Cancer staging and grading

Information about the stage and grade of the cancer helps your cancer team plan your treatment.

What is cancer staging and grading?

After you have been diagnosed, your cancer doctor may do further tests to learn more about the cancer. This usually includes tests to find out the stage and the grade of the cancer:

  • The stage of a cancer describes its size and whether it has spread from where it started.
  • The grade of a cancer describes how abnormal the cancer cells are, compared to healthy cells. This can help your cancer doctor understand how quickly the cancer may grow, or how likely it is to spread.

Information about the stage and grade helps doctors plan the treatment you might need.

Cancer staging tests

Your cancer doctor will explain what tests you need to find out the cancer’s stage. Your cancer doctor or specialist nurse can tell you when you will have tests, and when your results will be ready.

Cancer staging tests may include:

  • Scans

    You may have a scan of an area of the body, or the whole body. For example, a CT, MRI or PET scan. This can show if a cancer has spread from where it started.

  • Surgery to remove the tumour

    Surgery is often part of treatment for many cancer types. When the tumour is removed, the surgeon sends it for tests and to be examined under a microscope. This can give detailed information about how far the cancer has started to grow into nearby areas.

  • Blood tests and bone marrow biopsies

    Sometimes a blood sample can help your doctor understand if cancer is likely to have spread.

    Doctors may also use blood tests or a bone marrow biopsy to measure the stage of some types of cancer, such as lymphoma, myeloma or leukaemia. These tests show the amount of cancer cells in the body.

The tests you need depend on the type of cancer. You can find more about this in our information about diagnosing each type of cancer.

How many stages of cancer are there?

Each cancer type has its own staging system. This usually uses numbers from 1 to 4 and sometimes letters to describe the cancer’s size and spread. But staging can be complicated. Some cancer types have a specific system that is only used for that type of cancer.

Your cancer doctor or specialist nurse can explain more about the staging system they use. You can also find more about staging in our information about each type of cancer.

Number staging system

For some cancer types, stage is described using the number system.

There are usually 3 or 4 number stages for each cancer type. Stage 1 describes an early cancer that has not spread anywhere else in the body. Stage 4 cancer describes a cancer that has spread to other parts of the body. This is also called advanced or metastatic cancer.

TNM system

The TNM staging system is used to describe many cancer types. TNM stands for tumour, node and metastases.

  • T describes the size of the tumour. Sometimes it also describes the exact area of the body affected by the tumour. This is usually a number between 1 and 4. T1 is a small cancer. T4 is a larger or more advanced cancer.
  • N describes whether the cancer has spread to the lymph nodes. The number can be between 0 and 3. N0 means there are no cancer cells in the lymph nodes. N3 means more lymph nodes are affected by cancer.
  • M describes whether the cancer has spread to another part of the body (known as metastatic or secondary cancer). The number is either 0 or 1. M0 means the cancer has not spread to other parts of the body. M1 means it has spread.

Other words to describe cancer stage

Your doctor may use other words to describe some cancer stages:

  • carcinoma in situ
  • localised
  • locally advanced
  • advanced
  • metastatic or secondary cancer.

These words can mean different things depending on the type of cancer. If your cancer doctor uses any of these words, ask them to explain what they mean.

Grading of cancer

Cancer grading describes how the cancer cells look compared with normal cells.

Your cancer doctor collects a sample of the cancer cells during a biopsy or surgery. They send the sample to a laboratory. A doctor called a pathologist checks the sample under a microscope.

For some cancer types, the grade of the cells is not used to help plan your treatment. For others, knowing the cancer grade helps your team decide what treatments are likely to be most effective for you. Your cancer doctor or specialist nurse can tell you more about the grade of cancer you have.

Many cancers are graded using the following system:

  • Grade 1, low grade or well differentiated – the cancer cells are not identical to normal cells, but they look similar. Grade 1 cancers usually grow more slowly.
  • Grade 2, moderate or intermediate grade – the cancer cells look more abnormal and are slightly faster growing.
  • Grade 3, high grade or poorly differentiated – the cancer cells look very different from normal cells and may grow more quickly.

Some cancers have different grading systems. Some of these systems also have a grade 4. Some cancer types have a specific system that is only used for grading that type. For example:

You can also find more about grading in our information about each type of cancer.

About our information

  • This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by members of Macmillan’s Centre of Clinical Expertise.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
  • structure the information clearly
  • make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 July 2023
Next review: 01 July 2026
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.