Cookies on the Bupa website

We use cookies to help us understand ease of use and relevance of content. This ensures that we can give you the best experience on our website. If you continue, we'll assume that you are happy to receive cookies for this purpose. Find out more about cookies



Cancer staging and grading

Cancer is an abnormal and uncontrolled growth of cells which multiply to form a tumour. They can either be benign or malignant. Benign tumours are not cancerous, but malignant tumours are.

Cancer staging and grading describes the size of your tumour, whether it has spread and how it might behave. It’s an important part of helping your doctor understand more about your cancer and how to treat it.

If you’re diagnosed with cancer, your doctor will try to find out:

  • the size of your tumour
  • how far your tumour has spread
  • the speed at which your tumour may grow

This is called staging and grading. Staging is important because it helps your doctor decide what might be the best treatment for you. It also helps your doctor determine the likely course of your cancer. Grading your cancer cells will involve your doctor looking at how much they look like normal cells under a microscope.

Read more Close
How cancer develops
Cells begin to grow in an uncontrolled way


  • Cancer staging Cancer staging

    Staging may be used by your doctor to describe the size of your tumour and how far it has spread within your body.

    A commonly used method to describe cancers is the TNM staging system. However, not all cancers are staged using this method. Depending on the type of cancer you have your doctor may use other staging systems to describe your cancer. Ask your doctor to explain these to you.

    TNM staging system

    The TNM system describes:

    • the size of your original (primary) tumour and if it has grown into any of your nearby tissues
    • whether any cancer cells have spread from your primary tumour to nearby lymph nodes
    • if there are any metastases (when cancer spreads to other parts of your body)

    Each stage has numbers and letters that are used to categorise your cancer more specifically.

    T in TNM staging

    The T in the TNM system stands for tumour. This part of the staging system generally describes the size or growth of your original tumour.
    • TX may be used if your tumour can’t be evaluated.
    • T0 means there is no evidence of a tumour.
    • Tis or Cis (tumour or cancer in situ) means your tumour is in one small area, usually in the uppermost layer of tissue and hasn’t spread yet.
    • T1 to T4 refer to the size of your tumour and how much it has spread into your nearby tissues. The higher the number, the larger your tumour and the more likely it has grown into your nearby tissues.

    N in TNM staging

    The N in the TNM system stands for lymph nodes. Your lymph nodes are glands throughout your body that are part of your immune system. This part of staging describes whether or not your cancer has spread to any nearby lymph nodes.
    • NX may be used if your lymph nodes can’t be evaluated.
    • N0 means there are no cancer cells in your lymph nodes.
    • N1 to N3 refer to either how many lymph nodes your cancer has spread to or the position of the nodes in relation to your primary tumour. The higher the number, the more lymph nodes may be affected.

    M in TNM staging

    The M in the TNM staging system stands for metastasis. It describes whether or not your cancer has spread to other parts of your body.
    • MX may be used if metastasis can’t be evaluated.
    • M0 means your cancer has not spread to any other parts of your body.
    • M1 means your cancer has spread away from your primary tumour and into one or more other areas of your body.

    It’s important to remember that the numbers and letters for each type of cancer don’t mean the same thing. The TNM combinations correspond to four stages. When your doctor has worked out T, N and M of your cancer they will combine them to get an overall stage of your cancer.

    It can be a bit confusing because across different forms of cancer, the same TNM code can indicate a different stage of cancer. So, as an example, if you have colon cancer and your  TNM is T3 N0 M0, your cancer will be at stage two. However, this combination corresponds to stage three in bladder cancer. Ask your doctor to explain anything you’re unsure about.

    Dukes staging system

    The Dukes staging system is a lettered (A-D) system and may be used to describe bowel cancer.

    • Dukes A means your tumour is contained within the wall of your bowel.
    • Dukes B means your tumour has grown into the muscle of your bowel wall.
    • Dukes C means one or more of your lymph nodes near your bowel are affected.
    • Dukes D means your original tumour has spread to other parts of your body.

    Doctors may talk about the Dukes staging system, but it’s worth knowing that it’s an older system. If your doctor uses the Dukes staging system, you may want to ask if it can be translated into the TNM staging system. This is because it’s gradually being replaced by the TNM staging system as it provides more information about your cancer.

    TNM and Dukes are the main staging systems, but other cancers, such as those that affect your blood or brain are staged differently.

    Bupa On Demand

    Want to talk to a Bupa consultant? We’ll aim to get you seen the next day.

