Diagnosis and Staging
Cancer can cause many different symptoms. Most often these symptoms are not caused by cancer but by benign tumors or other problems.
If you have symptoms that last for a couple of weeks, your doctor will do a physical exam and order tests or other procedures to find out what is causing your symptoms.
If you do find out you have cancer, your doctor will order another set of tests or procedures to figure out its stage.
Stage refers to the extent of your cancer and is based on factors such as how large the tumor is and if it has spread.
Once your doctor knows the stage of your cancer, he will be able to suggest treatment and discuss your prognosis with you.
Understanding your cancer and knowing what to expect can help you and your loved ones feel more in control and cope with your diagnosis.
Symptoms of Cancer
If you have symptoms that last for a couple of weeks, it is important to see a doctor.
Cancer can cause many symptoms, but these symptoms are most often caused by illness, injury, benign tumors, or other problems.
If you have symptoms that do not get better after a few weeks, see your doctor so that problems can be diagnosed and treated as early as possible.
Often, cancer does not cause pain, so do not wait to feel pain before seeing a doctor.
Some of the symptoms that cancer may cause include:
Breast changes
Lump or firm feeling in your breast or under your arm
Nipple changes or discharge
Skin that is itchy, red, scaly, dimpled, or puckered
Bladder changes
Trouble urinating
Pain when urinating
Blood in the urine
Bleeding or bruising, for no known reason
Bowel changes
Blood in the stools
Changes in bowel habits
Cough or hoarseness that does not go away
Eating problems
Pain after eating (heartburn or indigestion that doesn’t go away)
Trouble swallowing
Belly pain
Nausea and vomiting
Appetite changes
Fatigue that is severe and lasts
Fever or night sweats for no known reason
Mouth changes
A white or red patch on the tongue or in your mouth
Bleeding, pain, or numbness in the lip or mouth
Neurological problems
Headaches
Seizures
Vision changes
Hearing changes
Drooping of the face
Skin changes
A flesh-colored lump that bleeds or turns scaly
A new mole or a change in an existing mole
A sore that does not heal
Jaundice (yellowing of the skin and whites of the eyes)
Swelling or lumps anywhere such as in the neck, underarms, stomach, and groin
Weight gain or weight loss for no known reason
How Cancer Is Diagnosed
X-rays use low doses of radiation to create pictures of the inside of your body.
If you have a symptom or a screening test result that suggests cancer, your doctor will find out whether it is due to cancer or some other cause. There is no single test that can diagnose cancer.
So your doctor may start by asking about your personal and family medical history and doing a physical exam. They may order lab tests, imaging tests (scans), or other tests or procedures.
You may also need a biopsy, which is often the only way to tell for sure if you have cancer.
Results from lab tests, imaging, and biopsies are often posted in your patient portal before your doctor can discuss them with you. It is normal to feel anxious and want to know right away what the results are and what they mean.
But your doctor is the best person to explain the results of all your tests and what they mean for you.
Lab tests used to diagnose cancer
High or low levels of certain substances in your body can be a sign of cancer.
Lab tests of your blood, urine, and other body fluids that measure these substances can help doctors make a diagnosis. However, abnormal lab results are not a sure sign of cancer.
Lab test results are used along with the results of other tests, such as biopsies and imaging, to help diagnose and learn more about a person’s cancer.
For many tests, it is possible to have normal results even if you have cancer. And it is possible to have test results outside the normal range even if you are healthy.
These are some of the reasons why lab tests alone can’t say for sure if you have cancer or any other disease.
Your doctor is the best person to explain your lab test results and what they mean for you.
Some common types of lab tests used to help diagnose cancer are listed below.
Blood chemistry test
What it does: A blood chemistry test measures the amounts of certain substances that are released into the blood by the organs and tissues of the body. These substances include metabolites, electrolytes, fats, sugars, and proteins, including enzymes.
