ArcaMax

DEAR DR. ROACH: Can you define the characteristics of the four stages of cancer? I understand that stage I is generally when cancer is caught early and can be treated with a good success rate, while stage IV is usually the opposite. But I'm not sure what the intermediate stages are. -- B.G.

ANSWER: Unfortunately, the exact staging for cancers depends on the type of cancer. But in general, you are correct that stage I cancers for solid organs generally consist of small tumors that have not spread, while stage IV usually signifies that cancer has spread to distant organs. Stage I cancers are often curable, and although stage IV has a worse prognosis, even these are increasingly treatable and sometimes curable depending on the cancer type.

For solid organs, staging is done by assessing the TNM system: Tumor, such as its size and whether there is evidence that it has gone through the natural barriers in the organ; lymph Nodes (how many are positive for cancer and sometimes whether they are in the region of the primary tumor); and Metastatic disease (if there is definitive evidence that the cancer has spread).

The stage (I-IV) depends on each of the TNM criteria, and as a medical student, we had to learn them all for each of the different cancers. For colon cancer, there are 16 different stage groups (including subgroups like IIC and IIIA).

Liquid tumors, such as leukemia and lymphoma, are staged differently based on the number of lymph node groups and which side of the diaphragm (lymphoma) gets affected. Or they're based on cell counts and the involvement of the lymph nodes, liver or spleen (leukemia).

Staging is important for both the prognosis and to help determine the type of treatment. Increasingly, however, treatment is dependent on the molecular nature of the cancer itself, which is determined by the presence of genetic mutations. These mutations help determine which kind of treatment the cancer is expected to be the most sensitive to.

DEAR DR. ROACH: I am 93, and my wife is 88. After a summer of fresh garden vegetables and fruit, we are having problems with our bowels, which aren't working as they should. Our doctor advised half a dose of MiraLAX daily, but when we tried it, my wife had diarrhea for three days.

Is there any natural treatment to help keep the bowels working normally? We tried apple and pineapple juice with little effect. We are going to try prunes and prune juice next. -- D.W.

ANSWER: Fresh fruit and vegetables are probably the best choice since they have so many benefits not only for your digestive system, but your cardiovascular system as well. They also help reduce cancer risk. Since it's more difficult to get fresh produce, frozen produce is still a good choice when buying many vegetables and some fruits. (Frozen berries are ideal for smoothies and sauces.)

If what you consume in your diet isn't enough, then prunes are my second choice. Prunes contain substances that stimulate the bowel. Since your wife seems very sensitive, I would have her start off with them very slowly. Finally, fiber supplementation is another great and natural option. I usually recommend psyllium husks, like what is used in Metamucil.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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