  • Cancer grading Cancer grading

    Grading is used to describe what your tumour looks like under a microscope so your doctor can get an idea of how it may progress. A low grade cancer cell looks like a normal cell and is likely to grow more slowly. A high grade cancer cell looks abnormal and is more likely to grow and spread faster.

    If you have cancer, your doctor will take a sample of cells from your tumour (a biopsy) to send to a laboratory for testing. The cancerous cells will be looked at under a microscope to see how your tumour may grow.

    There are four grades used to rate cancer. These are described below.

    • Grade 1 or low grade cancer is slow growing. The cancer cells look very much like healthy cells in your body.
    • Grade 2 or intermediate grade cancer grows slightly faster. The cancer cells look different from healthy cells in your body.
    • Grade 3/4 or high grade cancer is fast growing. The cancer cells look very different from healthy cells in your body.

    If you have a high grade cancer, you may need different treatment than if you have a low grade cancer. Even though the grade doesn’t change a cancer’s stage, it may still affect your treatment.

    The most common types of cancer that have their own grading systems include prostate cancer and breast cancer. These grading systems are described below.

    If you’re unsure about how your cancer may be graded or need more information, ask your doctor.

  • Gleason scoring system Gleason scoring system

    The Gleason scoring system is used to grade prostate cancer.

    Your cancer cells are graded one to five, according to the pattern of cells under the microscope. Grade one cells look like normal prostate cells, whereas grade five cells look very different to normal prostate cells. A Gleason score is worked out by adding together the most common grade and the highest grade of what is left in your sample.

    Your combined Gleason score will normally be six or higher. It’s rare to get a score lower than six as grade one and two are not cancer.

  • Bupa cancer promise

    We understand the impact that cancer can have on you and your family. That’s why our health insurance comes with Bupa cancer cover as standard. Find out more today.

  • Nottingham grading system Nottingham grading system

    The Nottingham grading system is used to grade breast cancer based on:

    • if your tumour has any normal structures within it
    • the size and shape of your tumour
    • how fast your tumour is growing

    These three factors each get a score between one and three. The scores are then added together to give you a total score between three and nine. From this, three grades are possible.

    • Low grade – a score between three and five.
    • Intermediate grade – a score between six and seven.
    • High grade – a score between eight and nine.
  • FAQs FAQs

    How long do biopsy results take?


    You may have to wait several days before you get your biopsy results. The time it takes for your results to come back can depend on many factors. It’s best to check with your specialist nurse or doctor.


    A biopsy involves taking a small sample of tissue from your tumour. This is sent to a laboratory where a specialist doctor looks closely at the cells in your sample using a microscope. He or she will examine the type of cells and find out if these are cancerous are not.

    It can take several days for your results come back. This is because different types of test might need to be carried out on your sample and some tests can take longer than others. Each clinic can have different waiting times too, so it’s best to talk to your specialist nurse or doctor about what to expect.

    Can I have a high stage with a low grade or vice versa?


    Yes, this can happen as the stage and grade of your cancer are two different things.


    The stage of your cancer is a description of the size of your tumour and how far it may have spread in your body. For example, if your cancer is at an advanced (high) stage, it may mean you have it in more than one place in your body. Whereas, the grade of your cancer is a description of what your tumour looks like under a microscope and how it’s likely to develop. If your cancer is slow growing, it may be described as low grade.

    If you have a slow-growing cancer, it can be found at either an early (low) stage before it has spread or at an advanced stage. For example, non-Hodgkin's lymphoma can be low grade but found at an advanced stage. This means the cancer is in more than one place in your body, but the cells look very similar to your healthy cells – so it’s slow-growing.

    It’s possible to have cancer that is fast-growing (high grade) but at an early stage. For example, a tumour in your brain can be fast-growing, but may be at an early stage. This means the cancer hasn’t spread, but the cells look very different to your healthy cells. Therefore, the tumour is fast-growing.

    In general, higher grade tumours tend to grow quicker and are more likely to spread, resulting in a higher stage. For more information about the stage and grade of your cancer or what it means, ask your doctor.

    How will the stage and grade of cancer affect my chance of recovery?


    If you have cancer, your treatment will depend on the type of cancer you have, its stage and its grade. Cancer staging and grading is important because it can help to determine the best way to treat your type of cancer.


    If you have a higher grade tumour it’s more likely to spread. A higher stage generally means your cancer is more advanced and has spread. However, this doesn't necessarily mean that your cancer can't be treated or that it will take longer for you to recover. Determining the stage and grade of your cancer will allow your doctor to decide on the most effective treatment for you.

    Different treatments are used for different types of cancer. Your doctor will be able to tell you what stage and grade your cancer is and how it may be treated.

