What Is Stage 3 Cancer?

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Cancer is a scary enough diagnosis on its own, but being told you or a loved one has stage 3 cancer might sound like a death sentence. It isn’t always. Stage 3 cancers are more advanced—generally, the tumors are more extensive and may have spread (metastasized) farther than stage 1 or 2—but there are effective treatments for many stage 3 cancers. 

Understanding cancer stages—called the TNM scale—is vital for anyone who has been or has had a loved one diagnosed with cancer. Staging affects patients’ survival rates, treatment options, and potential for remission.

On the TMN scale, stage 3 cancer is pretty advanced. The tumor in question has usually grown large, and the diseased tissue may invade other organs (metastasize). It is also called locally advanced cancer or regional cancer.

Treatment for stage 3 cancers varies by the affected organ, but they’re generally larger and harder to treat than stage 1 or 2 cancers.  The prognosis for stage 3 cancer depends on many other factors, including its location, how it reacts to treatment, and the patient’s health and age. 

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

Doctors use cancer stages to compare patients with similar diagnoses, to more easily study the effectiveness of treatments, to track a person’s cancer progression, and a way to estimate survival rates for specific cancers. Let’s review how these stages are determined and what they mean for a patient’s treatment and prognosis.

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Definition

When assessing a patient’s cancer stage, doctors use a classification system developed by the American Joint Committee on Cancer. It has three parts and is called the TNM system. While the actual breakdown of letters and numbers differs from cancer to cancer, they have the same general structure:

  • T in the system defines the tumor itself. Doctors will analyze the mass’s size and how far—either into the tissue or into the surrounding organs—it has spread. 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 defines if the tumor has invaded the body’s lymph nodes—white blood cells’ home base. Lymph nodes are found all over the body, so a tumor’s N varies from 0 to 3 depending on if it has not spread, was in just nearby nodes, or if it has spread widely. Lymph nodes are important for cancer prognosis, as they act like the body’s bus stops. If cancer cells make it to the bus stop, it’s easier for them to move on to other parts of the body, potentially spreading to other organs. 
  • M stands for metastasis—the spread of cancer cells to other solid organs. There are only two M Stages—0 or 1 for no or yes, respectively. Metastasis to other parts of the body makes the body’s fight against cancer harder, worsening prognosis.

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 since 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.

Stage 3 Diagnostic Criteria

While we talk about stage 3 cancers as one monstrous thing, their diagnosis differs drastically based on cancer type. Generally, stage 3 cancer diagnosis requires one of three features:

  • Tumor growth beyond a specific size (usually measured in centimeters)
  • Spread to a specific set of nearby lymph nodes (such as the axillary lymph nodes in breast cancer)
  • Spread to specific parts of the body (for example, the chest wall or collarbone in breast cancer)

Once diagnosed, a cancer stage never changes. Even if the doctor re-stages the cancer diagnosis, or it recurs (marked with an r), they keep the initial staging diagnosis.

The doctor will add the new staging diagnosis to the initial stage and differentiate it with letters—like c for clinical, p for pathological (after surgery), or after treatments (y).

Some stage 3 cancers are subdivided to give a more precise classification. These sub-stages will differ based on the specific cancerous organ. For example, stage 3 breast cancer has three subcategories:

3A:

  • The tumor is smaller than 2 centimeters (cm) but has spread to 4-8 nodes. 
  • The tumor is larger than 5 cm, and cancer clusters in nodes.
  • Or, the tumor is larger than 5 cm and found in up to 3 nodes near the breastbone or underarm 

3B: The tumor is any size but has invaded the chest wall or breast skin and is swollen, inflamed, or has ulcers. It may have also invaded up to 9 nearby nodes

3C: The tumor can be any size but has spread to either: 10 or more lymph nodes, nodes near the collar bones, or lymph nodes near the underarm and the breast bone

Doctors will also diagnose stage 3C breast cancers as operable or inoperable, but that doesn’t mean they aren’t treatable. It just means that surgery wouldn’t be able to remove the entire tumor.

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 it was that turned cancerous. Each of our organs has many types of cells with different functions—any of which could become cancerous. The actual cell type that turned into a tumor 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 from the esophagus’s lining.
  • Tumor location: Where within an organ the tumor is located can affect the cancers’ stage. For example, esophageal cancer staging partly depends on what part of the esophagus the mass is.
  • Tumor blood markers: For certain cancers, doctors can test for specific cellular materials, usually proteins, in the blood. These markers can help them determine how to stage the tumor. 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: The genes and mutations of a tumor influence cancer’s staging. When the body’s cells turn cancerous, their genes change rapidly, developing new characteristics. For example, breast cancers with mutations in the HER2 gene are usually staged higher.
  • Age of the patient: For many cancers, the patient’s age plays a significant role in the staging. Specifically, older age would suggest a higher stage for prostate and thyroid cancers.

