Additional tests you will see on the Pathology report:

Grade: describes the activity of the nucleus. A normal cell has normal activity of the nucleus. A cancer cell nucleus looks different. A grade 1 nucleus is less in disarray than a Grade 3 nucleus. The higher the grade, the worse the cell behaves.

Differentiation: is a measurement of how closely the cancer cell resembles the parent cell or the cell of origin.

If the cancer cell closely resembles the cell of origin, it is called well differentiated.

If it resembles it less, it is called moderately differentiated.

If it barely resembles it, it is called poorly differentiated.

And if there is no identifying feature, it is called undifferentiated.

I explain it to patients in this manner: if you have a room with bedroom furniture, you will call it a bedroom; a room with a dining table is a dining room, etc. If you gradually lose some of the furniture that gives the room its identifying features, it becomes a no-name room with four walls.

Both the grade and differentiation are helpers; the primary predictor of outcome is Stage. But within a Stage, people have different outcomes. Grade and Differentiation help to tease out the differences, and guide us as to how aggressive a treatment needs to be.

Additional tests are done on the cancer cell to try to improve prediction of response to treatment:

-Hormone receptors in breast cancer,

- Growth factor receptors mutations or hyperactivity,

- Gene signatures in the DNA of the cancer cell, and other newer techniques.

These will help target the newer (and more expensive) drugs against cancer cells which will be more susceptible to them.