Size, Grade and Stage

Growing up I was a good student, but had to apply myself for A’s. Correction, gym was very easy for me, but math was not.  I have yet to be in an interview where my potential employer asked me what my grade point was, so  what was all the hard work for anyway?

But with cancer grades DO make a difference with treatment.  Since I’m not a doctor to explain this, I’ve brought in resources to help you understand and work you through what your size, grade and stage means.

The following information is from

Cancer size and grade


The size (diameter) of breast cancer is usually measured in centimetres.

Although – in general – the smaller the cancer the better, size doesn’t always give the whole picture about how fast the cancer is growing.

For example, a small cancer may grow very quickly or a larger cancer may have been growing slowly over a long time. Sometimes there may be more than one area of breast cancer. In this case, each area is measured.

Multi-centric means there is more than one area of breast cancer in different quarters of the breast.

Multi-focal means more than one area has been seen but only in one quarter of the breast.

Treatment options

You are more likely to have chemotherapy if your breast cancer is larger than 2cm (about three quarters of an inch), but this will also depend on the other results from the pathology report.

This is because larger cancers may have been there for longer before being found so may have had more chance to spread.


Cancer cells are graded according to how different they are to normal breast cells and how quickly they are growing.

In your pathology report this may be called differentiation.

There are three grades:

  • grade 1 (well differentiated) cancer cells look most like normal cells and are usually slow-growing
  • grade 2 (moderately differentiated) cancer cells look less like normal cells and are growing faster
  • grade 3 (poorly differentiated) cells look most changed and are usually fast-growing.

With ductal carcinoma in situ (DCIS) the three grades are usually called low, intermediate and high instead of 1, 2 or 3.

Treatment options

People with grade 3 invasive breast cancers are more likely to be offered chemotherapy to help destroy any cancer cells that may have spread as a result of the cancer being faster growing.

More information is from

Grade is a “score” that tells you how different the cancer cells’ appearance and growth patterns are from those of normal, healthy breast cells. Your pathology report will rate the cancer on a scale from 1 to 3:

  • Grade 1 or low grade (sometimes also called well differentiated): Grade 1 cancer cells look a little bit different from normal cells, and they grow in slow, well-organized patterns. Not that many cells are dividing to make new cancer cells.
  • Grade 2 or intermediate/moderate grade (moderately differentiated): Grade 2 cancer cells do not look like normal cells and are growing and dividing a little faster than normal.
  • Grade 3 or high grade (poorly differentiated): Grade 3 cells look very different from normal cells. They grow quickly in disorganized, irregular patterns, with many dividing to make new cancer cells.

Having a low-grade cancer is an encouraging sign. But keep in mind that higher-grade cancers may be more vulnerable than low-grade cancers to treatments such as chemotherapy and radiation therapy, which work by targeting fast-dividing cells.

Be careful not to confuse grade with stage, which is usually expressed as a number from 0 to 4 (often using Roman numerals I, II, III, IV). Stage is based on the size of the cancer and how far it has (or hasn’t) spread beyond its original location within the breast.

Stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body.

Understanding Breast Cancer Stages

Your pathology report will include information about the stage of the breast cancer — that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.

Cancer stage is based on four characteristics:

You also may see or hear certain words used to describe the stage of the breast cancer:

  • Local: The cancer is confined within the breast.
  • Regional: The lymph nodes, primarily those in the armpit, are involved.
  • Distant: The cancer is found in other parts of the body as well.

Sometimes doctors use the term “locally advanced” or “regionally advanced” to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast’s shape, and lymph node enlargement that is visible or that your doctor can feel during an exam.

The stage of the breast cancer can help you and your doctor understand your prognosis (the most likely outcome of the disease) and make decisions about treatment, along with all of the other results in your pathology report. Cancer stage also gives everyone a common way to describe the breast cancer, so that the results of your treatment can be compared and understood relative to that of other people.

Your doctor may use another staging system known as TNM to describe the cancer. This system is based on the size of the tumor (T), lymph node involvement (N), and whether the cancer has spread, or metastasized, to other parts of the body (M). TNM is discussed later in this section.

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