Introduction to Neoplasia Quiz

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Which statement best distinguishes tumour grading from tumour staging?

A Grading is decided by the presence of metastases alone, whereas staging is decided by the mitotic count
B Grading describes lymph node involvement, whereas staging describes the degree of pleomorphism
C Grading assesses cell differentiation and mitotic activity, whereas staging assesses tumour size and spread ✓
D Grading is based on tumour size, whereas staging is based on the appearance of the nuclei
E Grading assesses the presence of vascular invasion, whereas staging assesses the degree of cellular atypia

The answer is C: Grading assesses cell differentiation and mitotic activity, whereas staging assesses tumour size and spread

Explanation

Why C is correct

See Malignant Neoplasms. Option C is correct because grading and staging answer two different questions. Grading is made by the pathologist and describes how abnormal the tumour cells look compared with normal ones, which includes how well differentiated they are (how closely they resemble the tissue they come from), how abnormal the nuclei are and how often the cells are dividing. A high-grade tumour has poorly differentiated cells with many mitoses and tends to grow and spread faster. Staging describes how far the cancer has spread: the size of the tumour and local growth, whether lymph nodes are involved and whether there are distant metastases. The standard system is TNM, in which T stands for tumour, N for nodes and M for metastases. Memory aid: grade is about the cells' appearance (how bad they look), stage is about the cancer's spread (how far it has got).

Grading: made by the pathologist, it describes how abnormal the tumour cells look, including differentiation, nuclei and mitoses.
Staging: it describes how far the cancer has spread, using tumour size, lymph nodes and distant metastases.
Staging system: TNM stands for tumour, nodes and metastases.

Why the other options are incorrect

A. Grading is decided by the presence of metastases alone, whereas staging is decided by the mitotic count: This reverses the two terms. Metastases are a part of staging, and the mitotic count is a part of grading.
B. Grading describes lymph node involvement, whereas staging describes the degree of pleomorphism: This reverses the two terms. Lymph node spread belongs to staging, and pleomorphism is part of grading.
D. Grading is based on tumour size, whereas staging is based on the appearance of the nuclei: This reverses the two terms. Size is part of staging, and nuclear appearance is part of grading.
E. Grading assesses the presence of vascular invasion, whereas staging assesses the degree of cellular atypia: Vascular invasion is a feature of local spread rather than cell differentiation, and cellular atypia is a grading feature; this option swaps the two ideas.

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1
A histopathology report describes a malignant tumour arising from the glandular epithelium of the colon. Which term best describes this neoplasm?
2
Which feature is most typical of a benign neoplasm rather than a malignant neoplasm on gross and histological examination?

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Key concepts in this topic

Short revision pages: the key facts, a memory aid and the exam traps for each concept.

Benign neoplasm: pushing margin and encapsulation
A benign neoplasm (a new growth of cells that has escaped normal control) grows by expansion, pushing neighbouring tissue aside, which typically gives a well-circumscribed (clearly outlined) lump.
Carcinoma in situ versus invasive carcinoma
Carcinoma in situ (in place) is malignant-looking epithelium that stays above the basement membrane (the thin supporting layer beneath it), while invasive carcinoma has broken through it.

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