as surgery, radiation therapy or chemotherapy to eradicate the cancer.

The fourth category is called "distant", where the cancer has spread from the primary site to distant organs or distant lymph nodes.  This is the most advanced stage of cancer and carries the worst five year survival rate.  When cancer has spread to distant organs, i.e., lung cancer spreading to the brain or liver, the five-year survival rate is very grim and is often as low as 5% or lower.

The fifth and final category is "unknown" in which there is not enough information to determine the stage of the cancer.

How will your doctor determine the stage of your cancer?

The stage of your cancer can be determined in a variety of ways, including operative reports, imaging studies, blood results and most importantly, pathology reports.  When your tumor is surgically removed, samples of the tumor will be submitted to the pathology department of the hospital for a microscopic inspection by a pathologist. The pathology report prepared by the pathologist will include information about the size of the tumor, the growth of the tumor into other tissues and organs, the type of cancer cells, and the grade of the tumor.

The "grade" of the tumor refers to how much the tumor cells resemble normal cells of the same tissue type.  The cells of tumors that resemble normal cells tend to grow and multiple slowly.  Pathology reports typically describe the cancer cells as "undifferentiated", "moderately differentiated" or "markedly differentiated" in order to indicate how closely your cancer cells resemble a normal cell.  This will help you determine how aggressive your cancer cells are.

Make sure you ask this one, very simple question to your doctor

You must ask your doctor, "What is the stage of my cancer?"  Trust me, your doctor will have an answer to your question, even if he/she is reluctant to tell you.  Once you know the stage of your case, you can determine your five-year survival rate based upon statistics published by the American Joint Committee on Cancer (AJAC).  Now, you're getting somewhere.

Do not accept vague answers from your doctor.  You need the truth.  Make sure you get the truth by asking the right questions.

What you can do if you want to learn more about cancer staging

I welcome your phone call on my toll-free cell at 1-866-889-6882 if you want more information about cancer staging or just want to chat.  Another option is to send me an e-mail at jfisher@fishermalpracticelaw.com and I will try to answer your question within 24 hours.  Don't hesitate to request a FREE copy of my book, The Seven Deadly Mistakes of Malpractice Victims, if you want more information about patients' rights.





Most cancers have TNM designations