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GRADING AND STAGING OF

TUMORS
Dr. Indri Windarti, Sp.PA

Degree of maturity or differentiation


under the microscope

Histologic grade resemblance between


tumor and normal cells
2. Nuclear grade
size and shape of
nucleus, dividing cells
1.

Derajat

maturitas
dan diferensiasi sel

1.Histologic

grade
bdsk kemiripan sel
tumor dgn sel
normal
2.Nuclear grade

ukuran dan bentuk


inti, mitosis

GRADING

TUMOR GRADES
Microscopic

apperance of cancer cells


4 degrees of severity
Grade:

GX
grade)
G1
G2
grade)
G3
G4

Grade cannot be assessed (Undetermined


Well-differentiated (Low grade)
Moderately differentiated (Intermediate
Poorly differentiated (High grade)
Undifferentiated (High grade)

Different for different types of


cancers

Gleason

prostate cancer
Elston-Ellis breast cancer
Fuhrman kidney cancer

system

Gleason

Fuhrman system

GRADING
SYSTEMS

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

GRADING TREATMENT

Perluasan

tumor primer dan


penyebarannya ke bagian tubuh

Kegunaan:

- merencanakan pengobatan
- estimasi prognosis

STAGING

This

is an estimate of how much cancer


there is based on the physical exam,
imaging tests (x-rays, CT scans, etc.), and
tumor biopsies.
For some cancers, the results of other tests,
such as blood tests, are also used in staging.
The clinical stage is a key part of deciding
the best treatment to use.
Its also the baseline used for comparison
when looking at the cancers response to
treatment.

Staging klinis

Pathological

staging (also called surgical staging)


relies on what is learned about the cancer during
surgery.
Often this is surgery to remove the cancer and
nearby lymph nodes, but sometimes surgery may
be done to just look at how much cancer is in the
body and take out tissue samples.
In some cases, the pathologic stage may be
different from the clinical stage (for instance, if the
surgery shows the cancer has spread more than it
was thought to have spread before surgery).
The pathological stage gives the health care team
more precise information that can be used to
predict treatment response and outcomes
(prognosis).

Staging patologis

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)
- Presence or absence of metastasis

STAGING SYSTEMS

Most

common (accepted by UICC, AJCC)

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

TNM - system

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)

staging

Each

cancer type has its own version of this


classification system, so letters and numbers
dont always mean the same thing for every
kind of cancer.
For example, in some types of cancer T1 means
the tumor is smaller than a centimeter, but in
another type a T1 may be up to 2 centimeters.
In still another cancer type, T may tell how far
the cancer has invaded into the layers of tissue.

OTHER CLASSIFICATION
Ann Arbour lymphomas

Dukes classification colon cancer

Breslow scale and Clarks level melanoma

Physical

exams

examination,
looking,
listening
Imaging studies X-ray,
US, CT, MRI, PET
Laboratory tests blood,
urine,
AST/ALT,
tumor
markers
(CA19-9,CA195.)
Pathology
reports

biopsy, cytology
Surgical reports

Questions?