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GRADING
• Degree of maturity or differentiation under the microscope
1.Histologic grade – resemblance between tumor and normal cells
2.Nuclear grade – size and shape of nucleus, dividing cells
Carcinoma,adrenal gland
How is tumor grade determined?
Biopsy – benign or malignant - pathologist
– level of differentiation
http://www.youtube.com/watch?v=Ms4b7eGLtf8&feature=related
TUMOR GRADES
Microscopic apperance of cancer cells 4 degrees of severity
Grade:
GX Grade cannot be assessed (Undetermined grade)
G1 Well-differentiated (Low grade)
G2 Moderately differentiated (Intermediate grade)
G3 Poorly differentiated (High grade)
G4 Undifferentiated (High grade)
GRADING SYSTEMS
• Different for different types of cancers
Gleason – prostate cancer
Bloom-Richardson – breast cancer
Fuhrman – kidney cancer
Gleason system
Fuhrman system
GRADING – TREATMENT
For treatment and prognosis
Lower grade better prognosis (outcome of diease) Higher grade worse prognosis
Important in treatment of prim. brain tumors (astrocytomas)
lymphomas
breast cancer
prostate
STAGING Extent of the prim. tumor and extent of spread in the
body
Important - helps planning treatment
- helps estimating prognosis
- helps identifying clinical trials
STAGING SYSTEMS
No unique staging system
Common elements :
- Location of the primary tumor
- Tumor size and number of tumors
- Lymph node involvement (spread of cancer into lymph nodes)
- Cell type and tumor grade (how closely the cancer cells resemble normal tissue)
- Presence or absence of metastasis
TNM - system
Most common (accepted by UICC, AICC)
Based on : T extent of the tumor
N extent of spread to the lymph nodes
M presence of metastasis
Number indicates size or extent of the prim. tumor and the extent of spread of metastasis
Primary Tumor (T) TX Primary tumor cannot be evaluated T0 No evidence of primary tumor Tis Carcinoma in situ (has not spread) T1, T2, T3, T4 Size and/or extent of the primary tumor
Regional Lymph Nodes (N) NX Regional lymph nodes cannot be evaluated N0 No regional lymph node involvement N1, N2, N3 Involvement of regional lymph nodes (number and/or extent of spread)
Distant Metastasis (M) MX Distant metastasis cannot be evaluated M0 No distant metastasis M1 Distant metastasis (cancer has spread to distant parts of the body)
OTHER CLASSIFICATION
Ann Arbour lymphomas
Duke’s classification colon cancer
Breslow scale and Clark’s level melanoma
DETERMINATION OF STAGES
Physical exams examination, looking, listening
Imaging studies X-ray, US, CT, MRI, PET
Laboratory tests blood, urine, AST/ALT, tumor markers (CA19-9,CA19-5….)
Pathology reports biopsy, cytology
Surgical reports
Lung cancer,PET scan