What does Grade 1,2,3, etc mean?

stacyRuss

I almost feel like just staying stupid and not wanting to know what everything means on my biopsy report. I guess not everyone gets really involved. Yhe more info I have the more scared I become. I think I am running away from the pressure of it all. I do want to know what grade means, I see it under posts all the time. Can Some one tell me? 

I will be haveing surgery on Friday the 4th of Sept. I have IDC. I was told I am stage 1, the lump is a tad over 1 cm. It is deep in the tissue. resting on my muscle wall. So lumpectomy with one node removed. What scares me is so many have said that they were stage 1 or stage 2 and jumped to a stage 3 etc. Geeze I am scared  of my outcome. 

Ok enough baby talk from me.  Gotta get ready for my blood work and xray in a few...

Thanks all.

StacyRuss 

AmyIsStrong

I think the stage is based on the size of the tumor and # of lymph nodes involved. And the grade is the degree of aggressiveness of the tumor cells. But I could be wrong - hopefully some more informed ladies will answer soon. Plus I'm sure in the informational area of this website there are more scientific complete answers.

I do know that Stage and Grade are different things. At least I am sure of that part!

stacyRuss

Thanks for your speedy reply. So where do you find with grade you are? I know my stage but not my grade. ahhh... Im getting sucked into the breast cancer information highway... And I dont want toooooo.... 

StacyRuss 

suemed8749

Hi Stacy and welcome! I'm so sorry you had to come here, but this is a great place for support and information. I know what you mean about not wanting to know everything on your path report - everyone's reaction is different. Some people want to know everything, some people want to know only what their doctor thinks they need to know. Sounds like you want to educate yourself slowly, which is fine.

Amy is right about stage being based on the size of the tumor, the number of lymph nodes invovled, and if it has spread outside of the breast. The stage really can't be absolutely determined until after surgery so the size can be assessed accurately and the surgeon can remove lymph node(s) to be tested. Doctors sometimes also order tests like an MRI, CT scan and/or PET scan to determine if the cancer has spread. When all of this is done, they can accurately stage you.

Grade is determined by how different the cancer cells look under a microscope. Grade 1 cells look the most like healthy breast cells, 2 look more different, and 3 cells are the most unlike normal cells. Amy is right that the higher the grade, usually the more aggresive the cancer. She's also right that the information section of bc.org (the home page) has good, very understandable information about your path report. Check it out. Probably best to stay off Google right now - I scared myself silly when I was first diagnosed!

I got my grade with the first biopsy report. The stage came after surgery and testing.

Wishing you all the best - I know it's scary, but you can do this!

Sue

deborye

  Welcome Stacy, I agree with all the comments above.  Keep us informed and good luck♥

pj12

Good wishes, Stacey.  We all have been as confused as you are now so know that it will all begin to make sense before long.  Always ask for copies of operative notes, pathology reports, and reports from any and all doctors who read your scans.  My hospital provides CDs of Cat scans, x-rays and MRIs and I always take them with me if I am seeing a new doctor who might ask something I can't answer.  No one will mind providing them to you and they will be essential to you as you try to learn more about your particular medical situation.  Also ask about testing like Oncotype DX and whether you are a candidate for this test -  if you are in a grey area a piece of your tumor is sent away for testing to see if you would benefit from chemotherapy.  It is quite expensive but increasingly, insurance will pay for it.  Finally ask all your doctors to send notes to your other doctors about what they are doing... at least have one doctor who is kind of your central clearing house so someone coordinates your care.  Right now you are dealing with a surgeon but you will add an oncologist, a radiologist, a pathologist, your primary care provider, and possibly other specialists.  It can get confusing!  Finally, keep a diary of every medical visit.  Sometimes that book is the only way I can tell who is sending me  a bill for what?

This is a great place to be... if you have to be here.

Pam 

stacyRuss

Thanks all.

StacyRuss 

Brenda_R

Stacy, I was Stage 3, grade 3, with all unfavorable receptors, ER-PR-Her2+++, a high KI67 (70%), and a positive IM node.  But even with all that, I am now NED, meaning there is no discernable cancer. I am now almost 3 years out from dx and 1 & 1/2 years out from active treatment.  Cancer is no longer the first thing on my mnd, nor at the top of list of things to worry about.

Don't worry too much. 

OneBadBoob

The Bloom-Richardson Grading SystemThere are several different systems for grading cancer. The Bloom-Richardson system is used for grading breast cancer, and has a scale of 1 - 3. A pathologist will take a sample of tissue from your tumor, and examine it under a microscope. Tumor cells that look most like normal cells are given a low grade, while those that look the most abnormal are given a high grade. High-grade tumors are fast-growing, spreading (metastatic), and aggressive. Knowing your tumor grade helps your doctor decide which treatments may be best for you.

Starting the Tumor Grading Process

Illustration by National Cancer Institute, Pat Kenny (artist) A pathologist looks at the tumor cells and checks for three microscopic features:

• degree of tumor tubule formation (percentage of cancer composed of tubular structures)
• tumor mitotic activity (rate of cell division)
• nuclear grade (cell size and uniformity)

Each feature is scored on a scale of 1 - 3.

Cell Feature Scoring

Feature Score 1: Slow cell growth rate
Feature Score 2: Intermediate cell growth rate
Feature Score 3: Fast cell growth rate

Feature Scores Add Up to Three Tumor Grades

Illustration by Pam Stephan

The score of all three features are added together for a total between 3 and 9.

Click on the table on the left to expand it and see how Feature Scores and Tumor Grades compare. Grade 1 is the least aggressive, while Grade 3 is the most aggressive type of tumor.

Doing the Math for a Tumor Grade

Here is an example. If a tumor has these feature scores:

Tubule formation: 1
Mitotic activity: 2
Nuclear grade: 2

We add 1 + 2 + 2 = 5, which is given a Grade 1, the slowest growing, and least aggressive tumor type.

Sources:

_{National Cancer Institute. Tumor Grade: Questions and Answers. Reviewed: 05/19/2004.}

LisaEpstein

Does grade really matter once the tumor is out?

Gayle56

For me it seems to be the one piece that was leaning the MO towards recommending some chemo.

dreaming

What means infiltrating "well -differentiated  ductal carcinoma"?

Maybe somebody can translate ? Thanks

jacee

dreaming.....well differentiated  means the cells look the MOST like normal cells, and is a classification given to the lowest grade or Grade 1 ususally. Would typically mean the least aggressive of the 3 grades.