Grading and Staging

of Neoplasia
Prepared by:
Beryl Donesa
 After 30 minutes of class discussion
the BSN 4 students will be able to:
 Define what is staging and grading of neoplasia
Objectives:  Differentiate the staging from grading of tumor
 Discuss the TNM classification
 What is Refers to the classification of the tumor cells.
Grading systems seek to define the type of

GRADING? tissue from which the tumor originated and

the degree to which the tumor cells retain
the functional and histologic characteristics
of the tissue of origin (differentiation).
 Grading a malignant neoplasia is a method of
classification based on histopathologic
characteristics of the tissue.

 This information helps the health care team predict

the behavior and prognosis of various tumors.

 The objective of grading a tumor is to quantify

information so as to assist with treatment planning
and prognostic determinations.
Gx – Grade cannot be assessed
G1 – Well- differentiated
G2 – Moderately well- differentiated
G3 – Poorly differentiated
G4 – Undifferentiated

G1 implies the best prognosis

 Determines the size of the tumor and the
existence of local invasion and distant
What is metastasis.

STAGING? Staging process is a method classifying a

malignancy by the extent of its spread with
in the body. It is a clinical and histologic
determination that depends on the natural
course of each particular cancer.
Although most staging classification are
based on the anatomical extent of disease,
other criteria are included for specific
malignancies.

Staging reveals the prognosis, evaluates the

treatment modalities, facilitates the
exchange of information, compare mortality
and morbidity statistics among various
treatment centers.
  This system classifies solid tumors by the
anatomical extent of disease, as determined
clinically and histologically.

TNM T= Tumor
Staging N= Nodes
M= Metastasis

TNM staging is frequently used by American Joint

Committee on Cancer (AJCC)
 Staging also provide a convenient shorthand
notation that condenses lengthy description
into manageable terms for comparisons of
treatments and prognoses.
TNM Classification System for Describing the Anatomical
Extent of Disease
T The extent of primary tumor
N The absence or presence and extent of regional lymph node metastasis
M The absence or presence of distant metastasis
PRIMARY TUMOR (T)
Tx Primary Tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1,T2,T3,T4 Increasing size and/or local extent of the primary tumor.
REGIONAL LYMPH
NODES (N)
Nx Regional lymph nodes cannot be assessed
N0 No regional node metastasis
N1,N2,N3 Increasing involvement of regional lymph nodes
DISTANT
METASTASIS (M)
Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
TNM Classifications
cTNM or TNM Clinical manifestation: Based on the information obtained from the physical
examination, laboratory and imaging studies, endoscopy, biopsy, and surgical
exploration. Clinical staging uses all information available before the initiation of
definitive treatment.

pTNM Pathologic classification: Based on information acquired before treatment,

supplemented or modified by information from surgery and the pathologic examination
of a resected specimen. This includes resected tumor (pT). lymph nodes (pN), and
distant metastasis (pM).

rTNM Retreatment classification: Based on all information available after a disease- free
interval or at the time of second- look surgery. The extent or absence of disease
recurrence is documented before retreatment planning is begun.

aTNM Autopsy classification: Based on all information available at the time of a postmortem
examination. It is helpful in answering questions about the tumor’s response to
treatment, recurrence patterns, and the extent of disease at the time of death.
The use of numerical subsets of the TNM
components indicates the progressive
extent of the malignant disease.
That’s all!