What Is Stage 3 Cancer?

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Being told you or a loved one has stage 3 cancer can be frightening. Stage 3 cancers are more advanced, which means tumors are larger and may have spread (metastasized) farther than stage 1 or 2. Still, there are effective treatments for many stage 3 cancers. 

Understanding cancer stages—called the TNM scale—is vital. Staging affects survival rates, treatment options, and potential for remission (a period with few cancer symptoms).

On the TMN scale, stage 3 cancer is pretty advanced. The tumor has usually grown large, and diseased tissue can be found in other organs. It is also called locally advanced cancer or regional cancer.

Treatment for stage 3 cancers varies according to which organ is affected. Most are harder to treat than stage 1 or 2 cancers.  The prognosis or outlook for stage 3 cancer depends on many factors. Where the cancer is, how it reacts to treatment, your health, and your age can all affect the chances of recovery. 

Stage 3 cancers require expert care and likely a lot of it. Though some stage 3 cancers can be cured, they are more likely to come back after going away. 

Doctors use cancer stages to compare patients with similar diagnoses. It helps them to study the how effective treatments are, to track the growth of the cancer, and to estimate survival rates for different cancers.

This article reviews how these stages are determined. It also explains what they mean for a patient’s treatment and prognosis.

How the TNM Classification of Cancer Stages Works

Verywell / Theresa Chiechi

Definition

When doctors assess a cancer stage, they use a system developed by the American Joint Committee on Cancer. It has three parts and is called the TNM system. The letters and numbers differ from cancer to cancer, but they have the same structure:

  • T defines the tumor itself. Doctors analyze the its size and how far it has spread into the surrounding tissues and organs. The T rating ranges from 0 to 4. The bigger the tumor and the more it has spread, the worse the patient’s prognosis is likely to be.
  • N describes the extent of lymph node involvement and the number of lymph nodes in the area of the tumor. Lymph nodes are glands in your immune system. A tumor’s N value varies from 0 to 3 depending on how far it has spread.
  • M stands for metastasis. That's the spread of cancer cells to other organs. There are only two M Stages—0 or 1 for no or yes, respectively. It is harder to treat cancer that has spread.

Not all cancers use the TNM system for staging:

  • Gynecologic cancers use TMN and the FIGO system from the International Federation of Gynecologists and Obstetricians.
  • Cancers of the brain and central nervous system don’t have a formal staging system. They rarely spread beyond those organs.
  • Small-cell lung cancers are “limited” or “extensive” based on how far they’ve spread.
  • Blood cancers use the Rai, Lugano, or Binet staging systems.

Recap

The TNM system assigns a stage to cancer based on the size of the tumor, how many lymph nodes are involved, and whether it has spread to other organs. Not all cancers are staged using the TNM system. Some use other systems and some aren't staged at all.

Stage 3 Diagnostic Criteria

We tend to talk about all stage 3 cancers as if they are the same. In reality, these diagnoses differ widely based on cancer type. A stage 3 cancer often has one or more of three features:

  • The tumor has grown beyond a certain size (usually measured in centimeters).
  • It has spread to a set of nearby lymph nodes (such as the axillary lymph nodes in breast cancer).
  • It extends into nearby structures (for example, the chest wall in breast cancer).

Once diagnosed, a cancer stage never changes. Even if a doctor re-stages the cancer diagnosis, or it recurs, they keep the first staging diagnosis.

The doctor will add the new staging diagnosis to the initial stage. The new stage is denoted with letters—like c for clinical or r for recurring.

Some stage 3 cancers are subdivided to classify them more precisely. These sub-stages differ based on which organ is involved. For example, stage 3 breast cancer has three subcategories:

3A:

  • The tumor is smaller than 5 centimeters (cm) but has spread to 4-9 nodes. 
  • The tumor is larger than 5cm and has spread to 1 to 9 nodes.

3B:

  • The tumor is any size but has invaded the chest wall or breast skin.
  • It is swollen, inflamed, or has ulcers.
  • It may have also invaded up to nine nearby nodes.

3C:

  • The tumor is any size.
  • It has spread to 10 or more lymph nodes, nodes near the collar bones, or lymph nodes near the underarm and breast bone.

Doctors also say stage 3C breast cancers are operable or inoperable. That doesn’t mean they aren’t treatable. It just means that surgery wouldn’t be able to remove the entire tumor. In some cases, a treatment such as chemotherapy can shrink a tumor so much that it can be removed surgically even if it was considered inoperable beforehand.

