
In
pathology, grading is a measure of the cell appearance in
tumors and other
neoplasms. Some pathology grading systems apply only to
malignant neoplasms (
cancer); others apply also to
benign neoplasms. The neoplastic grading is a measure of cell
anaplasia (reversion of
differentiation) in the sampled tumor and is based on the resemblance of the tumor to the tissue of origin. Grading in cancer is distinguished from
staging, which is a measure of the extent to which the cancer has
spread.
Pathology grading systems classify the microscopic cell appearance abnormality and deviations in their rate of growth with the goal of predicting developments at tissue level (see also the 4 major histological changes in
dysplasia).
Cancer is a disorder of
cell life cycle alteration that leads (non-trivially) to excessive
cell proliferation
Cell proliferation is the process by which ''a cell grows and divides to produce two daughter cells''. Cell proliferation leads to an exponential increase in cell number and is therefore a rapid mechanism of tissue growth. Cell proliferation re ...
rates, typically longer cell lifespans and poor differentiation. The grade score (numerical: G1 up to G4) increases with the lack of cellular differentiation - it reflects how much the tumor cells differ from the cells of the normal tissue they have originated from (see
'Categories' below). Tumors may be graded on four-tier, three-tier, or two-tier scales, depending on the institution and the tumor type.
The
histologic
Histology,
also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...
tumor grade score along with the
metastatic (whole-body-level cancer-spread) staging are used to evaluate each specific cancer patient, develop their individual treatment strategy and to predict their prognosis. A cancer that is very poorly differentiated is called ''
anaplastic''.
Categories
Grading systems are also different for many common types of cancer, though following a similar pattern with grades being increasingly malignant over a range of 1 to 4. If no specific system is used, the following general grades are most commonly used, and recommended by the American Joint Commission on Cancer and other bodies:
*GX Grade cannot be assessed
*G1 Well differentiated (Low grade)
*G2 Moderately differentiated (Intermediate grade)
*G3 Poorly differentiated (High grade)
*G4 Undifferentiated (High grade)
Specific systems
Of the many cancer-specific schemes, the
Gleason system, named after
Donald Floyd Gleason, used to grade the adenocarcinoma cells in
prostate cancer
Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that sur ...
is the most famous. This system uses a grading score ranging from 2 to 10. Lower Gleason scores describe well-differentiated less aggressive tumors.
Other systems include the
Bloom-Richardson grading system for
breast cancer and the Fuhrman system for
kidney cancer. Invasive-front grading is useful as well in oral squamous cell carcinoma.
For
soft-tissue sarcoma two histological grading systems are used : the National Cancer Institute (NCI) system and the French Federation of Cancer Centers Sarcoma Group (FNCLCC) system.
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Examples of grading schemes
See also
*
TNM staging system (Other parameters)
* Tumor kinds that have their own grading system:
**
Teratoma
*
Gleason score
References
External links
CancerWeb
{{Tumors
Oncology
Pathology