This factsheet is for people who would like information about the main ways of staging and grading cancer.
 
Cancer develops when the cells of the body change and grow in an uncontrolled way. Doctors and surgeons stage and grade cancer to describe the size of the tumour and how far and fast it’s growing. It’s important because it can help determine what the best course of treatment is.
 
How cancer develops
About cancer
Staging
Grading
 

How cancer develops

The information on the video provided does not constitute advice on diagnosis or the treatment for heart disease and such advice should always be sought from a doctor or another suitably qualified health professional.

About cancer

 
A cancerous (malignant) tumour is a lump of cells in your body that grows in an abnormal and uncontrolled way. Cancerous tumours can grow in one of your organs and spread to other parts of your body through your bloodstream or lymphatic system (part of your immune system). Cancers that spread (metastasise) in this way may form secondary tumours. Non-cancerous tumours that don't invade other tissues or spread to other parts of the body are known as benign.
 

What is cancer staging and grading?

 
If your doctor or surgeon suspects you have cancer, you will need to have tests to confirm a diagnosis. The tests will be specific for the type of cancer you may have. At this point, your doctor or surgeon will try to find out the size of your tumour, how far it has grown and the speed at which it may grow. This is called staging and grading and is used to describe solid, cancerous tumours.
 
Staging is important because it helps your specialist decide what the best treatment is for you, as well as determining the likely course of your cancer.
 

Staging

 
Staging is used by doctors and surgeons to describe the size of your tumour and how far it may have spread within your body.
 
The most commonly used method to describe cancers worldwide is called the TNM staging system.

 
TNM staging system

 
Your doctor or surgeon will use the TNM staging system to describe your cancer if you have a solid tumour in your breast, head, neck or lungs, for example. A different staging system may be used for specific types of cancers.
 
The TNM system describes the size of your original (primary) tumour (T), whether any cancer cells have spread from your primary tumour and have reached nearby lymph nodes (N), and whether the cancer cells have spread further around your body (M). Each stage has numbers that are used to categorise your cancer more specifically. T in TNM staging

 
The T in the TNM system stands for tumour. This part of the staging system generally describes the size or growth of your tumour.
 

  • T0 means your doctor or surgeon can’t find any evidence of a primary tumour.
  • Tis or Cis stand for tumour or cancer in situ. If your cancer is described in this way it means your tumour is in one small area and hasn’t spread yet.
  • T1 to 4 refers to increasingly advanced cancer stages, for example, T1 means your tumour may be early stage and small, and T4 means it may be advanced and large. Sometimes a and b are also used to define your cancer further – for example, T2a and T2b – and may refer to the tissues that the cancer has spread into, although this will be specific to the type of cancer you have.
  • TX may be used if the stage of your cancer isn't clear.

 

N in TNM staging

 
The N in the TNM system stands for nodes (or lymph nodes). Your lymph nodes are small, bean-shaped organs that are part of your lymphatic system. This system contains fluid called lymph, which contains cells that fight infection.
 
Your doctor or surgeon will rate your cancer according to whether or not it has spread to any nearby lymph nodes.
 

  • N0 means there are no cancer cells in nearby lymph nodes.
  • N1, N2 and N3 generally refer to either how many lymph nodes your cancer has spread to or the position of the nodes in relation to your primary tumour. The higher the number, the more lymph nodes may be affected.
  • NX may be used if the stage of your cancer isn't clear.

 
If your cancer has spread to your lymph nodes it may mean that it has spread to other areas of your body too. Your doctor or surgeon can’t always tell if this has happened, but in this situation he or she will probably suggest you have adjuvant (preventative) treatment. This means you may have chemotherapy, radiation therapy, or hormone therapy alongside you primary treatment to try and kill any cancer cells that may have broken away from your primary tumour.
 

M in TNM staging

 
The M in the TNM staging system stands for metastases. If your cancer has metastasized, this means it has spread to other parts of your body. Your doctor or surgeon will rate your cancer according to whether it has spread or not.
 

  • M0 means your cancer has not spread to any other parts of your body.
  • M1 means your cancer has spread away from your primary tumour and into one or more other areas of your body.
  • MX may be used if the stage of your cancer isn't clear.

 
If you need more information about the stage of your cancer or what it means, ask your doctor or surgeon.
 

