Differences in cancer grades?

[Sherryg683]

How important is the grade of cancer to prognosis and what exactly does it mean? I see a lot are grade III. My report told me that I was grade II, my surgeon said that was good news. The only good news she had to tell me...what exactly do the cancer grades mean..sherryg683

[micheleu]

Sherry, they mean how "aggressive" the cancer is. Usually, but not always, HEr2 neg Hormone positive cancer is grade 1. Most people I know with Her2 pos are grade 3, like myself. I don't know if it has alot to do with prognosis anymore. Probably is one is Her2 neg and Hormone pos it might. It has been around and tested for along time, unlike Her2 testing

[Becky]

Michelle is right about grade but there are more things to consider. When scoring cancer, the grade can be the composite of 3 features of your tumor. The histologic grade, the nuclear grade and the mitotic grade. Each of these features is given a score from 1 (low) to 3 (high) and then these 3 scores are added up for a final grade where the lowest score is 3 and the highest score is 9.

Histology is if the cells are tubular or not with tubular being a 1 and practically no tubes is 3. Nuclear grade is how the cells look compared to normal cells with looking alot like normal cells as a 1 and very abnormal looking as 3. The mitotic score is like the Ki 67. Are the cells reproducing slowly then its a 1 or rapidly a 3. Naturally the score "2" is intermediate.

So, what if you score a 1 on histology and nuclear grade but your cancer rapidly divides? You score a 5 (intermediate or grade 2) but is it the same grade 2 if you scored a 2 on histology and nuclear and a 1 on mitotic? Probably not. However, lower scores are better in general. I too am a grade 2 with histology a 3, nuclear a 2 and very, very weirdly - mitotic grade a 1 (I had my pathology redone at Sloan because of this as it is very odd for Her2 to not divide rapidly.

I hope this helps somewhat.

[Sheila]

Becky is right on as usual!!!! This is what is known as the Bloom Richardson Score in the medical world....this may explain it.


Bloom-Richardson Grade for Breast Cancer

Beginning with breast cancer cases diagnosed January 1, 1996, the Bloom-Richardson grading system may be used.

Synonyms include: Modified Bloom-Richardson, Scarff-Bloom-Richardson, SBR Grading, BR Grading, Elston-Ellis modification of Bloom-Richardson grading system. This grading scheme is based on three morphologic features as follows:

1. <LI class=kadov-p-CSingleSpaced>degree of tumor tubule formation
   <LI class=kadov-p-CSingleSpaced>tumor mitotic acitivity
2. nuclear pleomorphism of tumor cells (nuclear grade)

Seven possible scores are condensed into three Bloom-Richardson grades. The three grades then translate into well-differentiated (BR low grade), moderately differentiated (BR intermediate grade) and poorly differentiated (BR high grade).
Tumor tubule formation

Score

>75% of tumor cells arranged in tubules

1

>10% and <75%

2

<10%

3

Number of mitoses
(low power scanning (X100), find most mitotically tumor area, proceed to high power (x400)
<10 mitoses in 10 high-power fields

1

>10 and <20 mitoses

2

>20 mitoses per 10 high power fields

3

Nuclear pleomorphism (nuclear grade)
Cell nuclei are uniform in size and shape, relatively small, have dispersed chromatin patterns, and are without prominent nucleoli

1

Cell nuclei are somewhat pleomorphic, have nucleoli, and are intermediate size

2

Cell nuclei are relatively large, have prominent nucleoli or multiple nucleoli, coarse chromatin patterns, and vary in size and shape

3

To obtain the final Bloom-Richardson score, add score from tubule formation plus number of mitoses score, plus score from nuclear pleomorphism. The combined score converts to the following BR grade:
Bloom-Richardson combined scores
Differentiation/BR Grade
ICD-O-3 6th digit

3, 4, 5

Well-differentiated (BR low grade)

1
6, 7

Moderately differentiated (BR intermediate grade)

2
8, 9

Poorly differentiated (BR high grade)

3

There are coding rules and conventions to be used to code breast cancer cases. Use grade or differentiation information from the breast histology in the following order:

1. <LI class=kadov-p-CSingleSpaced>Bloom-Richardson scores 3-9
   <LI class=kadov-p-CSingleSpaced>Bloom-Richardson grade (low, intermediate, high)
   <LI class=kadov-p-CSingleSpaced>Nuclear grade
   <LI class=kadov-p-CSingleSpaced>Terminology (well diff, mod diff…)
2. Histologic grade (grade I, grade ii…)

Caution : In this grading system, the terms low, intermediate, and high are codes 1, 2, and 3 respectively. This is an exception to the usual rule for all other grading systems which code "low", "intermediate", and "high" as 2, 3, and 4 respectively. In the Bloom-Richardson system, if grades 1, 2, and 3 are specified, these should be coded 1, 2, and 3 respectively.

Bloom-Richardson scores
Bloom-Richardson scores
Nuclear Grade
Terminology
Histologic Grade
Code

3- 5 points
Low Grade
1/3, 1/2
Well Differentiated
(BR low grade)

1

6, 7 points
Intermediate Grade
2/3
Moderately differentiated
(BR intermediate grade)

2

8, 9 points
High Grade
2/2, 3/3
Poorly Differentiated
(BR high grade)

3

[Joan M]

Sherry,

Here's something from the NIH that explains tumor grade:

http://www.cancer.gov/cancertopics/f...on/tumor-grade

I guess it's basically the same as Becky said with some more elaboration.

Joan

[Diana1993]

What is Tykerb "off label"?

[micheleu]

if you ae referring to my treatment, Tykerb is only given in trials to women that have not had Herceptin first. I took Herceptin to prevent a recurrence, and that's what they want to happen with Tykerb someday, use it to prevent a recurrence instead of Herceptin. So, I could not qualify to get Tykerb at all. But, off label means, your oncologist can order it for you and IF your insurance will pay for it you can have it. I took it for only 3 months then stopped it. I was having alot of diarrhea side effects from it. (I still have a 3 month stash, just in case!)