Michael Douglas reveals his throat cancer is stage four. What does that mean?

Michael Douglas’ revelation on the Late Show with David Letterman on Tuesday night that his throat cancer is stage four elicited a gasp from the audience. But what exactly does stage four mean?

As Douglas went on to explain, “You like to be down at stage one,” when the tumor is relatively small and isolated.

But, according to Douglas, doctors said his chances of survival are 80%.

That may be because even though stage-four cancer is considered advanced, there are different substages within it, said Dr. Gady Har-El, chairman of Lenox Hill Hospital’s Department of Otolaryngology-Head and Neck Surgery in New York. Douglas’ recovery may depend on the nature of that tumor.

Stage four cancer can be divided into two broad categories. Either the tumor is large (longer than 4 or 5 centimeters, or about 1.5 to 2 inches) and begun extending into neighboring tissues, or the tumor could be relatively small with cells that have managed to spread into the lymph nodes in the neck.

Douglas told Letterman that his cancer hasn’t spread to the rest of his body and was therefore still treatable. Har-El agreed, adding that if the cancer had spread below the neck, the doctors would not have ordered radiation treatments.

“We know he is receiving chemotherapy and radiation, which means they are going for a cure,” Har-El said.

In an interview with People magazine, Douglas’ wife, Catherine Zeta-Jones, expressed frustration that the cancer had been caught late, but Har-El was not surprised that the cancer had escaped early detection.

“In our field, if a patient develops a cancer on the front part of the tongue, on the roof of the mouth or on the tonsils, this can be seen by a general practitioner or a dentist,” Har-El said.

But a tumor sitting at the base of the tongue, like Douglas’, is far beyond the doctor’s sight.

The fact that Douglas told doctors he had ear pain rather than oral or throat pain may have thrown doctors off the trail as well, Har-El added.

That’s why it was important for people with prolonged symptoms -- say, a cold or cough that sticks around for a month -- to get checked, especially if they’re heavy drinkers and smokers. Douglas reportedly is an ex-smoker.

“If you’re a smoker, everything should raise red flags,” Har-El said. “I’d rather see false alarms” than the alternative.

For more about throat cancer (which comprises a lot of different types of cancer, by the way):

Here’s a description of the different stages of throat cancer, courtesy of Cancer Connect.

The Mayo Clinic explains how treatment progresses.

And the National Cancer Institute provides some information on life expectancy, depending on when the cancer is caught.

-- Amina Khan / Los Angeles Times

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