GRADING AND STAGING OF TUMORS

Dr. Indri Windarti, Sp.PA

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

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 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)

Different for different types of cancers Gleason prostate cancer Elston-Ellis breast cancer Fuhrman kidney cancer

Gleason system Fuhrman

GRADING SYSTEMS

system

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

STAGING
Perluasan tumor primer dan penyebarannya ke bagian tubuh Kegunaan: - merencanakan pengobatan - estimasi prognosis

Staging This is an estimate of howklinis 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.

 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

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) - Presence or absence of metastasis

TNM - system
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

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

staging

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 body) Distant metastasis cannot be evaluated No distant metastasis Distant metastasis (cancer has spread to distant parts of the

 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 (CA199,CA19-5.) Pathology reports biopsy, cytology Surgical reports