What is considered “high grade”?

linn56
linn56 Member Posts: 210
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

What is considered "high grade"?

Don't the numbers go from 1 to 4? I know High is bad and low is good.

My first path report said cribriform and solid types, Nuclear Grade 3. When I see references to Grade on this forum, are people talking about Histological grade or Nuclear grade? I don't have any Histological grade listed on my reports.

My second path report after re-excision (to get wider margins) found "residual high grade DCIS" but did not mention numbers. I assume it is also nuclear grade 3 since that's what I had the first time? 

Thanks!

Just read on the Understanding DCIS site:

Histologic grade refers to how much the tumor cells resemble normal cells (called differentiation). The lower the grade, the more the cells resemble normal cells. DCIS and low-grade tumors grow relatively slowly. High-grade tumors, in contrast, are thought to grow rapidly, and in the case of DCIS, are more likely to lead to invasive cancer in the future.

Nuclear grade refers to the rate at which the cells are dividing to form more cells (called proliferation). Cancer cells that divide more often are faster growing and more aggressive than those that divide less often. The nuclear grade is determined by the percentage of cells that are dividing. Cells have different grades ranging from 1 to 3.

This makes it look like since my nuclear grade is 3, my cells were more aggressive.

Is it common to have only one kind listed and not BOTH Histological and Nuclear?

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  • Eldub
    Eldub Member Posts: 276
    edited September 2009

    Hi!  Let me see if I can help clarify.  As you've found, "grade" is from 1 to 3 - or can be listed as "low" "intermediate" or "high."  Either way, there are only 3 options.  (For whatever reason, it seems most common for path reports for DCIS to use the terms "high," "intermediate," or "low," and not to list a number.  My path report said "high nuclear grade" - so I'm not sure if that meant Histologic grade or Nuclear grade.  When I asked the surgeon what the number was, he said that "we don't use numbers for DCIS."  Whatever...

    What you may be confusing grade with is the "stage" of a cancer.  Stages can range from 0 to 4.  A pure DCIS diagnosis is always stage 0.  That is because DCIS is pre-invasive.  It IS cancer, but caught before it has broken out from its original location in the ducts and become invasive.  Stage 1 - 4 (Usually written as I, II, III, or IV) refer to invasive cancer.  In breast cancer, stages I and II are referred to as "early stage" breast cancer and are highly curable.  Stage III is more serious, but it has not spread beyond the breast and lymph nodes into other parts of the body, so still has the potential of being cured.  Stage IV has spread to other parts of the body.  It is no longer considered curable, but in some cases may remain stable for many years (with ongoing treatment).

    And yes, DCIS that is high grade/grade 3 is considerd more aggressive than a lower grade DCIS.  In general, the higher the grade, the higher the risk of a recurrence/the cells become invasive cancer.  So, the higher the grade, the more aggressive the treatment.  With grade 3 DCIS, they'll want to make sure to get ALL of the DCIS out with surgery, and to have good, wide margins.  If the surgery is a lumpectomy, radiation will almost always be recommended to catch any stray cancer cells that may remain in the ducts.  When the surgery is a mastectomy, radiation is usually not needed.  Women with ER+ DCIS are also likely to be prescribed one of the hormone-suppressing drugs to take, also.

    Hope that helps clarify!

    Linda

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  • Mantra
    Mantra Member Posts: 968
    edited September 2009

    My cone biopsy used the terms Nuclear Grade 3, comedonecrosis and central necrosis. However, my post op pathology report listed things differently under headlines not found in my first report. This report had "histologic type': Comedo, solid micrpapillary and "Histologic Grade"" 3.

    Infact, the impact of my report left me in complete shock. I  was fully prepared for what I knew from the cone biopsy report but I was not prepared for additional probles such as multi focal in two quadrants, micropapillary, neoplastic glands, myoepithelial layer and ER/PR negative.  

    I am very fortunate that my lumpectomy showed it was still DCIS which makes the ER/PR irrelevant. I also had 3 nodes removed; all negative. But I know my breast cancer is extremely agressive and having a mastectomy ASAP is paramount. The closest margin was 1.2 mm and given the number of tumors found, my surgeon is not confident she got all of it. Hence, the mastectomy and in all likelyhood I will choose to have the other breast removed since the aggressive of my cancer is freaking me out.

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  • Dukette52
    Dukette52 Member Posts: 2
    edited July 2011

    Hi Linda!

    Did you do the Tamoxifen? and also, did you have side effect/ success?

    I'm going tomorrow to MAYBE pick up my script......have a gut feeling ....

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