Principal Director & Unit Head - Medical Oncology, Fortis Hospital, Shalimar Bagh, New Delhi, India
Part 5 of 8 in Diagnosis and Detection of Cancer
Cancer Staging, Tumour Markers and Screening Explained
May 19, 2024
Once cancer is suspected, staging and the right use of tumour markers determine how treatment is planned - and screening is what catches disease before symptoms appear at all.
Staging comes before treatment
Every cancer has four stages. Up to stage three, disease is generally local and can potentially be cured; even some stage-four cases can be completely cured with the right treatment. Treatment should not start before staging and biopsy confirm exactly what is being treated - for colorectal cancer, for example, a biopsy characterises the cancer, a PET-CT scan determines the stage, and stage 1-3 disease may proceed to surgery while stage 4 usually starts with medical management first.
Tumour markers are not screening tools
Tumour markers are not specific to cancer and can be elevated in non-cancerous conditions too, so they should not be used to screen the general population. In a patient already diagnosed with cancer, however, they are useful for monitoring the disease over time.
Bringing diagnosis closer to patients
The main way to bring cancer diagnosis down to the local level is through education and awareness: if patients and doctors recognise the seven warning signs and pursue screening and early consultation, cancer gets caught and treated earlier, closer to home.
This article is based on a Jivo Masterclass session conducted by Dr. Mohit Agarwal, Principal Director & Unit Head, Medical Oncology, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Mohit Agarwal taught doctors across Africa on May 19, 2024.
FROM THE LIVE Q&A
Moderator
To prevent cancer death and increase early treatment, what can be done to detect and diagnose cancer?
Dr. Mohit Agarwal
The same principle applies: go for screening, be aware of the warning signs, and maintain a healthy lifestyle - regular exercise, no tobacco, minimal alcohol and a balanced diet. Doing these things means you will either not develop cancer or you will catch it early.
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Frequently Asked Questions
What are the risks of working in a close environment to chemotherapy?▼
Chemotherapy, if not handled properly, can be toxic to people nearby. It has to be prepared in a specific mixing unit with proper precautions, and only staff trained in handling and administering chemotherapy should give it.
What are the best treatment options for already metastasised malignant disease?▼
It is not a one-size-fits-all approach. It depends on the individual patient, which cancer is present in the body, and which site it has metastasised to. Treatment can be chemotherapy, immunotherapy or targeted therapy depending on exactly what is being treated.
Why do brain tumours relapse so much compared with other tumours?▼
Brain tumours relapse mainly if they are high-grade or advanced-stage. Complete surgical removal of a brain tumour is nearly impossible, so high-grade or advanced tumours are more likely to recur; patients with low-grade tumours tend to be cured.
A male patient has a cystic mass with solid components draining blood-stained, chocolate-coloured, thick fluid from the left breast, with histology not yet available - what type of breast cancer is this likely to be, and what is the likely prognosis?▼
Any discharge from a male breast is not normal - it can be an infection, a malignancy, or something arising from the chest wall. The key next step is imaging and a histopathological diagnosis; this could turn out to be breast cancer, which would need immediate treatment.
What are the prognostic factors for breast cancer?▼
Two main factors: the patient's own disease stage, and the biology of the disease, meaning which receptors are present on the tumour for targeted or hormonal therapy.
Can tumour markers be used to screen for cancer?▼
No - they aren't specific to cancer and can rise in non-cancerous conditions; they're used for monitoring known disease, not screening.
How is a cancer like colorectal cancer staged?▼
A biopsy characterises the cancer type first, then a PET-CT scan determines the stage; stage 1-3 may proceed to surgery, while stage 4 typically starts with medical management.
In This Series: Diagnosis and Detection of Cancer
- 1.Diagnosis and Detection of Cancer
- 2.Cancer Myths: Family History, Genetic Testing and Who Gets Cancer
- 3.Smoking and Other Major Cancer Risk Factors
- 4.The Seven Warning Signs of Cancer and How Biopsy Works
- 5.Cancer Staging, Tumour Markers and Screening Explained
- 6.Chemotherapy, Targeted Therapy and Immunotherapy Explained
- 7.Breast Cancer: Prognostic Factors and Treatment Sequencing
- 8.The Role of Nutrition in Cancer Prevention and Care