hey everyone it's sarah with registerednessrn.com and in this video i'm going to be talking about tumor grading and staging for cancer and as always whenever you get done watching this youtube video you can access the free quiz that will test you on this content so let's get started cancer can be graded and staged however these two terms each have different meanings and as a nurse you want to be familiar with the lingo used to describe each of these things so first let's talk about tumor grading tumor grading assesses tumor cells underneath a microscope so how they do this is that a doctor goes in removes part of the tumor of the tumor takes it sends it to a pathologist who will take some of those cells and look at it underneath a microscope and the pathologist is looking at some things it's looking at the cell's size shape color and arrangement and seeing how much those cells deviate from how healthy normal cells from that area should look so you may see some different terms used to grade tumors one term is well differentiated that means that these cells are very similar to how healthy normal cells should look in their appearance and arrangement and these grades are termed low grade and they tend to spread fairly slowly and grow slowly on the flip side we have poorly differentiated and these cells that tells us that they are very abnormal they don't look much like normal cells at all and they are usually high grade and this tells us that this type of cancer is going to grow quickly and spread quickly now with this low to high grade rating we can take this and give it a numerical rating to reflect what type of grade it is however it's important to know that not all cancers use the same type of grading system it really depends on the cancer for example breast cancer uses the nottingham score system so with that said let's look at the basic numerical system that grades it one through three or one through four so here you're going to see an illustration of a tumor found in a bladder and here on the right is what the normal cell should look like in the bladder and then below we have the different grading systems so grade one this is well differentiated it's low grade and notice how the cells in this picture pretty much mirror the normal healthy cells and how they look and how they're arranged but then we look over at grade two this is moderately differentiated intermediate grade and these cells have some differentiation they look a little bit different than those normal cells and then beside of it we have grade three this is poorly differentiated and is considered high grade and notice we have various sizes and arrangement and it's very abnormal compared to those normal cells and then some scales will go into grade four and this is termed undifferentiated it's considered high grade and the cells are extremely abnormal in this type now let's look at tumor staging so this tells us about that main tumor like its location and size and if it's spread to any other parts of the body such as the lymph nodes and organs now how do we determine a patient's stage of cancer well we can look at a few things number one testing we can look at the results of let's say an mri a ct scan x-ray ultrasound or we can look at lab results or any physical findings that we find in that patient to help us determine that stage and it's useful to stage a patient's cancer because it can help us develop a treatment plan because earlier stages of cancer are going to be treated different than those later stages plus it helps us determine if a patient may be a candidate to participate in a clinical trial based on what stage of cancer they have and it provides some insight on how aggressive and treatable this cancer may be now it's important to note that once a cancer stage is designated at diagnosis it does not change so let's say that the cancer gets worse it spreads throughout the body well that original stage stays but that information is added on to that stage in addition let's say for some reason this cancer has to be restaged well the restage doesn't replace the original stage but is included with it and staging can occur at different times for example a cancer can be staged before treatment and it's based on these testing findings lab results or physical findings and we call that clinical staging or it can be staged after surgery whenever they remove the tumor they can see what's really going on what's really the extent of this cancer and that's called pathological staging and then we have post therapy staging and this is where the patient has received some treatment before the staging like radiation now here in a second that's going to make sense with the classifications so what are these staging classification systems well there are different types of staging systems depending on the cancer and the one you want to be familiar with as a nurse especially for exams is called the tnm staging system this is a system that's really used for solid tumor cancers like colon cancer and it's not used for blood cancers such as leukemia or brain and spinal cord cancers so tnm is an acronym that is made up of categories that stands for tumor nodal involvement and metastasis tumor is the first category and we're talking about that primary main tumor and this category describes the location and how much that tumor is growing into other tissues is it just hanging out all by itself in its primary site or is it growing inside other structures and layers and the higher the number with this tea the more it has grown into other layers or structures so some ways you'll see this t displayed on reports you could see a tx this stands for tumor can't be measured or a t0 that means no tumor is found then a t with a lowercase i and s means tumor is in situ inside two actually means in its original place so whenever it says this it means that the tumor is found in its original place and has not spread from its original location so at this time it's not cancerous but in the future it could turn cancerous and spread then there's t1 t2 t3 and t4 and this describes the size slash amount the tumor has grown and affected other areas so higher the number the larger the size slash amount it has grown into other areas so a t1 is smaller than a t4 and depending on the cancer type sometimes letters can be added after the number to further describe the tumor's growth for example breast cancer tumors can be described such as like t1a and this means tumor is greater than one millimeter but less than five millimeters or it could be like t4a and this means the tumor has spread to the chest wall then the next category is in for nodes and this is the regional lymph nodes and what happens is that parts of the tumor can break off and collect in the lymphatic system hence a nearby lymph node so this category refers to the spread of cancer in nearby lymph nodes closest to that primary main tumor and lymph nodes are small clustered structures that help us fight infection and they are found around many important organs so an nx can be given and this means cancer in regional lymph node can't be measured in zero means no cancer present in regional lymph node then n1n2 and n3 represents the number and location of the lymph nodes that have cancer so an n3 means there are more lymph nodes that contain cancer than an n1 so just like with the category t tumor for some types of cancers letters can be added after the number to provide further detail about the spread to the lymph nodes for example like an n2a or an n2b and then the last category we have is m for metastasis and this details if the cancer that primary tumor has spread to other parts of the body and if this is the case how much and the location of it an m0 can be given and that means no cancer found in other parts and then an m1 and this means that cancer has spread to organs and tissues again depending on the cancer letters can be added after the number to further describe the metastasis of the cancer to the other body parts now let me talk about some other add-ons that can be included with this staging system that helps provide further information about this patient's stage of cancer because as a nurse whenever you're looking at these reports you want to be familiar with what these other lowercase letters may mean so you may see either a lowercase c or a lowercase p for example like ct1 or pt2 what does that mean so first let's talk about that lowercase c the lowercase c stands for clinical staging and that means that this cancer was staged before treatment and was based on those test results like the mri ct scan whatever the patient had done and those physical findings the lowercase p stands for pathological staging and this is staging that is done after surgery so whenever the patient has that tumor removed they can see the extent of the cancer how far has it spread and it takes into account what the testing results lab results in the physical findings were as well so it gives us a more detailed picture of that cancer however some patients can't have surgery to have their tumor removed and if that is the case a pathological stage can't be determined at that time furthermore a lowercase y or r can be in front of that tnm category for example yct3 or rpt3 so let's talk about the lowercase y first this represents post-therapy staging either clinical or pathological and this is given after therapy was administered for example like chemo and how much of the tumor remains before surgery and a lower case r is to show reoccurrence of the cancer now the tnm system is used to calculate a number system like stage 0 to stage 4. and this is a lot of times how patients refer to their cancer like they have colon cancer stage 3 or colon cancer stage 2. you don't hear patients refer to their cancer as i have t1an0m1 instead they refer to this numerical system so stage 0 is cancer in situ and this means the cancer is still in its original place hasn't invaded surrounding tissues stage one is the cancer is localized and not spread into other tissues or lymph nodes stage two is the cancer has spread into surrounding tissues and close by lymph nodes stage three is the cancer has spread into even deeper tissues than stage two and further away lymph nodes but it has not spread to other distant structures in the body like organs and then the last stage stage four which is the most advanced called metastatic cancer and this means the cancer has spread to other parts of the body beyond where the cancer started okay so that wraps up this review over tumor staging and grading if you'd like to test your knowledge on this content don't forget to access the free quiz in the youtube link below