The burden of cancer continues to grow globally. It is a large group of diseases that can start in almost any organ or tissue of the body when abnormal cells grow uncontrollably.
According to the World Health Organization (WHO), Lung, prostate, colorectal, stomach and liver cancer are the most common types of cancer in men, while breast, colorectal, lung, cervical and thyroid cancer are the most common among women.
Cancer is the second leading cause of death globally, accounting for an estimated 9.6 million deaths, or 1 in 6 deaths, in 2018, the global health agency maintains.
Dr Aruj Dhyani, Consultant- Medical Oncology, Fortis Hospital, Noida told Financial Express.com that cancer is an abnormal proliferation of cells, which continue dividing on their own, despite the cessation of stimuli that promote growth.
“Over time these cells produce local symptoms due to the mass effect of which they spread to other areas of the body and grow there to cause the effect, physiological and biological. They can be differentiated into high grade and low-grade cancers, which represent a distinct level of aggressiveness in tumor behavior, influencing their presentation, work, and management,” Dr. Dhyani said.
Dr Vinay Samuel Gaikwad, Director, Surgical Oncology (The Oncology Centre), CK Birla Hospital, Gurugram explained that one of the things we hear about in cancer is the grade. So grade is not to be confused with the stage. The grade is regarding the growth of cancer cell that is how fast or how aggressively it is multiplying, he said.
What are high-grade cancers?
High-grade cancers often present with rapid growth, faster cell division and a propensity to spread early. According to Dr. Dhyani, they are the ones that will lead to incurable stages and ultimately death, if not catered to in a timely fashion. Hence, they need to be diagnosed early.
In high grade we need to check if the disease has spread to any other organ of the body.
What are low-grade cancers?
Dr. Dhyani explains low-grade tumors are slowly growing, taking up massive local sizes, and have a propensity for local invasion and cause local mass symptoms.
“These tumors will present with a long-standing history and patients often present when this low-grade transforms into a high-grade tumor, causing a sudden increase in size, pain, bleeding or similar symptoms,” Dr. Dhyani said.
The workup includes imaging, biopsy, and molecular testing. However, the intent changes, in low-grade tumors we tend to understand the origin and local extent of the disease.
How to treat?
Management differs significantly, high-grade tumors often need aggressive and multimodality treatment like surgery, radiation, chemotherapy, targeted therapy, immunotherapy, checkpoint inhibitors, and transplant, in different combinations.
Dr. Dhyani explains that low-grade tumors are usually catered with local modalities like surgery, radiation, targeted therapy, and sometimes just by surveillance.
“Ultimately tailoring the approach as per cancer grade is essential for optimizing outcomes and improving patients’ survival. By no means the importance of a healthy lifestyle and regular screening can be underscored in the fight against the deadly disease,” he said.
So, regarding symptoms, it’s not very different, but the rate of growth or spread of the disease will be higher for high grade, Dr. Gaikwad said.
“And the treatment also differs because we are more wary or more afraid of high grade tumors and we treat them more aggressively especially with systemic therapies such as chemotherapy, targeted therapies and immunotherapy. But in low grade tumors, the treatment is usually local, such as surgery, that takes the main priority surgery and intraperitoneal chemotherapy is for intra abdominal low grade tumors,” he said.
So its very important to understand the grade and tumor biology is the king that means the biology of the tumor is what determines the final outcome or the prognosis, he added.