    I have been told my cancer is recurrent. What does this mean?


    Recurrent cancer is when your cancer comes back after treatment.


    It’s possible for cancer to come back after treatment – sometimes many years later. This often happens when a small number of cancer cells survive. These cells grow and develop into a new tumour. Recurrent cancer may occur in the same area or in a different part of your body (called secondary cancer). If you have recurrent cancer, you may be given the same treatment as before or a more intensive treatment.

    Ask your doctor to explain the chance of your cancer recurring and what you should do if this happens.

    It’s not very common, but restaging may be used to measure how your cancer has responded to treatment or to assess if it has come back. Restaging may involve you having some of the tests you had when your cancer was first diagnosed and a new stage may be determined.

  • Resources Resources

    Further information


    • Different types of non Hodgkin lymphoma. Cancer Research UK., published 8 April 2014
    • Types of primary brain tumours. Cancer Research UK., published 26 November 2013
    • Dukes' stages of bowel cancer. Cancer Research UK., published 13 August 2013
    • The stages of a cancer, The cancer cell. Cancer Research UK., published 24 July 2013
    • Treatment for low grade non Hodgkin lymphoma. Cancer Research UK., published 31 October 2012
    • What is cancer? National Cancer Institute., published 2 August 2013
    • Cancer staging, Tumor grade. National Cancer Institute., published 3 May 2013
    • Sentinel lymph node biopsy. National Cancer Institute., published 11 August 2011
    • When cancer returns. National Cancer Institute., published 15 July 2011
    • Staging and grading of colon and rectal cancer. Macmillan Cancer Support., published 1 July 2012
    • Grading and staging of prostate cancer. Macmillan Cancer Support., published 1 May 2012
    • Why do some cancers come back? Macmillan Cancer Support., published 1 October 2011
    • Staging. American Cancer Society., published 7 June 2013
    • What is cancer staging? American Joint Committee on Cancer., accessed 8 May 2014
    • Getting the results. Prostate Cancer UK., published February 2014
    • Staging colorectal cancer. National Institute for Health and Care Excellence (NICE), 24 March 2014,
    • Breast cancer tests. Cancer Research UK., reviewed 30 July 2014
    • Breast and endocrine surgery. OSH operative surgery (online). Oxford Medicine Online., published 2011
    • Biopsies – what are they and how do they work? Cancer Research UK., reviewed 15 December 2014
    • Introduction to cancer. The Merck Manuals., reviewed July 2013
  • Has our information helped you? Tell us what you think about this page

    We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.

    Let us know what you think using our short feedback form
    Ask us a question
  • Related information Related information

  • Author information Author information

    Reviewed by Kuljeet Battoo, Bupa Health Information Team, June 2014.

    Let us know what you think using our short feedback form
    Ask us a question

About our health information

At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.

  • Information Standard

    We are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
    Information standard logo
  • HONcode

    This site complies with the HONcode standard for trustworthy health information: verify here.

    This website is certified by Health On the Net Foundation. Click to verify.

What our readers say about us

But don't just take our word for it; here's some feedback from our readers.

Simple and easy to use website - not alarming, just helpful.

It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.

Good information, easy to find, trustworthy.

Meet the team

Image of Andrew Byron

Andrew Byron
Head of health content and clinical engagement

  • Dylan Merkett – Lead Editor – UK Customer
  • Nicholas Ridgman – Lead Editor – UK Health and Care Services
  • Natalie Heaton – Specialist Editor – User Experience
  • Pippa Coulter – Specialist Editor – Content Library
  • Alice Rossiter – Specialist Editor – Insights
  • Laura Blanks – Specialist Editor – Quality
  • Michelle Harrison – Editorial Assistant

Our core principles

All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.

An image showing or editorial principals

                  Click to open full-size image

The ‘3Rs’ encompass everything we believe good health information should be. From tweets to in-depth reports, videos to quizzes, every piece of content we produce has these as its foundation.


In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.


We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.


We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.

Our accreditation

Here are just a few of the ways in which the quality of our information has been recognised.

  • The Information Standard certification scheme

    You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.

    It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.

    Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.

  • British Medical Association (BMA) patient information awards

    We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.

Contact us

If you have any feedback on our health information, we would love to hear from you. Please contact us via email: Or you can write to us:

Health Content Team
Bupa House
15-19 Bloomsbury Way

Find out more Close

Legal disclaimer

This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition.

The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.

For more details on how we produce our content and its sources, visit the 'About our health information' section.

ˆ We may record or monitor our calls.