People often talk about cancer in terms of stage. Staging is a way of categorizing the severity of a cancer and if a cancer has spread beyond the initial tumor. There are several different staging systems that are used, which give healthcare providers a common language when discussing cancer. Staging is also useful when deciding on a treatment plan. However, a stage is not always the most useful information to know about a cancer or a patient, and not all cancers are staged.
One example of a type of cancer that is not staged is Waldenstrom macroglobulinemia (WM), a type of non-Hodgkin lymphoma (NHL). Lymphomas are cancers of the lymphatic system, the network of vessels and organs that (among other functions) transports lymph throughout the body. Lymph is a fluid that contains white blood cells. WM occurs when there are mutations in B lymphocytes (B cells), a type of white blood cell.
Instead of assigning stages to WM, healthcare providers use something called the International Prognostic Scoring System for Waldenstrom Macroglobulinemia (ISSWM). This scoring system use several factors to help determine prognosis and guide treatment decisions. One of these factors is age—patients who are 65 or under tend to have a better outlook than patients who are over the age of 65. However, age is not the only factor, nor the most important factor. The ISSWM also takes into account:
- Hemoglobin levels 11.5 g/dL or less. Hemoglobin is a protein found in red blood cells that transports oxygen throughout the body. Low levels of hemoglobin are a sign of iron-deficiency anemia, which is a common symptom of WM. Anemia can be caused by a variety of contributing factors. WM can cause anemia when cancerous cells proliferate inside the bone marrow, leaving too few resources for the production of normal cells, such as red blood cells.
- Immunoglobulin M (IgM) 7 g/dL or more. When a person is diagnosed or being diagnosed with WM, lab tests will take a close look at the person’s blood. One characteristic of WM is elevated levels of IgM, an antibody. When levels of IgM are very high, they can cause the blood to become thicker (a condition called hyperviscosity syndrome), which can impede circulation and cause numerous symptoms, including nose bleeds, bleeding in the eyes, dizziness, confusion, congestive heart failure and stroke.
- Beta-2 microglobulin (B2M) more than 3mg/L. This is a protein found on the surface of cells. Higher than normal levels of it in the blood and urine can be a sign of cancer.
- Platelet count of 100/mcl or less. Also called thrombocytes, platelets are very small blood vessels that circulate through the blood and help the body stop bleeding when it is injured. People with WM tend to have lower than normal levels of platelets.
On the ISSWM, each of these criteria is given a point. Patients who are 65 years and under who have one point are considered low risk. Patients are at intermediate risk if they are 65 years or under and have 2 points, or over 65 and have fewer than 2 points. Patients who have 3 points are at high risk, regardless of their age.
It is difficult to learn you have cancer, and can be difficult to think of cancer in terms of labels like “low risk” and “high risk.” It is important to keep in mind that this information helps your healthcare providers make decisions about your treatment plan. If you have questions about your particular diagnosis, remember that your best source of information is your healthcare provider.
Medically reviewed in March 2019.
