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Stages and grade

The stage of a cancer tells you how big it is and whether it has spread. The grade gives an idea of how fast growing it is. This helps your doctor decide which treatment you need.

The tests and scans you had to diagnose carcinoid give your doctor some information about the stage. Sometimes it's not possible to be completely sure of the stage until after you have surgery.

Number and TNM stages

To stage carcinoid, your doctor usually uses the

  • number staging system
  • TNM staging system

You are most likely to be told the number stage of your cancer. This system divides carcinoid into 4 main groups, depending on the tumour size and how far it has spread. Stage 1 is the earliest stage and stage 4 is the most advanced.

The number stages for carcinoid are based on the TNM stages. TNM stands for tumour, node and metastasis:

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

The staging systems are slightly different depending on where the tumour started, for example in the appendix, small bowel or lung. Your doctor or specialist nurse will give you more information about the stage and what it means for you.

Stages for carcinoid of the lung

For carcinoid of the lung, doctors use the same number and TNM staging systems as for other types of lung cancer (carcinomas).

Simple stages for carcinoid of the digestive system

For carcinoid of the digestive (gastro intestinal) system, your doctor might use a simple staging system of 3 groups:

  • localised carcinoid – the tumour has not spread through the wall of the organ it started in (such as the bowel, stomach or appendix) to anywhere else
  • regional carcinoid – the tumour has gone through the wall of the organ it started in and is now in the surrounding tissue, such as fat, muscle or lymph nodes
  • metastatic carcinoid – the tumour has spread to another part of the body, such as the liver or lungs


The grade of a cancer gives doctors an idea of how quickly a tumour might grow and whether it might spread.

The grade shows how normal or abnormal the tumour cells look under the microscope, and how quickly they are dividing into new tumour cells. The rate of cell division (mitosis) is shown in tests by the mitotic count or Ki-67 index.

The grade is split into 3 groups:

Grade 1

The cells look very like normal cells. They are also called low grade or well differentiated. They have a low mitotic count or Ki-67 index. They tend to be slow growing and are less likely to spread.

Grade 2

The cells look more abnormal. They behave somewhere between low grade and high grade tumours. This grade is also called moderately differentiated or moderate grade.

Grade 3

The cells look very abnormal and not like normal cells. They have a high mitotic count or Ki-67 index. They tend to grow quickly and are more likely to spread. They are also called poorly differentiated or high grade.

Treatment decisions

The stage and grade of your cancer helps your doctor to decide which treatment you need. Your treatment also depends on:

  • which part of the body the tumour started in
  • the symptoms you have
  • your general health

Some people may not have treatment straight away if the tumour is not growing or causing symptoms. Doctors keep an eye on the tumour with regular scans.

The main treatments include:

  • surgery
  • drugs called somatostatin analogues
  • radiotherapy
  • chemotherapy
Last reviewed: 
05 Jul 2016
  • AJCC Cancer Staging Manual, 7th edition
    American Joint Committee on Cancer
    Springer, 2010

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