What Are Stage 0 and Stage I Cancers?

by Jane Ashley

Patients and their loved ones may be confused about the diagnosis of Stage 0 or Stage I cancer. Is it really cancer if your doctor recommends “watch and wait?” Or others may wonder, “Do I really have cancer if it was removed surgically but I didn’t have chemo or radiation?”

Is Stage0 Really Cancer

What is Stage 0 Cancer?

While most kinds of cancer have 4 stages (Stage I through Stage IV), some cancers also have a Stage 0. Stage 0 is an early, localized cancer … referred to as cancer “in situ.” That is, cancer in place, confined to the area where it started.

Surgery is potentially curative, without the addition of chemotherapy or radiation. Sometimes, a cautious “watch and wait” approach may be recommended.

Stage 0 cancer occurs in the following cancers:

Leukemia (CCL)
Nasal cavity

Stage 0 cancer is usually asymptomatic and is discovered through routine screenings, like mammograms, colonoscopies, Pap smears or eye, dental and skin exams. This is the reason that the screenings for cancer are so important — to catch cancer in its earliest stages when it highly curable.

Stage 0 cancer provides opportunities for us to help educate others on the value of regular screenings. Stage 0 cancers, undiscovered or untreated, will developed into invasive cancer, with less favorable cure rates.

What is Stage I Cancer?

Stage I cancer is also called early-stage cancer. It is a relatively small tumor that has not penetrated adjoining tissue. And most importantly, it has not spread into our lymph nodes. It is highly treatable, with high cure rates. The staging system as we think of it, Stages I through IV, describes cancers that produce solid tumors.

Not all cancers create tumors. Blood cancers are staged differently. Leukemia, lymphoma and multiple myeloma each have their unique staging system to describe the severity and extend of their blood cancer.

Stage1 Surgery

Because Stage I cancers are small tumors that have not penetrated into the surrounding tissue nor spread to the lymph nodes, surgery is usually the treatment of choice.

The pathology report helps your medical team determine if additional treatment is necessary. The pathology report provides the following information.

Invasive. Has the tumor penetrated deeper in the walls of the organ where it is growing?

Grade. This refers to how the individual cancer cells look — do they look like normal cells or do they look much different? Cancer cells that look similar to normal cells are called “low grade” or “well-differentiated.” Cells that are very different are called “high grade” or “poorly-differentiated.”

Rate of growth. The pathologist may note how many cells are in the process of growing. The fewer cells that are dividing, the lower the grade.

Tumor margin. The distance between the cancer cells and the edge of the biopsy sample is called the margin. If there is sufficient distance between normal tissue and the cancerous tissue, then it’s declared a clean margin.

Lymph nodes. Your surgeon removes some or all of the area lymph nodes. The pathologist examines the nodes to check for cancer cells. If cancer cells are in the lymph node, it is considered “positive.” Cancer which has spread into adjacent lymph nodes or blood vessels is more likely to spread.

Tumor markers. Pathologists send off a sample of the tumor to detect the presence of hormone receptors or other protein receptors. It may be several weeks before this part of the pathology report is completed. The presence of certain markers may indicate a particular treatment plan would be effective or if your cancer is more likely to recur.

Every patient is different, and their treatment is adjusted for their particular circumstances. The decision of whether a Stage I cancer patient needs chemotherapy or radiation is based on the results of their pathology report. Here are some examples of the different ways Stage I cancer can be treated, according to NCCN guidelines.

Regular Screenings

A patient with Stage I colon cancer who has a low-grade tumor where the tumor hasn’t penetrated the colon wall, has clean margins and no positive lymph nodes will not need to have adjuvant (mop-up) chemotherapy.

Most Stage I breast cancer patients receive radiation after surgery to help prevent recurrence. Depending on the patient’s receptor status (ER-positive, HER2-postive or Triple Negative)), patients usually receive some sort of targeted therapy or hormone therapy for a number of years afterward to prevent recurrence.

A Stage I bladder cancer patient may have an “incision-less” surgery (often performed as an outpatient procedure), called TURBT. Then, patients receive an intravesical immunotherapy using Bacillus Calmette-Guerin (BCG). BCG helps prevent development of muscle-invasive bladder cancer. BCG is given every 6 weeks for 1 to 3 years afterward.

The Bottom Line …

Cancer is cancer, regardless of its stage. Cancer, left untreated, will grow and progress. Every type of cancer is different. Each person’s presentation of Stage 0 or Stage I is different. For some patients, surgery is enough while other patients require radiation, hormone therapy, targeted therapy or chemotherapy to complete their treatment.

Tell us about your Stage 0 or Stage I diagnosis in the comments below. 

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