Diagnosis, Staging and Treatment Modalities
Core concepts
Diagnosis rests on history, imaging, and tissue biopsy with pathology and molecular testing. Staging describes anatomic extent (TNM) and often incorporates stage grouping plus prognostic and molecular features. Treatment modalities include surgery, radiation, cytotoxic chemotherapy, targeted therapy, immunotherapy, endocrine therapy, and transplant or cellular therapy. Understand intent - curative, adjuvant, neoadjuvant, palliative - and how intent changes toxicity tolerance.
Traps in questions
- Clinical versus pathologic staging: clinical staging precedes treatment; pathologic staging follows surgery.
- Adjuvant versus neoadjuvant: adjuvant follows definitive local therapy; neoadjuvant precedes it.
- Restaging is not routine: imaging is not repeated after every cycle without a specific clinical question.
- Response criteria: stable disease is not treatment failure; progressive disease is.
- Immunotherapy toxicity: immune-related adverse events can occur in any organ and may appear late.
Rule of thumb
Intent first, then modality, then sequence. Ask whether the goal is cure, control, or comfort, then whether treatment is given before or after local therapy.
Worked example
A patient with newly diagnosed colon cancer has a biopsy confirming adenocarcinoma and CT showing liver lesions. Biopsy establishes diagnosis and molecular profile; imaging establishes stage. The nurse should not assume palliative intent - stage IV disease can still be treated with curative-intent surgery plus systemic therapy in selected patients.