Staging reveals whether the disease has remained localised or if it has spread to other parts of the body. This is very important in helping your care team identify the specific areas affected by the tumour’s growth.
Grading, on the other hand, involves examining the tumour’s appearance under a microscope in comparison to healthy cells. This evaluation, known as the KI-67 index, determines the likelihood of the tumour spreading slowly or rapidly.
In this article, we’ll take a look at the three main grades of neuroendocrine cancer, their life expectancy, and rates of incidence in Australia. If you have any questions about the information on this page, feel free to get in touch.
Grading is important when planning how to treat a patient. It’s crucial that this information is tabulated patient’s medical record. A specialist NET pathologist will then look at the biopsy results and decide on a grade.
Once your doctor determines the stage and grade of your NET, you can have an informed discussion about suitable treatment options. Together, you and your healthcare team can decide on the best course of action tailored to your specific condition.
NETs are graded based on things like how many cell divisions are happening (kind of like cells dividing), how quickly cells are growing (which we call the Ki-67 index – biomarker), and whether there’s any dead tissue.
Different cutoffs for the Ki-67 index and cell division rate are used to figure out how serious the tumour is, and sometimes if there’s dead tissue, it’s even more serious.
A low-grade tumour with a low KI-67 index closely resembles normal cells and is often referred to as “well differentiated.” Such tumours typically exhibit slow growth and limited spreading.
In contrast, a high-grade tumour with a high KI-67 index shows abnormal cell features and grows rapidly. These tumours are often referred to as “poorly differentiated.”
There are other really important things that should be noted when grading NETs:
Apart from the counting of cell divisions, the Ki-67 index, and whether there’s dead tissue (which are super important for all NETs), there are some extra tests that might help in specific situations.
Grade 1 NETs are the least aggressive and tend to grow slowly. They have a low mitotic rate (few cell divisions) and a low Ki-67 proliferative index (cells are not dividing rapidly). NETs at Grade 1 generally has a favourable prognosis. Patients diagnosed at this early stage typically have a higher chance of successful treatment and long-term survival.
Treatment for Stage 1 neuroendocrine cancer often involves a surgical intervention to remove the tumour and surrounding tissues. Various surgical approaches may be considered, including local excision, endoscopic resection, or even organ removal in some cases. If complete tumour removal is achieved, patients may require careful monitoring and surveillance to detect any recurrence.
Other treatment options such as radiofrequency ablation, cryotherapy, or medical therapies such as Somatostatin Analogues may be explored to control tumour growth and manage symptoms.
Grade 2 NETs have a moderate level of aggressiveness. They exhibit a somewhat higher mitotic rate and Ki-67 index compared to Grade 1 NETs, indicating faster growth.
Treatment for Grade 2 NETs depends on factors like the tumour’s location, size, and whether it has spread. Surgical removal is often considered, especially for localised tumours. For tumours that cannot be removed completely, or if they have spread to nearby tissues or lymph nodes, a combination of surgery, medical treatments (such as targeted therapies), and occasionally other treatments like embolisation might be used.
Grade 3 NETs are the most aggressive. They have a high mitotic rate and Ki-67 index, indicating rapid cell division and growth. These tumours may be more likely to spread to other parts of the body.
Treatment for Grade 3 NETs can be more intensive. It often involves a combination of surgery, chemotherapy, targeted therapies, and sometimes radiation therapy. The goal is to slow down tumour growth, manage symptoms, and try to control the spread of the disease. Clinical trials and newer treatment approaches might also be considered for Grade 3 NETs.
It’s important to note that treatment decisions are made on an individual basis, considering factors like the tumour’s grade, stage, location, overall health of the patient, and patient preferences.
Your multidisciplinary care team will collaborate to develop a comprehensive treatment plan that balances the goal of eradicating the cancer while preserving your quality of life.
If you or someone you know is dealing with a NET, consulting with medical professionals who specialise in this area will provide the most accurate and personalised guidance.
