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"Nuclear Grade" and "Stage"

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Carolyn Vachani, RN, MSN, AOCN
Last Modified: January 10, 2006

I had a simple mastectomy for ductal carcinoma in situ, comedo type, nuclear grade III. I would like information regarding "nuclear grade" and "stage". What is the relationship between these terms? What is nuclear grade, and how is it determined?

Carolyn Vachani, RN, MSN, AOCN, OncoLink's Nurse Educator responds:

Stage and grade are two unrelated terms used in determining the extent of the disease and how aggressive the cells are. Stage is based on the tumor size and whether or not the lymph nodes or other parts of the body (i.e. liver, lungs) are involved by tumor. For invasive cancers stage can range from I to IV. For example, Stage I breast tumors must be under 3cm in size and have no involved lymph nodes, whereas stage IV disease has spread to other organs or the bones. The stage helps doctors determine the best treatment for the cancer. However, because ductal carcinomia in situ (DCIS) is not invasive cancer, it is consider stage 0.

The tumor grade is determined by the tumor cells' appearance under the microscope (how closely a tumor resembles normal tissue of its same type). If the tumor cells look like normal breast tissue cells the tumor is termed Low Grade . High grade cells look markedly different from normal breast tissue cells. The same rules apply to the appearance of the cells' nucleus. High Grade tumors tend to behave more aggressively and therefore have a poorer prognosis.