Grading

Question 1

What is the definition of grading?

Answer 1

An evaluation of the degree of differentiation and therefore the degree of malignancy

Question 2

Pre-malignancy

Answer 2

Any lesion that could be interpreted as pre-cancerous

Question 3

Carcinoma in situ (cis)

Answer 3

Group of abnormal cells

Question 4

Hyperplasia def

Answer 4

Enlargement of organ or tissue due to increase in reproduction rate of it’s cells

Question 5

Hypertrophy

Answer 5

Enlargement of organ on tissue due to increase in size of its cells- not number of cells

Question 6

What is a grade?

Answer 6

If grading system for a tumour is not specified, the following is used:
GX → grade can’t be assessed (undetermined)
G1 → well differentiated (low grade)
G2 → moderately differentiated (intermediate)
G3 → poorly differentiated (high grade)
G4→ undifferentiated ( high grade )

Question 7

Grading for prostate cancer

Answer 7

Well differentiated → moderately differentiated → poorly differentiated → anciplastic

Question 8

Differentiation → in relation to breast cancer

Answer 8

The arrangement of cells in relation to each other
Whether they form tubules (gland formation)
Now similar they look to normal breast cells (nuclear grade )

Question 9

Importance of grading

Answer 9

Indicates how quickly a tumour is likely to grow and spread
Prediction of future tumour progression
Assess urgency of treatment
Plan appropriate treatment

Question 10

Degree of malignancy

Answer 10

The degree of malignancy is inversely related to the degree of differentiation

Question 11

How are non-melanoma skin cancers classified?

Answer 11

Not normally graded 1-4
Clinical subtype is identified- along with other clinical features to indicate risk
Categorised into 2 groups → low and high risk

Question 12

Factors affecting risk of metastatic potential

Answer 12

Site (increasing risk) → arising at sun-exposed site (lip/ear ); non san-exposed sites ( perineum, sacrum, sole of foot ); SCC arising from radiation thermal injury, chronic inflammation or bowen’s disease
Diameter →> 2cm
Size → depth and level of invasion
Host immunosuppression
Previous treatment and modality

Question 13

Low risk

Answer 13

Sun exposed areas
Small well differentiated dermal tumours

Question 14

High risk

Answer 14

Recurrent
Large, poorly differentiated, invading beyond dermis
Immunosuppressed patient