Cancer Staging and Why It Decides the Treatment Plan

Unfortunately there is no specific genetic mutation identified for uterine fibroids and no targeted drug role for them, since fibroids are benign tumours, not cancers. Treatment options remain limited to hormonal therapy or surgery.

Targeted therapy's main advantage is that it is mostly oral medication without the classic side effects of chemotherapy, so it remains a reasonable option even in poor performance status, though this depends on the specific drug and its side-effect profile rather than being a blanket rule. Two cases illustrate this: a metastatic lung cancer patient with brain metastases who was bedridden with severe headache and vomiting, and a metastatic breast cancer patient with cerebellar metastasis causing incoordination, both showed marked improvement on targeted therapy despite their poor baseline state. Overall, more patients in poor performance status can be treated with targeted therapy than with chemotherapy, since chemotherapy is often not feasible in a very poor clinical state.

FNAC (fine needle aspiration cytology) involves inserting a needle into a tumour or fluid-filled cyst and aspirating fluid along with a few detached cells for slide evaluation under a microscope; sensitivity is low since so few cells come through, and a pathologist can typically only confirm abnormal cells are present, not the exact cancer subtype needed for hormone receptor and HER2 testing. Core biopsy uses a biopsy gun that removes a cylindrical piece of tissue roughly a centimetre long, providing enough tissue for full histopathological and genetic workup, which is why core biopsy, not FNAC, is preferred whenever cancer is suspected.

Breast cancer is broadly split into three types: hormone receptor positive, HER2 positive, and triple negative. The diagnostic procedure itself does not change based on subtype: a biopsy is still required, with mammography used only for initial evaluation. IHC testing on the biopsy sample determines ER, PR and HER2 status; if all three come back negative, the cancer is classed as triple negative, a more aggressive subtype that is harder to treat once it reaches stage four.

Neither is simply better in every case. MRI is the more definitive test to rule out cancer, but mammography, a form of X-ray, can miss a tumour hidden in fattier breast tissue, which is common in women under 30 to 35. In younger women, ultrasound or MRI is preferred; mammography becomes more effective after around 35 to 40, once fibrous tissue outweighs fat. MRI is more accurate but costlier and more involved for the patient, which is why mammography is offered first, with a PET-CT or a CT of the chest, abdomen and pelvis used for staging.

Stage four means the cancer has spread beyond its organ of origin and nearby lymph nodes to distant organs elsewhere in the body.

In stage three or early stage four disease, chemotherapy is often given first to shrink the tumour enough to make surgery feasible, with surgery following once the tumour has responded.

Rectal cancer, breast cancer and head and neck cancers are commonly treated with radiation therapy after surgery specifically to reduce the risk of the cancer recurring.