Two weeks ago Oscar winning actor/producer Michael Douglas, 65, announced that he has been diagnosed with a tumor in his throat. This week, the “Wall Street” actor, son of Hollywood legend Kirk Douglas, and husband of Academy Award winner Catherine Zeta-Jones,revealed on Late Night with David Letterman, that he is suffering from Stage 4 throat cancer. The actor was diagnosed in early August when he was evaluated for a persistent sore throat and ear pain. Douglas, 65, blames his past history of alcohol use and smoking as contributing to the cause of the tumor, which is apparently at the base of his tongue. He has already begun 8 weeks of radiation and chemotherapy.
This kind of therapy can cause severe soreness in the throat and difficulty swallowing. Some patients require a feeding tube. Despite all this, Douglas seemed quite upbeat about his chances and, what seems to be no metastases: “I am head and neck,” Douglas said. “I am above the neck, so nothing’s gone down, and the expectations are good….” When pressed for odds, Douglas said it was about an” 80% chance” of recovery, and possibly higher at “certain hospitals”, and that he is doing all he can to beat this disease.
Here's what we tell our patients when they ask about what it means that he has Stage 4 disease. Perhaps it will help you in your discussions.
Staging describes the extent or severity of an individual’s cancer and is based on the extent of the primary tumor and the extent of its spread. This is important because:
- It helps the doctor plan a person’s treatment.
- It can be used to estimate the person’s prognosis.
- It can help identify that may be suitable for a particular patient. Staging helps researchers and healthcare providers exchange information about patients. It also gives them a common language for evaluating the results of clinical trials and comparing the results of different trials.
They continue to change as we learn more about cancer. Some staging systems cover many types of cancer; others are specific to a particular type. The common elements considered in most staging systems are:
- Location of the primary tumor
- Tumor size and number of tumors
- Lymph node involvement
- Cell type and
- Presence or absence of metastasis.
The TNM system is one of the most commonly used staging systems. Most medical facilities use the TNM system as their main method for cancer reporting. PDQ, the NCI’s comprehensive cancer database, also uses the TNM system. It is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis (M). A number is added to each letter to indicate the size or extent of the tumor and the extent of spread.
Tumors (T) and lymph nodes (L) designated as:
- X: Tumor or lymph nodes can’t be evaluated
- 0: No evidence of tumor or lymph nodes
- 1,2,3,4: Size and extent of the primary tumor or number and/or extent of spread of regional lymph nodes
As an example, breast cancer T3 N2 M0 refers to a large tumor that has spread outside the breast to nearby lymph nodes, but not to other parts of the body.
For many cancers, TNM combinations correspond to one of five stages. Criteria for stages differ for different types of cancer. For example, bladder cancer T3 N0 M0 is stage III; however, colon cancer T3 N0 M0 is stage II.
Most types of cancer have TNM designations, but some do not. For example, cancers of the brain and spinal cord are classified according to their cell type and grade. Different staging systems are also used for many cancers of the blood or bone marrow, such as lymphoma. The Ann Arbor staging classification is commonly used to stage lymphomas and has been adopted by both the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC).
| Stage | Definition |
| Stage 0 |
Carcinoma in situ (early cancer that is present only in the layer of cells in which it began). |
| Stage I, II, III, |
Higher numbers indicate more extensive disease: greater tumor size, and/or spread of the cancer to nearby lymph nodes and/or organs adjacent to the primary tumor. |
| Stage IV |
The cancer has spread to another organ. |
Stages of Throat Cancer:
What types of tests are used to determine stage?
The types of tests used for staging depend on the type of cancer. Tests may include the following:
- Physical exams
- Imaging such as x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans can show the location of the cancer, the size of the tumor, and whether the cancer has spread.
- Laboratory tests are studies of blood, urine, other fluids, and tissues taken from the body. For example, tests for liver function and tumor markers (substances sometimes found in increased amounts if cancer is present) can provide information about the cancer.
- Pathology reports may 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.
- Surgical reports tell what is found during surgery. These reports describe the size and appearance of the tumor and often include observations about lymph nodes and nearby organs.