Grade and Stage of Neuroendocrine Tumors

A female doctor sits at her desk and chats to a male patient while looking at his test results on her digital tablet . She is a blue shirt with the sleeves rolled up and a stethoscope around her neck.

What is tumor grade?

Tumor grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Tumor grade is determined using laboratory tests of tumor cells. Generally, a lower grade indicates a better prognosis.17 A higher-grade cancer may grow and spread more quickly and may require immediate or more aggressive treatment.

  • Well-differentiated: The cells of the tumor and the organization of the tumor’s tissue are close to those of normal cells and tissue. These tumors tend to grow and spread at a slow rate.15
  • Poorly differentiated: These tumors have abnormal-looking cells and may lack normal tissue structures. They tend to grow fast.15

Patients should talk with their doctor for more information about tumor grade and how it relates to their treatment and prognosis.

What is cancer stage?

Stage refers to the extent of your cancer, such as how large the tumor is, and how far it has spread.15 Knowing the stage of your cancer helps your doctor:

  • Understand how serious your cancer is
  • Plan the best treatment for you
  • Identify clinical trials that may be treatment options for you

The stages of cancer

Cancer stage is often determined with imaging tests. To learn the stage of your disease, your doctor may order lab tests, imaging tests or diagnostic procedures. Doctors may use numbers to describe your cancer stage.18

  • Stage 0 — Abnormal cells are present but have not spread to nearby tissue. These abnormal cells may not yet be cancer but may become cancer.
  • Stage I, Stage II, and Stage III — Cancer is present. The higher the number, the larger the tumor and the more it has spread into nearby tissues or organs.
  • Stage IV — Cancer has spread to distant parts of the body.

Doctors may also use words to describe the stages of cancer. 15

  • Transparent tumor tomography of tumor hypoxia. Credit NIH, NCI
    As tumors grow they change in order to take oxygen from surrounding blood vessels. (Credit: NCI/NIH)
    In situ — Abnormal cells are present but have not become invasive.
  • Localized — Cancer is limited to the place where it started, with no sign that it has spread.
  • Regional — Cancer has spread to nearby tissues, like lymph nodes.
  • Distant — Cancer has spread to distant parts of the body.
  • Unknown — There is not enough information to figure out the stage.

The phrases early stage and late stage may also be used, the latter generally referring to metastases or distant disease. The stage of your cancer affects your treatment options. Doctors may “restage” cancer if it comes back or spreads to other parts of the body. When treatment has been successful, you may hear the phrase “no evidence of disease” or “NED,” which means that current testing methods cannot detect any signs of cancer in the body.19

Spark Awareness of NETs
of NET patients felt there is room for improvement in the diagnosis of NETs.13
0 %

More than
1 in 3

NET patients did not know their tumor grade.2

More than

of NET patients reported their grade as 1 or 2.13

Search for NET specialists

Find NET doctors, treatment programs, and support groups near you

Get connected.
Follow us on social media.

2Singh S, Granberg D, Wolin E, et al. Patient-reported burden of a neuroendocrine tumor (NET) diagnosis: results from the first global survey of patients with NETs. J Glob Oncol. 2016;2(1):43-53.

13National Cancer Institute. Pheochromocytoma and paraganglioma treatment (PDQ®)-patient version. 2017. Accessed October 23, 2018. 

15National Comprehensive Cancer Network® (NCCN). NCCN Guidelines Neuroendocrine and Adrenal Tumors. (Version 3.2018) Accessed October 24, 2018

17National Cancer Institute. Tumor Grade. Accessed August 1, 2018.

18National Cancer Institute. Cancer Staging. Accessed August 1, 2018.

19Memorial Sloan Kettering Cancer Center. What is “cure?” Accessed December 21, 2012.