What it tells us: Blood chemistry tests give important information about how well your kidneys, liver, and other organs are working.
High or low levels of some substances in the blood can be a sign of disease or treatment side effects.
Complete blood count (CBC)
What it does: The CBC measures the number of red blood cells, white blood cells, and platelets in your blood.
It also measures the amount of hemoglobin (the protein that carries oxygen) in your blood, the amount of your blood that is made up of red blood cells (hematocrit), the size of your red blood cells, and the amount of hemoglobin in your red blood cells.
How it is used: The CBC is often part of a routine health check-up. It can help diagnose some cancers, especially leukemias. It is also used to monitor your health during and after treatment.
Cytogenetic analysis
What it does: Cytogenetic analysis looks for changes in chromosomes in samples of tissue, blood, bone marrow, or amniotic fluid. Chromosome changes may include broken, missing, rearranged, or extra chromosomes.
Changes in certain chromosomes may be a sign of a genetic condition or some types of cancer.
How it is used: Cytogenetic analysis may be used to help diagnose cancer, plan treatment or find out how well treatment is working.
Immunophenotyping
What it does: Immunophenotyping uses antibodies to identify cells based on the types of antigens or markers on the surface of the cells. It is most often done on blood or bone marrow samples. But it may also be done on other body fluids or tissue samples.
How it is used: Immunophenotyping helps diagnose, stage, and monitor blood cancers and other blood disorders, such as leukemias, lymphomas, myelodysplastic syndromes, and myeloproliferative disorders.
Liquid biopsy
What it does: Liquid biopsy is a test done on a sample of blood to look for cancer cells or pieces of DNA from tumor cells that are sometimes released into the blood.
How it is used: A liquid biopsy may help find cancer at an early stage. It may also be used to help plan treatment or to find out how well treatment is working or if cancer has come back.
Sputum cytology
What it does: Sputum cytology looks for abnormal cells in sputum, which is mucus and other matter brought up from the lungs by coughing.
How it is used: Sputum cytology can help diagnose lung cancer.
Tumor marker tests
What they do: Tests for tumor markers measure substances that are produced by cancer cells or other cells of the body in response to cancer.
Most tumor markers are made by both normal cells and cancer cells. But they are produced at much higher levels by cancer cells.
How they are used: Tumor markers can be used to help diagnose cancer, decide on treatment, measure how well treatment worked, and watch for signs that the cancer has returned.
Learn more about tumor markers.
Urinalysis
What it does: Urinalysis describes the color of urine and measures its contents, such as sugar, protein, red blood cells, and white blood cells.
How it is used: Urinalysis can help diagnose kidney cancer, bladder cancer, and rarer urothelial cancers.
Urine cytology
What it does: Urine cytology finds disease by looking for abnormal cells shed from the urinary tract into the urine.
How it is used: Urine cytology helps diagnose kidney cancer, bladder cancer, and rarer urothelial cancers. After cancer treatment, it is used to watch for signs that cancer has returned.
Imaging tests used in cancer
Imaging tests create pictures of areas inside your body that help the doctor see whether a tumor is present. These pictures can be made in several ways.
CT scan
A CT scan uses an X-ray machine linked to a computer to take a series of pictures of your organs from different angles. These pictures are used to create detailed 3-D images of the inside of your body.
Sometimes, you may receive a dye or other contrast material before you have the scan. You might swallow the dye, or it may be given by a needle into a vein. Contrast material helps make the pictures easier to read by highlighting certain areas in the body.
During the CT scan, you will lie still on a table that slides into a donut-shaped scanner. The CT machine moves around you, taking pictures.
Learn more about CT scans and how they are used to diagnose cancer.
MRI
An MRI uses a powerful magnet and radio waves to take pictures of your body in slices. These slices are combined to create detailed images of the inside of your body, which can show places where there may be tumors.
When you have an MRI, you lie still on a table that is pushed into a long chamber that surrounds part or all of your body. The MRI machine makes loud thumping noises and rhythmic beats.
