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NCCN Guidelines for Patients


Adolescents and Young Adults with Cancer, Version 1.2017

Some cancers are staged using the TNM system,

which is based on the extent of the primary tumor (T),

whether or not cancer was found in nearby/regional

lymph nodes (N), and whether distant metastases are

present (M).

See Chart 1


The blood cancers like lymphoma and leukemia use

other ways to stage disease since they are not solid

tumors. Brain tumors may not spread outside of the

brain, so they also don’t use the TNM system. Each

type of cancer has a slightly different staging system,

so the letters and numbers can mean something

different for someone with ovarian cancer than they

do for someone with lymphoma.

When finding out a stage for cancer a doctor also

looks at the tumor grade and tumor markers. The

rating of how much cancer cells look like normal cells

under a microscope is the tumor grade. This grade

tells how quickly the cancer can grow or spread.

The doctor also tests for tumor markers that can be

found at high levels in the blood or other bodily fluids.

Certain tumor markers are used to check for certain

types of cancer. For example, CA-125 may show in

the blood at high levels for someone with ovarian

cancer. This may mean cancer is present, but this

marker is only one piece of the puzzle. Once your

doctor puts all the pieces together, you will know

more about your cancer diagnosis and how to fight

this disease.

What do the test results mean?

Reviewing the test results marks the beginning of

your cancer journey. The results from your blood

tests, imaging studies, and biopsy will determine the

treatment you get, so it is important you understand

what they mean.

Of course, the shock of hearing that you have cancer

can make it hard to absorb all the technical and

scientific words. If you feel overwhelmed, follow a few

simple rules to help prepare for your next steps:

Chart 1. TNM Staging System

Primary tumor (T)

Regional lymph nodes (N)

Distant metastases (M)

TX: unable to evaluate

NX: unable to evaluate

MX: unable to evaluate

T0: no evidence of primary tumor N0: no cancer found in lymph nodes M0: no distant metastases found

T1-T4: size of primary tumor

N1-N3: cancer in lymph nodes

M1: distant metastases found


Dealing with the diagnosis

What do the test results mean?