Grading And Staging Of Cancer

Physicians use a system called "staging" to describe the size of a tumor and whether it has spread beyond the area in which it started. Each type of cancer has a different system of staging that helps to describe the progress of that cancer. In general, there are a number of stages that begin with a small, localized cancer, right through to one that has spread extensively into surrounding areas of the body, a so-called advanced cancer. Knowing the stage is important in deciding on the most appropriate treatment.

After the determination is made as to the type of cancer, the cancer is graded—a measurement of the aggressiveness of the tumor. Most cancer cells are graded by how much they look like normal cells. Grading is done in the lab using cancerous cells taken during biopsy. There are many different types of grading systems used by doctors. These vary depending on the cancer. In general, however, lower grades mean a less aggressive behavior, and higher grades predict for a relatively more aggressive cancer. The most commonly used grading system is called the Gleason System, which is based on a number range from 2 to 10. The lower the number, the lower the grade. Grades under 4 mean that the cancer cells look similar to your normal cells and the cancer is likely to be less aggressive. Grades in the 5 to 7 range are intermediate, which means that the cancer cells do not look like normal cells and are more likely to be aggressive and grow faster. Grades of 8 to 10 indicate that the cancer cells are more likely to be very aggressive in growth.

Once cancer is diagnosed, more tests will be done to find out if the cancer cells have spread to other parts of the body. This testing is called staging. To plan treatment, a physician needs to know the stage of the disease. Stage refers to the extent, or the size, of the cancer. Each cancer, by organ, has its own staging system.

Stage 0 (carcinoma in situ): Carcinoma in situ is very early cancer. The abnormal cells are found only in the first layer of cells of the primary site and do not invade the deeper tissues.

Stage I: Cancer involves the primary site, but has not spread to nearby tissues.

Stage IA: A very small amount of cancer that is visible under a microscope and is found deeper in the tissues.

Stage IB: A larger amount of cancer is found in the tissues.

Stage II: Cancer has spread to nearby areas but is still inside the primary site.

Stage IIA: Cancer has spread beyond the primary site.

Stage IIB: Cancer has spread to other tissue around the primary site.

Stage III: Cancer has spread throughout the nearby area.

Stage IV: Cancer has spread to other parts of the body.

Stage IVA: Cancer has spread to organs close to the pelvic area.

Stage IVB: Cancer has spread to distant organs, such as the lungs.

Recurrent: Cancer has come back (recurred) after it has been treated and supposedly eliminated.

The recurrence may be in the same location as the original tumor or in a different location.

Once a stage is assigned and treatment given, the stage is never changed. The important thing about staging is that it determines the appropriate treatment, provides a prognosis, and allows for comparison of treatment results between different treatments.

1.4 CANCER: STATISTICS

The data in this section are based on information from the SEER Cancer Statistics Review2 and the American Cancer Society.3 Note that the values presented in this chapter are estimates and are offered as a guide and should be interpreted with caution.

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