Nikola BlaževićMentor: A. Žmegač Horvat

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

References http://www.cancer.gov/ www.wikipedia.com Oxford handbook of clinical medicine,Murray Longmore