Other Factors

There are a few other things that help doctors determine cancer’s stage:

  • Cell type: Even when cancers occur in the same organ, they might act differently based on what kind of cell turned cancerous. Each of our organs has many types of cells—any of which could become cancerous. The cell type can affect how cancer acts and reacts to treatments. For example, esophageal cancer from the mucus-producing gland cells reacts to treatment differently from cancer in the lining of the esophagus.
  • Tumor location: Where in an organ the tumor is found can affect the cancer's stage. For example, esophageal cancer staging partly depends on what part of the esophagus has cancer.
  • Tumor blood markers: For certain cancers, doctors can test the blood for certain cellular materials. Usually, it's proteins. These markers can help them decide on a stage. For example, prostate cancer stage depends on blood levels of a protein called prostate-specific antigen, PSA. Higher levels of PSA could mean a higher stage of cancer.
  • Tumor genetics: A tumor's genes and mutations influence cancer’s staging. When the body’s cells turn cancerous, their genes change rapidly and develop new traits.

Diagnosis

Because cancers are so complicated, many tests and procedures are used to stage them. They vary by the type of tumor. Not all tests are appropriate for all cancers. Here are a few of the standard tests and what they check for:

  • Imaging tests: Doctors use imaging tests like X-ray, computed tomography (CT), MRI, ultrasound, and positron emission tomography (PET) scans to peer inside the body without cutting you open. These images give the doctor a better idea of the size and makeup of a tumor. They can also tell them about other affected organs and blood flow.
  • Endoscopy: Endoscopy involves the doctor inserting a small tube or wire into the body to look at the organs with a small camera. It includes tests like a colonoscopy, bronchoscopy, and laparoscopy. The doctor uses the scope to take pictures or samples of unusual areas. 
  • Biopsy: During a biopsy, the doctor takes a tissue sample of the tumor, then looks at it under the microscope. These tissue samples can be from anywhere on the body—including the skin, bone marrow, or breast. Some biopsies use a vacuum device to draw out tissue samples through a needle. This process is called fine-needle aspiration (FNA).
  • Lab tests: Doctors can learn a lot by testing your blood, other body fluids, and tissue samples. Tests can look for tumor markers that tell them more about your cancer. They can test the cancer’s genes to learn more about it. And they can do general blood testing to keep track of your health.  

Recap

When doctors diagnose a cancer stage, they look at the tumor itself. Its size, location, cell type, genetics, and blood markers all matter. Doctors also consider how many lymph nodes are involved and where those nodes are located. They gather this information from many different kinds of tests.

Treatment

Surgery is often the first line of defense against a tumor. Some surgeries involve an open incision. Others use a tiny incision and a camera on a flexible tube. The goal is to remove the cancerous tissue.

In some cases, stage 3C cancers will need other treatments to shrink the size of the tumor. Here's how some of those treatments work.

  • Chemotherapy uses potent drugs to kill cancer cells. It can also ease cancer symptoms. Chemo kills the body’s fast-growing cells, such as those that line the mouth or hair follicles. That causes many side effects—including hair loss.
  • Radiation therapy uses radiation to kill cancer cells. Radiation is energy that can damage cells, so doctors use it to weaken the cancer cells. They usually target this treatment to the area of the body where the cancer is. It can take days or weeks to see an impact. 
  • Hormone therapy is also known as endocrine therapy. It's used with tumors that need hormones to grow. Prostate and breast cancers are two examples. By depriving the cancer cells of hormones, the treatment keeps cancer from growing as quickly. It also eases cancer symptoms. Because these treatments target the body’s hormones, they have side effects that differ by sex.
  • Targeted therapy is a form of personalized medicine. It attacks the cancer based on its genetics. These therapies can slow or stop the growth of cancer cells by targeting the gene changes that let these cells grow out of control. Targeted therapies can be drugs or antibodies made against the tumor’s special proteins.
  • Immunotherapy uses the body’s immune system against cancer. It might be surprising, but the body has ways to find and destroy cells that could become cancer. These therapies help support the body’s immune system as it fights cancer.

Which treatments the oncologist uses depends on the type of cancer, how far it has spread, and many other factors. Here are three treatment approaches as examples:

  • Breast cancer: Doctors often treat stage 3 breast cancers with chemotherapy to shrink the tumor’s size before surgery. After surgery, radiation and hormone therapies may be used to kill any cancer cells that are left.
  • Colorectal cancer: The first move for stage 3 colorectal cancer is often surgery to remove cancer from the colon and lymph nodes. Radiation may be used on the parts of the tumor they couldn’t completely remove.
  • Melanoma: Treatment for Stage 3 melanoma starts with surgery. Doctors remove a wide area of skin and the lymph nodes in the area. Immune and targeted therapies can reduce the risk of the tumors coming back. Radiation or chemotherapy may follow if the lymph nodes are heavily involved.

