tumor stages& grades

Staging is a way of describing how much a cancer has grown and spread.

Tumor Stages

The stage of a tumor refers to its size or extent and whether or not it has spread to other organs and tissues. Oncologists use staging to arrive at a prognosis of the disease and help choose the best treatment.

Different types of staging systems are used for different types of cancer.
Below is an example of one common method of staging — a number system:

Stage 0 –the cancer is in the primary growth area and hasn’t spread
Stage 1 – the cancer is small and hasn’t spread anywhere else
Stage 2 – the cancer has grown, but hasn’t spread
Stage 3 – the cancer is larger and may have spread to surrounding tissues and/or the lymph nodes
Stage 4 – the cancer has spread from where it started to at least one other area of the brain and/or the spine

More than

people are living with
brain tumors that have yet to be detected

Another way of staging cancer is called the
TNM Classification:

Tumor, TNM classification for staging brain tumors

TUMOR

How much the primary tumor
has grown locally

Nodes, TNM classification for staging brain tumors

NODES

If the cancer has spread
to the local lymph nodes

Metastes, TNM classification for staging brain tumors

METASTES

If the cancer has spread
to other parts of the body

So, when a cancer is staged, a number is given for each of these three characteristics. For example:

T-1 means the primary tumor is still in the original area of growth; T-3 means the primary tumor has grown right through the tissues of the primary area; and T-4 means it has invaded nearby structures.

N-0 means there is no spread to the lymph nodes; N-1 means, that some local lymph nodes are affected; and N-2 means extensive spread to local lymph nodes.

M-0 means there are no metastases; M-1 means there are metastases to other areas of the brain or spine.

So, for a certain case, you may be told “the stage is T-3, N-1, M-0” – meaning the cancer has spread through the primary area, there is some spread to local lymph nodes, but no metastases to other areas of the brain or spine.

Why Staging is Necessary
Your doctor needs to know what the amount of cancer is in your body – and where it is – in order to be able to choose the best treatment options. While the treatment for an early-stage cancer may be surgery or radiation, a more advanced-stage cancer may need to be treated with chemotherapy. Your doctor will also use cancer staging to help predict the course of the disease.

If you have been diagnosed with cancer, you may need some tests to determine accurate staging. The tests can include some or all of the following: blood tests, CT scan, MRI, bone scan, and ultrasound.

There are times when a cancer cannot be accurately staged until after removal of the primary tumor in order to analyze the tissues removed with the tumor to see if the cancer has grown through normal tissues, and whether nearby lymph nodes are involved.

Tumor Grades

Grade describes how much the tumor cells look like healthy cells when viewed under a microscope. The doctor compares the tissue from the tumor with healthy tissue.

Healthy tissue usually contains many different types of cells grouped together. If the tumor looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor.

GRADE I TUMOR

Grade I is a separate group of tumors called Juvenile Pilocytic Astrocytoma (JPA). The term juvenile does not refer to the age of the patient, but the type of cell. This is a non-cancerous, slow-growing tumor that can often be cured with surgery.

It is different from a low-grade astrocytoma or Grade II Glioma, which are likely to come back after treatment.

Characteristics:
Benign (non-cancerous)
Slow growing
Cells look almost normal under a microscope
Usually associated with long-term survival
Rare in adults

GRADE II TUMOR

A Grade II tumor does not have dead cells in the tumor, called necrosis, but shows an abnormally large number of cells, called hypercellular.

Characteristics:
Relatively slow growing
Sometimes spreads to nearby normal tissue and comes back (recurs)
Cells look slightly abnormal under a microscope
Sometimes comes back as a higher grade tumor

GRADE III TUMOR

A Grade III tumor is hypercellular and has cells that are actively dividing called mitosis. It is often called Anaplastic Astrocytoma.

Characteristics:
Malignant (cancerous)
Actively reproduces abnormal cells
Tumor spreads into nearby normal parts of the brain
Cells look abnormal under a microscope
Tends to come back, often as a higher grade tumor

GRADE IV TUMOR

A Grade IV tumor is usually a Glioblastoma, also called Glioblastoma Multiforme or GBM. Cells in the tumor are actively dividing, and it has blood vessel growth and areas of dead cells in addition to the factors common to Grade II and Grade III tumors.

Characteristics:
Most malignant
Grows fast
Easily spreads into nearby normal parts of the brain
Actively reproduces abnormal cells
Cells look very abnormal under a microscope
Tumor forms new blood vessels to maintain rapid growth
Tumors have areas of dead cells in their center called necrosis

Impact of Tumors

(by lobe)

The effects of a tumor may result in certain deficits, depending on its location in the brain.

FRONTAL LOBE

Problem solving
Judgment
Inhibition of behavior
Planning
Anticipation
Speaking (expressive language)
Emotional expression
Awareness of abilities
Self-monitoring
Motor planning
Personality
Sexual behavior
Behavior control
Limitations
Organization
Attention
Concentration
Mental flexibility
Initiation

PARIETAL LOBE

Sense of touch, taste and smell
Differentiation: size, shape, color
Spatial perception
Visual perception
Academic skills
Math calculations
Reading
Writing

OCCIPITAL LOBE

Visual reception area
Visual interpretation
Reading (perception and recognition)

CEREBELLUM

Coordination of voluntary movement
Balance and equilibrium
Some memory for reflex motor acts

BRAIN STEM

Sense of balance (vestibular function)
Reflexes to seeing and hearing
Autonomic nervous system
Blood vessel control
Breathing
Heart control
Digestion
Heart rate
Swallowing
Consciousness
Blood pressure
Temperature
Alertness
Ability to sleep
Sweating

TEMPORAL LOBE

Understanding language
Organization and sequencing
Information retrieval
Musical awareness
Memory
Hearing
Learning
Feelings
Digestion
Heart rate
Swallowing
Consciousness
Blood pressure
Temperature
Alertness
Ability to sleep
Sweating

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