Grade 2 - what does it really mean?

Hiya :slight_smile:

There is a little discussion on another thread re whether to have chemo or not as some of us seem to get the option. I noticed on this trhead that a lot of people had no chemo that they were grade 2. I’m a grade 2 but I assume because of its original size (7.5cm x 5cm) and lymph node involvment I was told to have chemo. I’m glad about that, i think given the option I would have wanted chemo anyway!

I read and heard before that chemo works best with more aggressive cancer and grade 2 is not as aggressive as grade 3. At the clinic (pre chemo) this morning they said that the grade has more to do with long term prognosis. I find this all a bit confusing. I also read various things re grading

* acc to a German breast clinic hopsital website grade 2 means there is a mixture of grade 1 and grade 3 cells present

* on MacMillan website it says grade 2 is a distinct grade from grade 1 and 3

* someone on the forum mentioned that her onc said as soon as there are a few grade 3 cells present it will be classed as grade 3, althoug there are still grade 2 cells there

So what does it acutally mean to have a grade 2? Does it give a better prognosis long term? Or a less better one as not as treatable?

Rather confusing all this, can anyone shed more light?

Thanks and love from Christine xxx

Hi Christine,
The system used in this country has three grades, and as you’ve already discovered from the MacMillan website, the categories refer to how abnormal the cells are.

Working out prognoses is something that is far from trivial, and there are a lot of different tools around from NHS predict (which anyone can use online) via Adjuvant Online (for which you have to register) to the Nottingham Prognostic Index (a simple ‘rule of thumb’ tool, although various versions exist).

All three factors - size, grade and node involvement - are taken into account in all of the tools; the online ones also consider the kind of treatment offered/had.

As a very broad ‘rule of thumb’, it seems that grade is more significant than size in affecting prognosis.

In terms of chemo, I think anyone who has node involvement is offered chemo as a matter fo course just in case there are any micro-mets (or ‘stray cells’ as my surgeon put it) swimming around your body.

I do appreciate that you want to understand as much as you can about your treatment, but for the most part I simply trusted my doctors and tried not to focus on the ‘what if’ thoughts.

Hope this is some vague use. Take care.

Yes RevCat, thanks very much. I had a look now on the cancer research website. Mkaes intersting reading. Since I’m HER2 +++ I also read about Lapatinib on there, not funded by the NHS Scotland (cheaper to buy a coffin).

Christine xx

Christine… The grade of a tumour is made up of three elements, mitosis, nuclei and tubules… Each of these elements get graded from 1 to 3 and the figures are added together… If the overall score is 3,4 or 5 this grade 1, 6 or 7 is grade 2 and 8 or 9 is grade three.

Some parts of a tumour may have lower figure than another area of the tumour… But the tumour will be given the highest grade identified even if that is still a small area they want to treat the highest grade rather than the most commonly occurring one.

If yu have a tumour over 5cm then you are more likely to get chemo, if you have positive nodes again you are more likely to get chemo and if you have a Her2 positive tumour you are more likely to get chemo… What they do is put all the factors together to decide what is the best treatment option for each person?

I think lapatanib isn’t freely available in England either… Think it’s use is only for metastatic disease and not for primary BC… It may change in time but treatment is normally herceptin for primary her2 tumours given with or after chemotherapy… Although there is a research trial looking at giving it to women who haven’t had chemo but it’s a new trial and only just started last year so will be a wee while before the results are out for that.

Lulu x

Lulu34, when they talk about grade and stage are they talking about the same thing? When I was diagnosed way back in 2006 I was only ever told it was Stage 3 and there was no mention of the word grade - it was one of those things I never thought to ask about at the time. My breat care nurse used to talk about the team having “staging meetings” for the new patients prior to the clinic appointments starting.

I was also told that if you were Her2 positive you had to some chemo as it worked in tandem with Herceptin. (Although I think there may be changes on the Herceptin front as I’ve read they are reconsidering the way it’s given?)

Lulu thanks very much for this explanation. Makes it a lot clearer to me. In some ways it’s a scary thought that this cancer is in my breast for years slowly growing silently, hadn’t a clue it was there.

Cherub - stage and grade are two different things. I had to ask all these things otherwsie there weren’t telling me. Grade has to do with the cells and staging with the size and spread. The MacMillan site explains it well, if you like to have a look

Hope this helps and thanks again Lulu xxx



When I was diagnosed I was told whether you have chemo or not depends on several factors. One is the type of cancer, I have invasive lobular and as that has a tendency of spreading by blood they use chemo and an earlier stage.

Grade 2 means moderately aggressive, it depends on how much the cells look like normal breast cells ( Grade 1 quite like them , Grade 2 less like them,Grade 3 not like them at all). They go for the highest grading in the tumour.

My Onc used the american adjuvant to work out what treatment I needed.

Yup it is scary, we probably had it, especially the in-situ version for several years before.

Fiona x

Yes I look at some old photos and think I had cancer at that time already just didn’t know it. Pity I discovered it late. I hope it hasn’t manifested itself in my vertebra yet, that’s my only worry just now. I like the thought of being on a road to a potential recovery even if I don’t recover. Although sometimes I think if I have to have secondaries than maybe I don’t want them later as the hope grows the longer you’re NED and the landing would be very hard.

Christine xx

Cherub grade basically is how aggressive or not the cancer is and stage is how far is spread… There are 3 grades… 1, 2 and 3 and as the ther have said grade 1 is most like normal cells and grade three is least like normal cells… Grade 1 is slower growing and garde 3 is faster growing.

There are 4 stages of breast cancer stage 1-3 is primary cancer and stage 4 is advanced or metastatic cancer… Stage 1 is a small tumour in the breast, stage 2 is a bigger tumour or if you have positive nodes, stage 3 is a bigger tumour and/or clumpy nodes, or in the chest nodes or inflammatory breast cancer… IBC is always classed as stage 3 even if it’s small and not in the nodes.

The page Christine posted goes into more detail about stages.

Christine sill hoping that your bones are normal.

Lulu x