Staging and grading

If your tests show you have primary bone cancer, your doctor may do some further tests to see whether the cancer has spread outside the bone. This will tell them the stage and the grade of the cancer. This helps doctors decide on the most appropriate treatment for you.

The grade of a cancer gives an idea of how quickly the cancer may develop. Primary bone cancer can be low-grade or high-grade. Low-grade cancer is slow-growing and unlikely to spread. High-grade cancer grows rapidly and can spread to other parts of the body.

The stage of a cancer describes its size and whether it has spread. There are two different staging systems used for primary bone cancer. The Enneking staging system is commonly used and has three stages.

  • Stage 1 is for low-grade cancer that has not spread.
  • Stage 2 is for high-grade cancer that has not spread.
  • Stage 3 is for a cancer that has spread.

Grading

Grading describes what the cancer cells look like under a microscope. The grade gives an idea of how quickly the cancer may develop. The most common grading system for primary bone cancer uses two grades: low-grade and high-grade.

Low-grade means the cancer cells look very similar to normal bone cells. They are usually slow-growing and are less likely to spread.

In high-grade tumours, the cells look very abnormal. They are likely to grow more quickly and are more likely to spread. All Ewing’s sarcomas and most osteosarcomas and spindle cell tumours are high-grade.


Staging

The stage of a cancer describes its size and whether it has spread. The stages of primary bone cancer are also based on the grade of the cancer.

There are two different staging systems used for primary bone cancer. This is the Enneking staging system, which is commonly used to stage primary bone cancers:

Stage 1

The cancer is low-grade and hasn’t spread beyond the bone. Stage 1 is divided into:

  • Stage 1A The cancer is low-grade and is still completely inside the bone it started in. The cancer may be pressing on the bone wall and causing a swelling, but it has not grown through it.
  • Stage 1B The cancer is low-grade and has grown through the bone wall.

Stage 2

The cancer is high-grade and has not spread beyond the bone. Stage 2 is divided into:

  • Stage 2A The cancer is high-grade and is still completely inside the bone it started in.
  • Stage 2B The cancer is high-grade and has grown through the bone wall.

Stage 3

The bone cancer may be any grade and has spread to other parts of the body, such as the lungs.


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