Diagnosis

Because cancers are so complicated, there are many tests and procedures used to stage them. These vary by type of tumor and won’t all be appropriate for every cancer. Here are a few of the standard tests and what they’re usually looking 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 a patient 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, in which the doctor inserts a small tube or wire into the body to visualize the internal organs using a small camera, includes tests like colonoscopy, bronchoscopy, laparoscopy. The doctors will use the tube to take pictures and even take a sample of any unusual findings. 
  • Biopsy: During a biopsy, the doctor takes a tissue sample of the potential 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. Biopsies can be vacuum-assisted or fine-needle aspiration (FNA).
  • Lab tests: Doctors can learn a lot by testing your blood, other bodily fluids, and tissue samples (biopsies). Tests can look for tumor markers which can tell them more about your cancer. They can test the cancer’s genes to learn more about it and do general blood testing to monitor the patient’s health.  

Treatment

Surgery is usually a doctor’s first line of defense against a tumor. Surgical resection is the preferred treatment option for most solid tumor cancers—Stage 3A and Stage 3B cancers are usually removed, then treated.

Doctors rarely consider Stage 3C cancers operable, though that doesn’t mean they aren’t treatable. It’s just more likely that your doctor will start with other treatments to shrink the tumor’s size before trying surgery to remove it. 

 Those treatments include:

  • Chemotherapy uses potent drugs to kill cancer cells. It treats cancer and can also ease cancer symptoms. Cancer cells usually grow quicker than many of the body’s other cells, and chemo drugs use this to tell cancer cells from healthy cells. Chemo also kills the body’s fast-growing cells—for example, those that line the mouth, intestines, and 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 a specific area of the body—where the cancer is—but can take days or weeks to see an impact. 
  • Hormone therapy, also known as endocrine therapy, only applies to some forms of tumors—those that require hormones to grow—usually prostate and breast cancers. By depriving the cancer cells of hormones, this treatment can treat cancer and ease cancer symptoms. Because these treatments target the body’s hormones, they have side effects that differ by sex.
  • Targeted therapy, a form of personalized medicine, is specially designed against the cancer based on its genetics. These therapies can help slow and stop the growth and spread of cancer cells by targeting the changes that let these cells grow out of control. Targeted therapies can be drugs or antibodies made against the tumor’s specialized proteins.
  • Immunotherapy uses the body’s immune system against cancer. It might be surprising, but the body has many mechanisms in place that find and destroy potentially cancerous cells every day. These therapies help support the body’s immune system in its fight against the cancer.

Which treatments the oncologist uses for a cancer diagnosis depends heavily on the type of cancer, how far it has spread, and many other criteria. For example, let’s review a general treatment approach for a stage 3 diagnosis of the five most common cancer types:

  • Breast cancer: Doctors typically treat stage 3 breast cancers first to shrink the tumor’s size before surgery. These treatments can include targeted therapy and hormone therapy, depending on the tumor’s characteristics. Then, surgery removes the tumor, followed by radiation and more targeted and hormone therapies, to kill the remaining cancer cells.
  • Lung cancer: Doctors treat stage 3 lung cancers with a combination of radiation, chemotherapy, and surgery. Surgery usually comes after other treatments, and only if the patient is healthy enough. Immunotherapies can be used, especially if the patient isn’t healthy enough for other treatment options.
  • Colorectal cancer: The first move for stage 3 colorectal cancer is usually surgery to remove the colon’s cancerous parts and the associated lymph nodes. Chemotherapy usually comes next, but doctors may add radiation to shrink the tumor if they couldn’t altogether remove it.
  • Melanoma: Treatment for Stage 3 melanoma starts with surgery, usually with a wide berth, and local lymph nodes removal. Immuno- and targeted therapies can reduce the risk of the tumors returning—potentially along with radiation or chemotherapy, especially if the lymph node infiltration is heavy.

When the signs and symptoms of cancer have gone away, the patient is declared successfully treated and in remission. Remission rates for stage 3 cancers, like survival rates, vary by the type of cancer and available treatments. 

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

Prognosis

Woman And Child Sitting On Sofa At Home

Heidi Sain / EyeEm

The prognosis of stage 3 cancers can vary by cancer type, grade, genetics, and other traits. Patient traits can also affect prognosis. Age, general health, if they’re an active or previous smoker, and their performance status—a way of scoring the patient’s ability to perform everyday tasks all impact prognosis and survival.

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

Survival is typically measured in 5-year survival rates (the number out of a hundred people who are expected to live for at least five years), although you might see 1-year, 2-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, which has been collecting and publishing 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 developed
  • 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

While these definitions make it easier for cancer registries to categorize patients, there are limitations to the SEER definitions. Namely, many stages 2 and 3 cancers meet the SEER definition of “regional,” while stage 3C edges closer to “distant.”

Keep this in mind when reviewing the 5-year survival rates below—they only offer you only a general estimation of life expectancy. 

For an overview of survival rates, see these figures below from the NCI’s SEER database, which monitors cancer incidence and outcomes. The numbers below for the top 10 cancers are the five-year survival rates (relative to similar people without cancer) for a “regional” diagnosis, from data between 2010 and 2016.

The exceptions are for lymphoma and leukemia, which doctors stage differently. The non-Hodgkin lymphoma number is the Stage 3 survival, and the leukemia is the overall five-year relative survival rate (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%

A Word From Verywell

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

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