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  • 1. Nikola Blažević Mentor: A. Žmegač Horvat
  • 2. GRADING • Degree of maturity or differentiation under the microscope 1.Histologic grade – resemblance between tumor and normal cells 2.Nuclear grade – size and shape of nucleus, dividing cells Carcinoma,adrenal gland
  • 3. How is tumor grade determined?  Biopsy – benign or malignant - pathologist – level of differentiation  v=Ms4b7eGLtf8&feature=related
  • 4. TUMOR GRADES    Microscopic apperance of cancer cells 4 degrees of severity Grade: GX G1 G2 G3 G4 Grade cannot be assessed (Undetermined grade) Well-differentiated (Low grade) Moderately differentiated (Intermediate grade) Poorly differentiated (High grade) Undifferentiated (High grade)
  • 5. GRADING SYSTEMS • Different for different types of cancers Gleason – prostate cancer Bloom-Richardson – breast cancer Fuhrman – kidney cancer Gleason system Fuhrman system
  • 6. GRADING – TREATMENT  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
  • 7. STAGING  Extent of the prim. tumor and extent of spread in the body  Important - helps planning treatment - helps estimating prognosis - helps identifying clinical trials
  • 8. STAGING SYSTEMS  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) - Cell type and tumor grade (how closely the cancer cells resemble normal tissue) - Presence or absence of metastasis
  • 9. TNM - system  Most common (accepted by UICC, AICC)  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
  • 10. 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 M0 M1 Distant metastasis cannot be evaluated No distant metastasis Distant metastasis (cancer has spread to distant parts of the body)
  • 11. OTHER CLASSIFICATION Ann Arbour  lymphomas Duke’s classification  colon cancer Breslow scale and Clark’s level  melanoma
  • 12. DETERMINATION OF STAGES Physical exams  examination, looking, listening Imaging studies X-ray, US, CT, MRI, PET Laboratory tests  blood, urine, AST/ALT, tumor markers (CA199,CA19-5….) Pathology reports  biopsy, cytology Surgical reports Lung cancer,PET scan
  • 13. References    Oxford handbook of clinical medicine,Murray Longmore