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Practice English Speaking&Listening with: Pathology Grade and Staging

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Knowing the language makes navigating through cancer land a lot easier. It also helps us

feel more in control of our destinies because we can make better decisions when we can

understand the lingo. Today Dr. Erba and Dr. Johnson will discuss grade and stage. Two

words that take on a new meaning after a cancer diagnosis and greatly influence both the

course of treatment and prognosis. We'll also look at how our individual biology

influences both the cancer and approach to treatment. What happens in cancer is that there

is breakdown in that organization such that the relationship between cells to

one another is lost. Part of that relationship requires an organizational closeness. During

the cancer process, it's advantageous to the cancer cell for its own long term survival

to depart from that organization and start to spread to other places. Staging is the process

the clinician does with the patient. Once that diagnosis is made, we want to know where in

the body that tumor is for a number of reasons. One is to tell what type of therapy the

patient should receive. For example if it is an early stage, or low stage and localized to an

organ, it can often be cured with surgery or radiation therapy alone or as a

combination as opposed to a more advanced stage where the disease has already spread and you have

to think about more systemic therapies....treatments that go everywhere in the body to take

care of the disease. And so a clinician will do a staging evaluation to come up with a

prognosis and the best therapy. The tests that are done in that staging evaluation depends on

that clinicians knowledge of what that tumor normally does. For example...if we had a scan

of toenails, we're not going to do a scan of toenails in a person with lung cancer because

we know lung cancer doesn't go to toenails. So, histologic grade ...the grading is the

description of the microscopic appearance of the cells. It is informative to the clinician in

that it depicts the degree of abnormality of the cells. When you assign a high histologic

grade to a cell, it implicitly informs the clinician, that this is a tumor with tendency to an

aggressive clinical course. Now ideally, that information is also going to be conveyed in the

context of stage which Dr. Erba described earlier which is the clinical evaluation of the

extent to which the tumor has spread from its primary site of origin. So, high grade does not

mean high stage. And high stage does not mean high grade. It just conveys some of the

biological properties. So when you see the grade you'll say this is likely to be an

aggressive tumor. And there's a system by which numbers are assigned to give a description

of how aggressive histologicly microscopically the tumor cells look. One thing for people to

understand is that cancer is not always the isn't the same in different people. It's

not one disease. These cancers of different organs behave very differently and have different

underlying events genetic changes that lead to them. But moreover, we are learning that

even when we see something under the microscope and we say, "A Ha! That's breast cancer or

that's prostate cancer or lung cancer....that there can be differences between the genetics

of that cancer in different people. And that's what we're investigating right now. And

what we are finding in a variety of malignancies is how heterogeneous these cancers are.

That brings up the challenge and the hope for the future. By getting these samples from our

patients, and evaluating these genetic changes typically done in pathology labs and nuclear

diagnostic labs, we are going to learn about the biology of the disease. And hopefully in the

future, be able to have better drugs that can interfere with the cancer process. That process

might be very different from one person to another with the same disease under the microscope. So

it's quite a challenge and underscores the need for people with cancer allowing the biopsy

to be taken for research purposes . We can study the heterogeneity of the tumor which

The Description of Pathology Grade and Staging