Number staging system

Some cancers, including lymphomas and liver cancer, aren’t described using the TNM system. If you have a tumour that isn’t classified by TNM, your doctor or surgeon may describe it with a numbered stage – ranging from 1 to 4.
 
The higher the number, the more your cancer is likely to have spread in your body. For example, Stage 1 (or early stage) refers to a small tumour that hasn't spread to your lymph nodes and Stage 4 (or advanced stage) refers to tumours that have spread to other major organs in your body. Your doctor or surgeon may also use a letter with a stage number to define your cancer further – for example, stage 2a or 2b – to refer to the tissues that the cancer has spread into, but this will depend on the particular type of cancer you have.
 

Dukes staging system

If you have bowel cancer, your doctor or surgeon may describe it using the Dukes lettered (A–D) system. However, the TNM system is gradually replacing Dukes letters.
 

  • Dukes A means your tumour is contained within the wall of your bowel.
  • Dukes B means your tumour has grown into the muscle of your bowel wall, but has not spread to any nearby lymph nodes.
  • Dukes C means one or more of your lymph nodes near your bowel are affected.
  • Dukes D means your original tumour has spread to other parts of your body.

 

Grading

 
Grading is used to describe what your tumour looks like under a microscope to get an idea of how it may progress.
 
If your doctor or surgeon suspects you have cancer, he or she will take a sample of cells from your tumour (a biopsy) to send to a laboratory for testing. The cancerous cells will be looked at under a microscope to try and find out the speed at which your tumour may grow and how aggressive it is. There are three grades used to rate cancer.
 

  • Low grade, or grade 1, refers to cancers that are slow growing. If your cancer is low grade, the cancerous cells may look much like other, healthy cells in your body. Low grade cells may be referred to as ‘well differentiated’. They are less likely to spread.
  • Moderate (intermediate) grade, or grade 2, refers to cancers that are growing slightly faster and are more likely to spread than low grade cancers. At this stage, the cancerous cells are known as ‘moderately differentiated’ and look different from healthy cells in your body.
  • High grade, or grade 3 cancer cells look very different from healthy cells in your body. If you have a high grade cancer this means the cancerous cells are likely to grow faster and spread more easily than moderate grade cancer cells. They may also be called ‘poorly differentiated’ or sometimes ‘undifferentiated’, or ‘anaplastic’ cancerous cells.

 
If you are unsure about how your cancer may be graded or need more information, ask your doctor or surgeon.

Tags:

been suggested by health professionals, website feedback and requests via email
 
I have Gleason score 6 prostate cancer and the doctor said it was at an early stage. This is a much higher number than the grading system in the factsheet. Does this mean it's more serious?
Can I have a high stage with a low grade or vice versa?
How will stage/grade affect my chance of recovery?
I have been told my cancer is recurrent. What does this mean?
 

I have Gleason score 6 prostate cancer and the doctor said it    was at an early stage. This is a much higher number than the grading system in the factsheet. Does this mean it's more serious?

Answer

Prostate cancer may be graded using a different system called the Gleason scoring system.
 

Explanation

Sometimes your doctor or surgeon may use the Gleason scoring system to grade your prostate cancer. The system is based on a scale of 1 to 10 and depends on what your cancer cells look like under the microscope. Most prostate cancers are graded between 6 and 10. For example, grade 7 refers to a moderate cancer and grades 8 to 10 are high grade cancers, which are more likely to spread. A grade of 6 (or below) means you have a low grade cancer, which is less likely to spread.
 
If you're unsure about what stage your cancer is or how you will be treated, ask your doctor or surgeon.
 

Further information

 Macmillan Cancer Support
0808 800 0000
www.macmillan.org.uk

 

Sources

 

Can I have a high stage with a low grade or vice versa?

 Answer

 
Yes, this can happen as stage and grade are two different things.
 

Explanation

 
If your doctor or surgeon refers to the stage of your cancer it means he or she is describing how far it may have spread in your body. For example, if your cancer is at a higher stage, it may mean you have it in more than one place.
 
If your doctor or surgeon refers to the grade of your cancer, he or she is describing what the cancerous cells look like under the microscope and how your cancer is likely to develop. For example, a slow-growing cancer in your body may be described as low grade.
However, if you have a slow-growing cancer (low grade) it can be found at either an early (low) stage before it has spread or at an advanced (high) stage. As high grade tumours tend to grow and spread more quickly, they are often found at a later (higher) stage – although this is not always the case. Your doctor will be able to guide you through your treatment and how your cancer stage and grade will affect you.
 

