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All sarcomas should also be given a grade based on factors seen under the microscope. They can be designated as low grade or high grade.
There is also a three-tiered system based on a number of factors (differentiation, mitotic activity and necrosis). Each of these factors is given a score of 1 to 3 and tallied for a final grade:
1 Gurney JG, Young JL, Roffers SD, Smith MA, Bunin GR. SEER pediatric monograph – soft tissue sarcomas. National Cancer Institute. Page 111. http://seer.cancer.gov/publications/childhood/softtissue.pdf.
2 Fletcher CDM, Rydholm A, Singer S, Sundaram M, Coindre JM. Soft Tissue Tumours. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology & genetics WHO Classification. Lyon: IARCPress; 2005.
3 Zhang MQ, El-Mofty SK, Dávila RM. Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary. Cancer. 2008;114(2):118-23.
4 Cunningham MJ, Myers EN, Bluestone CD. Malignant tumors of the head and neck in children – a 20 year review. International Journal of Pediatric Otorhinolaryngology. 1987;(13)3:279-292.
5 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Page 611.
6 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed June 20, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
7 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma V.1.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed July 17, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
8 Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.
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