Staging
Staging is a process that tells a doctor if the cancer has spread, and if it has, how far. Staging for Merkel cell carcinoma depends on the location and thickness of the tumor, whether or not it has spread to nearby lymph nodes, and whether or not it has metastasized to other parts of the body. Staging is an important step in evaluating prognosis and treatment options.
Stage 0 (carcinoma in situ)
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Description
- Abnormal, but non-invasive cells are found in the top layer of skin (epidermis).
Treatment
- Surgery with or without lymph node dissection, followed by radiation therapy.
Stage Ia
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Description
- Tumor is less than or equal to 2 cm in diameter. No cancer is detected in the lymph nodes when examined under a microscope.
Treatment
- Surgery with or without lymph node dissection, followed by radiation therapy.
Stage Ib
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Description
- Tumor is less than or equal to 2 cm in diameter. No cancer is detected in the lymph nodes by physical examination or imaging tests.
Treatment
- Surgery with or without lymph node dissection, followed by radiation therapy.
Stage IIa
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Description
- Tumor is greater than 2 cm in diameter. No cancer is detected in the lymph nodes when examined under a microscope.
Treatment
- Surgery with or without lymph node dissection, followed by radiation therapy.
Stage IIb
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Description
- Tumor is greater than 2 cm in diameter. No cancer is detected in the lymph nodes by physical examination or imaging tests.
Treatment
- Surgery with or without lymph node dissection, followed by radiation therapy.
Stage IIc
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Description
- Tumor can be any size, and it has invaded nearby structures such as bone, muscle, cartilage, or connective tissue. However, cancer has not spread to any nearby lymph nodes.
Treatment
- Surgery with or without lymph node dissection, followed by radiation therapy.
Stage IIIa
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Description
- Tumor may be any size and may have invaded nearby structures such as bone, muscle, cartilage or connective tissue. A small amount of cancer cells are found in lymph nodes when they are viewed under a microscope.
Treatment
- Surgery with or without lymph node dissection, radiation therapy.
Stage IIIb
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Description
- Tumor may be any size and may have invaded nearby structures such as bone, muscle, cartilage or connective tissue. Cancer has spread to nearby lymph nodes, and can be seen on physical exam, imaging tests, and under a microscope. There may also be a second tumor, called "in transit metastasis". This second tumor may be in between the primary tumor and regional lymph nodes, or closer to the outside of the body than the primary tumor.
Treatment
- Surgery with or without lymph node dissection, radiation therapy.
Stage IV
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Description
- Tumor has spread to distant organs or parts of the body.
Treatment
- Chemotherapy, surgery, radiation therapy. Treatments in this stage are primarily palliative.
