Neoplasm systems of grading and staging have been developed to help standardize cancer diagnosis, prognosis, and treatment.

o Tumor is graded to classify cellular aspects of the cancer while staging classifies clinical aspects of the cancer. Some cancer are more malignant that others, varying in their aggressiveness and sensitivity to treatment. Some cancer cells barely resemble the tissue from which they arose, are aggressive, and spread rapidly. These cells are a high grade cancer. On the basis of cell appearance and activity, grading compares the cancer cell with the normal parent tissue from which it arose. Cancer cells that closely resemble normal cells are given the lowest rating while higher rating are given to cancer cells that barely resemble normal cell. o Staging determines the exact location of the cancer and its degree of metastasis at diagnosis. Staging is important because, for most cancers, the smaller the cancer is at diagnosis and the less it has spread, the greater the chances are that treatment will result in a cure. Cancer stage also influences selection of therapy. Staging is done in three ways: 1. Clinical setting. This staging assesses the clients clinical manifestations and evaluates clinical signs for tumor size and possible spread. Clinical tests are used, and cancer cells may be obtained for biopsy but clinical staging does not include major surgery. 2. Surgical staging. This staging assesses the tumor size, number, sites, and spread by inspection at surgery. 3. Pathologic staging. This staging is the most definitive type. The tumor size, number, sites, and spread are determined by pathologic examination of tissues obtained at surgery. The American Joint Committee on Cancer developed the TNM (tumor, node, metastasis) system to describe the anatomic extent of cancers. The stages guides treatment and are useful for prognosis and comparison of treatment results. The TNM staging systems have specific prognostic value for each solid tumor type. TNM staging are not useful for leukemia or lymphomas. Grading of Malignant Tumors Grade Cellular characteristics Gx Grade cannot be determined. G1 Tumor cells are well differentiated and closely resemble the normal cells from which they arose. This grade is considered a low grade of malignant change. These tumors are malignant but are relatively slow growing. G2 Tumor cells are moderately differentiated; they still retain some of the characteristics of normal cells but also have more malignant characteristics than do G1 tumor cells. G3 Tumor cells are poorly differentiated but

G4

the tissue of origin can usually be established. The cells have few normal cell characteristics. Tumor cells are poorly differentiated and retain no normal cell characteristics. Determination of the tissue of origin is difficult and perhaps impossible

Tx T0 Tis T1, T2, T3, T4

PRIMARY TUMOR (T) Primary tumor cannot be assessed No evidence of primary tumor Carcinoma in situ Increasing size and or local extent of the primary tumor

Nx N0

REGIONAL LYMPH NODES (N) Regional lymph nodes cannot be assessed No regional lymph node metastasis

N1,N2,N3 Increasing involvement of regional lymph node DISTANT METASTASIS (M) Presence of distant metastasis cannot be assessed No distant metastasis M1 Distant metastasis

Mx M0