Sometimes, you might have a special dye injected into your vein before or during your MRI exam.
This dye, called a contrast agent, can make tumors show up brighter in the pictures.
Nuclear scan
A nuclear scan uses radioactive material to take pictures of the inside of the body. This type of scan may also be called a radionuclide scan.
Before this scan, you receive an injection of a small amount of radioactive material, which is sometimes called a tracer. It flows through your bloodstream and collects in certain bones or organs.
During the scan, you lie still on a table while a machine called a scanner detects and measures the radioactivity in your body, creating pictures of bones or organs on a computer screen or film.
After the scan, the radioactive material in your body will lose its radioactivity over time. It may also leave your body through your urine or stool.
Bone scan
Bone scans are a type of nuclear scan that check for abnormal areas or damage in the bones. They may be used to diagnose bone cancer or find out whether cancer has spread to the bones from elsewhere in the body (called metastatic bone tumors).
Before this test, a very small amount of radioactive material is injected into your vein. As it travels through the blood, the material collects in abnormal areas in the bone. Areas where the material collects show up on pictures taken by a special scanner. These areas are called “hot spots.”
PET scan
A PET scan is a type of nuclear scan that makes detailed 3-D pictures of areas inside your body where glucose is taken up. Because cancer cells often take up more glucose than healthy cells, the pictures can be used to find cancer in the body.
Before the scan, you receive an injection of a tracer called radioactive glucose. During the scan, you will lie still on a table that moves back and forth through a scanner.
Ultrasound
An ultrasound exam uses high-energy sound waves that people cannot hear. The sound waves echo off tissues inside your body. A computer uses these echoes to create pictures of areas inside your body. This picture is called a sonogram.
During an ultrasound exam, you will lie on a table while a technologist slowly moves a device called a transducer, which makes high-energy sound waves, on the skin over the part of the body that is being examined. The transducer is covered with a warm gel that helps it glide over the skin.
X-rays
X-rays use low doses of radiation to create pictures inside your body. An X-ray technologist will put you in position and direct the X-ray beam to the correct part of your body.
While the images are taken, you will need to stay very still and may need to hold your breath for a second or two.
Biopsy
In most cases, doctors need to do a biopsy to be certain that you have cancer. A biopsy is a procedure in which the doctor removes a sample of abnormal tissue.
A pathologist looks at the tissue under a microscope and runs other tests on the cells in the sample.
The pathologist describes the findings in a pathology report, which contains details about your diagnosis. The information in your pathology reports can also help show what treatment options might work for you.
Learn more about pathology reports and the type of information they contain.
The biopsy sample may be obtained in several ways.
With a needle: The doctor uses a needle to withdraw tissue or fluid. This method is used for bone marrow aspirations, spinal taps, and some breast, prostate, and liver biopsies.
With endoscopy: The doctor inserts a thin, lighted tube called an endoscope into a natural body opening, such as the mouth or anus. The doctor can remove some or all of the abnormal tissue through the endoscope.
Examples of endoscopy exams include:
Colonoscopy, which is an exam of the colon and rectum. In this type of exam, an endoscope goes through the anus.
Bronchoscopy, which is an exam of the trachea, bronchi, and lungs. In this type of exam, an endoscope goes through the mouth or nose and down the throat.
With surgery: A surgeon removes an area of abnormal cells during an operation. Surgery may be excisional or incisional.
In an excisional biopsy, the surgeon removes the entire area of abnormal cells. Often some of the normal tissue around these cells is also removed.
In an incisional biopsy, the surgeon removes just part of the abnormal area.
Some biopsies may require a sedative or anesthesia.
Sedatives are medicine that helps you relax and stay very still or sleep during a biopsy.
