When Your Cancer Stage Changes After Surgery

This page is for people whose cancer stage changed after surgery. It explains why the stage from surgery can differ from the one before it, and what that change does and does not mean.

Before surgery, your team gave you a stage. It came from an exam, imaging, and a biopsy. That is the clinical stage. It is written with a lowercase c — cT2 N0 M0, for example.

After surgery, a pathologist (a doctor who examines tissue under a microscope) looks at the whole specimen and at the lymph nodes that were removed. They assign a pathologic stage, written with a p, such as pT3 N1.

These are not competing answers. They are two staging steps made at different times. The American Cancer Society puts it this way: pathologic staging uses what was learned during surgery as well as everything known beforehand, so it gives more precise information.

Sometimes the pathologic stage comes out higher than the clinical stage. This is called upstaging. ACS says this can happen if surgery shows the cancer has spread more than was seen on imaging tests.

NCI describes imaging tests as creating pictures of areas inside your body that help the doctor see whether a tumor is present. A pathologist examines removed tissue directly. Clinical staging relies on physical exams, imaging tests and biopsies done before treatment. Pathologic staging adds what surgery shows.

Upstaging does not by itself mean a scan was misread. Ask your team to walk you through what was found at surgery that the scans did not show.

ACS says pathologic staging gives more precise information, which can be used to help determine what other treatments might be needed. Ask your team whether your recommended treatment has changed and why.

Stage is not the whole story of what to expect. Ask your team what other factors, such as the findings in your pathology report, matter in your case.

If you had treatment before surgery, your report may carry a "y" prefix, as in ypT1. ACS says this marks restaging after treatment. When cancer is restaged, the new classification is added to the original stage but does not replace it. That is why your notes may carry more than one stage. Ask your team how to read yours.

Ask what the pathologic stage is, and how it differs from what was expected. Ask whether the recommended treatment has changed as a result, and what the benefit of any added treatment is, expressed in numbers. Ask whether the margins were clear. Ask how many lymph nodes were examined. And ask for a copy of the pathology report. It is the document every later decision will refer back to.

• NCI — Cancer Staging
• American Cancer Society — Cancer Staging