Stage vs Grade

[teratomas]

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In what type of tumors is grade more prognostic than stage? Any?

 

[waitlist22]

I don't think any. According to our pathologists, grade is basically how ugly the tumor cells look and how close to the tissue of origin the tumor cells appear. You can have a high grade tumor but have it be an early stage cancer. Grade is pretty much meaningless when it comes to prognosis, stage is much more important.

 

[SLC]

I don't think any. According to our pathologists, grade is basically how ugly the tumor cells look and how close to the tissue of origin the tumor cells appear. You can have a high grade tumor but have it be an early stage cancer. Grade is pretty much meaningless when it comes to prognosis, stage is much more important.

This!

Stage has everything to do with spread, and spread has everything to do with prognosis. A tumor that hasn't spread is often surgically treatable, and a tumor that hasn't spread is easy to monitor.

TNR (Tumor Size, Node presence, Metastasis), those are the aspects of stage, and those are the things that will determine how the tumor can be expected to affect the patient.

Grade just tells you how differentiated/undifferentiated the cells in the tumor are.

Though one has to wonder about Leukemia.

 

[CrouchingLiger]

The only one I can think of now is an astrocytoma: Pilocytic is low grade, GBM is high grade. Not sure how the staging on those work, but the grade 1 pilocytic has a good prognosis while grade 4 Glioblastoma Multiforme has poor prognosis.

I thought there was atleast one other type in which grade is more prognostically important than grade, and I feel like I heard at some point in lecture, but I can't recall now. Maybe it was a leukemia or something like that. But if in doubt, TNM stage is much more prognostic.

 

[teratomas]

yeah, that's what I thought but I just wanted to make sure there were not any exceptions to that rule

 

[pkwraith]

I saw it on Uworld recently.

With brain tumors, the situation is a little unique. The two main points was that the staging of brain tumors were less useful, because they very rarely metastasize, and location of the tumor is much more important to prognosis than the size. At that point, TNM is basically meaningless.

However, conventional grading is not reliable indicator of aggressiveness as it is obviously difficult to access the tumors. Some tests of grading may use things like bromodexoyuridine uptake (high uptake = high grade = poor prognosis)

 

[Jamiu22]

The only one I can think of now is an astrocytoma: Pilocytic is low grade, GBM is high grade. Not sure how the staging on those work, but the grade 1 pilocytic has a good prognosis while grade 4 Glioblastoma Multiforme has poor prognosis.

I thought there was atleast one other type in which grade is more prognostically important than grade, and I feel like I heard at some point in lecture, but I can't recall now. Maybe it was a leukemia or something like that. But if in doubt, TNM stage is much more prognostic.

Tis why brain cancers are often termed malignant, even though they have low metastatic potential... (if massive necrosis of the neural tissue don't kill ya, mass effect will).