Anesthesia keeps you from feeling pain. It refers to drugs or other substances that cause you to lose feeling or awareness. There are three types of anesthesia.
local anesthesia, which causes loss of feeling in one small area of the body
regional anesthesia, which causes loss of feeling in a part of the body, such as an arm or leg
general anesthesia, which causes loss of feeling and a complete loss of awareness that seems like a very deep sleep
What happens if tests show you have cancer
If the biopsy and other tests show that you have cancer, you may have more tests to help your doctor plan treatment.
For instance, your doctor may do other tests to figure out if the cancer has spread and how far. This information is important for knowing the stage of your cancer.
For some cancers, other pathology studies are done to find out the grade of the tumor. Tumor markers are studied to find out the risk group that you fall into.
This information is important for deciding on the best treatment. Your tumor may also be tested further for other tumor markers or biomarkers.
Cancer Staging
To learn the stage of your disease, your doctor may order x-rays, lab tests, and other tests or procedures.
Stage refers to the extent of your cancer, such as how large the tumor is and if it has spread.
Knowing the stage of your cancer helps your doctor
understand how serious your cancer is and your chances of survival
plan the best treatment for you
identify clinical trials that may be treatment options for you
A cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads.
New information about how a cancer has changed over time is added to the original stage. So the stage doesn’t change, even though the cancer might.
How Stage Is Determined
To learn the stage of your disease, your doctor may order x-rays, lab tests, and other tests or procedures.
Systems That Describe Stage
There are many staging systems. Some, such as the TNM staging system, are used for many types of cancer. Others are specific to a particular type of cancer. Most staging systems include information about:
where the tumor is located in the body
the size of the tumor
whether the cancer has spread to nearby lymph nodes
whether the cancer has spread to a different part of the body
The TNM Staging System
The TNM system is the most widely used cancer staging system.
Most hospitals and medical centers use the TNM system as their main method for cancer reporting.
You are likely to see your cancer described by this staging system in your pathology report unless there is a different staging system for your type of cancer.
Examples of cancers with different staging systems include brain and spinal cord tumors and blood cancers.
In the TNM system
The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.
The N refers to the number of nearby lymph nodes that have cancer.
The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.
When your cancer is described by the TNM system, there will be numbers after each letter that give more details about the cancer—for example, T1N0MX or T3N1M0. The following explains what the letters and numbers mean.
Primary tumor (T)
TX: The main tumor cannot be measured.
T0: The main tumor cannot be found.
T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. T’s may be further divided to provide more detail, such as T3a and T3b.
Regional lymph nodes (N)
NX: Cancer in nearby lymph nodes cannot be measured.
N0: There is no cancer in nearby lymph nodes.
N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer.
Distant metastasis (M)
MX: Metastasis cannot be measured.
M0: Cancer has not spread to other parts of the body.
M1: Cancer has spread to other parts of the body.
Other Ways to Describe Stage
The TNM system helps describe cancer in great detail. However, for many cancers, the TNM combinations are grouped into five less-detailed stages.
The following chart shows how your doctor or nurse may describe your cancer.
Stage What it means
Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer.
Stage I, Stage II, and Stage III (may also be written as Stage 1, Stage 2, and Stage 3) Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.
Stage IV (may also be written as Stage 4) The cancer has spread to distant parts of the body.
The higher the number, the more advanced the cancer is. Letters and numbers are often used after the first number to describe the cancer in more detail. For instance, Stage 2 prostate cancer may be further divided into 2A, 2B, or 2C.
Another staging system that is used for all types of cancer groups cancer into one of five main categories. This staging system is more often used by cancer registries than by doctors. But you may still hear your doctor or nurse describe your cancer in one of the following ways.
In situ—Abnormal cells are present but have not spread to nearby tissue.
Localized—Cancer is limited to the place where it started, with no sign that it has spread.
Regional—Cancer has spread to nearby lymph nodes, tissues, or organs.
Distant—Cancer has spread to distant parts of the body.
Unknown—There is not enough information to figure out the stage.