Further information

 Macmillan Cancer Support

0808 800 0000
www.macmillan.org.uk

 

Sources

  • What is the difference between ‘stage’ and ‘grade’? Macmillan Cancer. www.macmillan.org.uk, accessed 23 February 2010

 

How will stage/grade affect my chance of recovery?

 Answer

Generally, the higher the grade or stage of your cancer, the faster it's growing and more advanced it is.
 

Explanation

 
A higher grade or stage generally means your cancer is more advanced and is likely to have spread. However, this doesn't necessarily mean that your cancer can't be cured or that it will take longer for you to recover.
 
Determining the stage and grade of your cancer will allow your doctor to decide on the most effective treatment for you. Different treatments and techniques are used for different types of cancer so your doctor or surgeon will discuss this with you. He or she will be able to tell you what stage and grade your cancer is and how it may be treated.
 

Further information

Macmillan Cancer Support
0808 800 0000
www.macmillan.org.uk

Sources

  • What is the difference between ‘stage’ and ‘grade’? Macmillan Cancer. www.macmillan.org.uk, accessed 23 February 2010

 

I have been told my cancer is recurrent. What does this mean?

 

Answer

If you have recurrent cancer, this means the cancer has come back after your treatment.

 
Explanation

 
Sometimes cancer comes back after you have had treatment. If you have recurrent cancer, you may be given the same treatment as before or another option. Sometimes, your doctor may advise you to have more intensive treatment for recurrent cancer. Ask your doctor or surgeon to explain the chance of your cancer recurring and what you should do if this happens. Secondary and recurrent cancers are also graded and staged in the same way as primary cancers.

Further information

Macmillan Cancer Support
0808 800 0000
www.macmillan.org.uk

Sources

Related topics

Bile duct cancer
Bladder cancer
Bowel cancer
Brain cancer
Breast cancer
Cervical cancer
Chemotherapy
Eye cancer
Hodgkin's lymphoma
Leukaemia - a general overview
Lung cancer
Mouth cancer
Non-Hodgkin's lymphoma
Ovarian cancer
Prostate cancer
Radiotherapy
Skin cancer
Stomach cancer
Testicular cancer
Womb cancer
 
 
This information was published by Bupa’s Health Information Team and is based uupon reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
 
Publication date: May 2010
 

Cancer staging and grading

 
Visit the cancer staging and grading factsheet for more information.

Related topics

 
Bile duct cancer
Bladder cancer
Bowel cancer
Brain cancer
Breast cancer
Cervical cancer
Chemotherapy
Eye cancer
Hodgkin's lymphoma
Leukaemia - a general overview
Lung cancer
Mouth cancer
Non-Hodgkin's lymphoma
Ovarian cancer
Prostate cancer
Radiotherapy
Skin cancer
Stomach cancer
Testicular cancer
Womb cancer
 

Further information

  • Macmillan Cancer Support

            0808 800 0000
            www.macmillan.org.uk

  • CancerHelp UK

            0808 800 4040
            www.cancerhelp.org.uk

 Sources

  • The stages of a cancer. Cancer Research UK. www.cancerhelp.org.uk, published 26 March 2010
  • Greene FL, Sobin LH. The staging of cancer: a retrospective and prospective appraisal. CA Cancer J Clin 2008:58(3):180–90.
  • What is cancer staging? American Joint Committee on Cancer. www.cancerstaging.org, published February 2010
  • Souhami R, Tobias J. Cancer and its management. 5th ed: Cancer Research UK, 2005:42-56
  • Cassidy J, Bissett D, Spence R, et al. Oxford handbook of oncology. 2nd ed. Oxford: Oxford University Press, 2006:315–17
  • Dukes stages of bowel cancer. Cancer Research UK. www.cancerhelp.org.uk, published September 2008
  • Staging and grading of breast cancer. Macmillan Cancer Support. www.macmillan.org.uk, published September 2008
  • Grading and staging of prostate cancer. Macmillan Cancer Support. www.macmillan.org.uk, published July 2007
  • What is the difference between 'stage' and 'grade'? Macmillan Cancer Support. www.macmillan.org.uk, accessed 23 February 2010

This information was published by Bupa’s Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

 
Publication date: May 2010

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