When the signs and symptoms of cancer have gone away, doctors say the treatment was successful and the patient is in remission. Remission rates for stage 3 cancers vary by the type of cancer and available treatments. 

Treatment plans for stage 3 cancer can be complex. They often involve many doctors, nurses, and centers. One thing that can help patients is a palliative care team. These doctors, nurses, and social workers work with seriously ill patients to relieve symptoms and treat side effects. They work to improve patients’ stress levels. No matter what stage of cancer, palliative care can help. 

Recap

Different types and stages of cancer need different treatments. Surgery, chemotherapy, radiation, hormones, targeted therapy, and immunotherapy are the main options. An entire treatment team works to shrink or remove cancer from your body. If a treatment works and there are no signs of cancer, you're said to be in remission.

Prognosis

Woman And Child Sitting On Sofa At Home

Heidi Sain / EyeEm

Lots of factors can impact the outcome of stage 3 cancers. Some examples are:

  • Cancer type
  • Grade
  • Genetics
  • Traits such as age, health, and smoking history

Another factor is known as performance status. It's a way of scoring your ability to perform everyday tasks.

Doctors use survival rates to estimate how likely it is that someone with a certain diagnosis will still be alive in five years. The cancer-specific survival rate would be the portion of people with a particular diagnosis who had not died from that cancer. The relative survival rate estimates how many of those people had not died from anything (cancer or otherwise) during that time.

Survival is typically measured in five-year rates (the number of people in 100 who are expected to live for at least five years). You might see one-year, two-year, and 10-year survival rates, too.

You can find cancer survival rates in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program’s database. It has been reporting cancer statistics from 19 states since 1973.

The SEER database does not use the TNM staging system. Cancer registries like SEER typically use a three-stage approach:

  • Localized: In which the cancer cells are only in the area in which it first grew
  • Regional: In which the tumor has spread to nearby lymph nodes, tissues, or organs (generally, this includes Stage 3 cancers)
  • Distant: In which cancer has spread to remote parts of the body

These stages make it easier for cancer registries to categorize patients. But there are limitations to the SEER definitions. For example, many stage 2 and 3 cancers meet the SEER definition of “regional.” Stage 3C edges closer to “distant.”

Keep this in mind when you think about the five-year survival rates below. They only offer a general estimate of life expectancy. 

The figures below are from the NCI’s SEER database. It tracks how many cases of cancer are diagnosed and what the outcomes are. The numbers below are the five-year survival rates for the top 10 cancers at a "regional" stage. This data was collected from 2010 to 2016.

Note that doctors stage lymphoma and leukemia differently. The non-Hodgkin lymphoma number is the stage 3 survival. The leukemia number is the overall five-year relative survival rate for any stage. 

Stage 3 “Regional” Cancer Survival Rates
 Number Location  Survival Rate
1 Breast (female) 85.7%
Lung and bronchus 31.7%
Prostate 100%
Colon and rectum 71.8%
Melanoma (skin) 66.2%
Bladder 36.5%
Non-Hodgkin lymphoma* 70.5%
Kidney and renal pelvis 70.4%
9 Uterine (endometrial) 69.4%
10  Leukemia* 63.7%
11  Pancreas 13.3%
12  Thyroid 98.3%

Summary

Stage 3 cancer is fairly advanced. It often means that a tumor has grown larger and cancer cells can be found in lymph nodes and other organs. To discover exactly how far cancer has spread, doctors use a variety of tests.

To arrive at a stage 3 diagnosis, doctors consider the tumor's size, where it is, and what type of cells make it up. They also look at its genetics and other markers. Once they diagnose a stage, it stays the same, even if the cancer goes into remission or comes back later.

Public health organizations keep track of new cancer cases and deaths from cancer. They estimate the chances that someone with a certain type and stage of cancer will be alive in one, two, five, or 10 years' time. The outlook for a person with stage 3 cancer depends on more than this estimate, though. Overall health, age, the type of cancer, its stage, and treatments all shape the prognosis.

A Word From Verywell

A cancer diagnosis is a life-changing event. This is especially true if you're diagnosed with later-stage cancer. But stage 3 cancer isn’t a death sentence. Survival rates are improving, and researchers are continually discovering and testing new targeted drugs and immunotherapies.

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