Grading of the tumors?

What is tumor grade?

Tumor grade is a description of how the tumor tissue changes with time and how it appears under a microscope. It indicates how your tumor will grow with time and spread to other body parts. This is highly important when it comes to determining how to limit the growth of a tumor. A tumor is said to be well-differentiated if it resembles more or less of normal cells in the body. On the contrary, undifferentiated tumors are very tough to control.

Thus, based on the appearance under a microscope, a specialist will be able to find out the stage or grade of a tumor. However, the tumor stage is not the same as that of the tumor grade. The stage of cancer indicates the extent of the spread of the tumor, whether the tumor cells have affected other parts of the body. While the stage of cancer helps find the size of the tumor, its location, the involvement of the local lymph nodes, and more.

How is tumor grade determined?

Tumor grading is done in several ways, which depend on whether the tumor is a malignant one. Your doctor may remove all of your tumors if it is suspected to be a malignant one by a process called a biopsy. In this procedure, a specialist (pathologist) uses a surgical blade to remove the piece or whole of the tumor and observes it under a microscope. He/she will be able to determine the grade of the tumor as well as its stage.

How are tumor grades classified?

Depending on the type of cancer, different methods of tumor grading are used. Generally, depending on the extent of abnormality, the tumors are graded as 1, 2, 3, or 4. Grade 1 tumors are close in association with the normal cells. Such tumors do not grow as fast as upper-grade tumors. Similarly, the higher the grades, the less resemblance they show with the normal cells. That means the grade 3 and grade 4 tumors grow very fast and tend to spread to other body parts quickly than the lower grade tumors.

Besides, if there is no specified grading system for a particular tumor type, the following system is used:

GX: It means that the grade cannot be specified

G1: This indicates a low-grade tumor that is slightly differentiated.

G2: The tumor is of intermediate-range and moderately differentiated.

G3: A high-grade tumor that is poorly differentiated.

G4: This means a high-grade tumor that is undifferentiated.

However, certain tumors have their systems for grading, which include breast cancer and prostate cancer.


Breast cancer.

 For breast cancers, a special type of grading system is used, which is called as Nottingham grading system. It uses various features to grade breast cancer which includes:

Tubule formation: This indicates the tumor tissue that has normal milk structures.

Nuclear grade: This gives an idea about the shape and size of the nucleus in the tumor cells.

Mitotic rate: It gives an idea about the number of cells that are dividing, which measures how quickly the tumor cells have been growing and dividing.

In the above-mentioned scale, these categories are put in the range of 1 and 3, which means that these cells look similar to the normal tissues present in the breasts. Then, the scores of these 3 categories are added, which gives total values ranging from 3 to 9.

Thus, if the score is between 3 to 5, then the tumor is well-differentiated or of a low grade. If the score is between 6 to 7, then the tumor is moderately differentiated. If the score lies between 8 to 9, then the tumor is highly differentiated and of a high grade.

Prostate cancer. To grade prostate cancer, the Gleason scoring system is used. In this test too, your doctor will take a small sample of the tissue and observe it under a microscope. He/she will try to know how much the tumor resembles the normal prostate tissues. He/she will identify both the primary and secondary patterns of the tissue organization. The most usual pattern that is seen in the tumor is the primary pattern, while the next most common pattern is the secondary pattern. Each of these patterns is given the grades that start from 1 to 5, where 1 means the lower grade, where the tumor cells are highly differentiated and 5 is the range where most undifferentiation is found. Then, these scores are added which gives the score as:

Gleason X: it means that the Gleason score cannot be determined.

Gleason 2–6: Here, the tissue in the tumor is well differentiated.

Gleason 7: The tissue of the tumors is well differentiated.

Gleason 8–10: Here, the tissue tumor is undifferentiated or poorly differentiated.

How does the grade affect the treatment options of the tumor?

The determination of the grade of the tumor is highly essential for determining the treatment option for a patient. The treatment plan will be determined that is going to depend on the stage of the tumor and the general health of a patient. If the grade of the tumor is lower, then it becomes highly easier to treat the tumor efficiently. If the grade of the tumor is higher, then it becomes tough to treat the tumor efficiently. In that case, more care and attention may be required to control the tumor.

Furthermore, in some specific types of tumors, it is highly essential to determine the grade of the tumor that helps your doctor determine the treatment. You should always try to know more about your tumor by asking your doctor certain questions that are related to the stage of your tumor, as it is necessary for the proper cure and control of your tumor.