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Featuring Demian Dressler, DVM and Sue Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide

Dog Cancer Words You Should Know: Grade and Stage

Updated: December 21st, 2018

I think it is important to clear up some words about dog cancer, and cancer in general.  It helps to define what you are talking about with the vet or oncologist so you can get the best info to make your decisions.

As your dog’s primary health advocate, you will be called upon to make some choices.  When that time comes, you need to have the clarity of thought to make wise decisions.

So, let’s clarify some terms!

Medical people throw the terms stage andgrade around like everyone knows what they are talking about.  They are kind of close conceptually, but are not the same.

The stage of a tumor usually refers to how far along it is.  When we say “stage”, we look at the size of the tumor, the number of tumors, and whether the cancer cells have invaded the system to travel to other sites in the body.

So a late stage tumor, or a late stage cancer, usually means it is far along.  Generally speaking, this implies it is more difficult to cure or get long term remissions.

An early stage tumor or cancer means that it is not far along.  Usually these are smaller, fewer, and have not traveled to other sites in the body other than where you find the tumor or cancer cells.

The grade of the cancer describes how aggressive it is.  This means that a low grade cancer is one that is not very aggressive, but a high grade cancer is more aggressive.

Get a copy of the Dog Cancer Survival Guide for more helpful information and tools

Aggressive cancers do things like grow quickly, invade the area right around the tumor, or get into the circulation and spread to other body parts (metastasis).  More aggressiveness means more danger.

Certain cancers have different grades.

Mast cell tumors, white blood cell tumors (lymphosarcoma, leukemia), mammary tumors (breast cancer), melanomas,  and hemangiosarcomas can vary in terms of their aggressiveness.  Some advance very quickly while others are more smoldering.  So you have different grades in single cancer types.

Osteosarcoma (the most common bone cancer in dogs) is usually aggressive. So usually this cancer type is high grade.

Different cases of cancer can have different stages too.

You could have a bladder cancer (usually transitional cell carcinoma) that is a tiny bump in the bladder wall (but has not spread) in one dog, and a large bladder mass that has spread to lymph nodes in another.

This is an example where you have the same cancer type, but different stages in different dogs.

Let’s keep the info stream going so you can best help your dog!


Dr Dressler

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  1. Rod on September 15, 2010 at 6:33 pm

    Dr. Dressler,
    My 9 year old Golde Retriever, Ollie was recently diagnosed with chemodectoma at the base of his heart. We had to rush him into emergency a few Sunday’s ago as he was in pericardial effusion and heart failure. This is when they found the tumor. He had surgery where they removed the pericardial sac but of course could not remove the tumor as it would have killed him. He has recovered well and is already playing and swimming. We took our Oncologist’s recommendation on getting him on a drug compound of Cyclophosomide, Piroxicam and Doxycycline. Our Oncologist wants to start additional Chemo next week which would be 4 rounds of alternating Doxorubicin and Carboplatin each given 21-28 days apart depending on any adverse reactions. I have found (through reading medical articles and speaking to various vets in my city that there is very little data that leads one to believe that Chemotherapy has any significant effect on chemodectoma cancers. While I was at first ready to move forward with injecting chemotherapy, now I am not sure as everything I have seen leads me to believe that there will be little to no benefit while risking possible side effects of therapy.. Most of what I found said that about only 10% have some sort of beneficial reaction to chemodectoma. I wanted to ask for any general thoughts or advisement. We are blessed that cost in no concern, only making the right decision for our beloved Ollie. Thank you so much. Best regards – rod

  2. Kay on January 27, 2010 at 7:36 pm

    Dr. Dressler,
    Could you please define another cancer word for me: remission.

    Here is the situation leading to my confusion: I have a 5 year old collie diagnosed with multicentric lymphoma, stage Vb. I started the UWMadison protocol – she had two treatments with L-asparaginase, cyclophosphamide, and prednisone (she has the mutant MDR gene, so she can’t have normal doses of doxorubicin or vincristine). Six days after the second treatment, she became very ill – high fever, pneumonia, etc. – and had to spend a day and night in an emergency vet getting IV fluids and antibiotics. Unfortunately, because of this, I had already spent about 90% of the estimate I got for the 6-month treatment. So when she recovered, I took her back to the oncologist to see if there were any cheaper, easier options (after her long stays at the vet it became apparent to me that she would not have “quality of life” if she had to keep spending time away from me in hospitals). The vet said we should try CCNU – its an oral medication that she would only need every three weeks, and my local vet could give her the meds (I am 2 hours away from the oncologist), and it was a safer drug for her due to her mutant MDR gene. However, before giving her the drug, they ran the usual blood tests, and it turns out she went from nearly dead to complete remission in about 9 days. So my question is, if remission means there are no signs/symptoms of the cancer, what is the point behind starting a whole new protocol? I thought remission was the goal of chemotherapy?

    • Dr. Dressler on January 31, 2010 at 3:23 pm

      Dear Kay,
      I believe they are worried about remission duration. I bet the thought is that the loss of control of the cancer would be too brief without finishing up the chemo.
      Hope this helps,
      Good luck with everything,
      Dr D

  3. Diane on July 21, 2009 at 4:22 am

    Dr D

    Just came upon your website..hope you have ANY info you could share.

    Jack is our 7 yr old boxer..boxers have been in our family forever and the only breed we’ve ever had. I have been through cancer before with my dogs..this however is a bit unusual..

    Jack woke up last Thursday with a “dewlap”, we thought he got a bug bite or a bee sting..we waited to see how things turned out as he wasn’t in pain and acted his loving self. Well the dewlap retreated on one side and a huge ball remains on the other..this is in a matter of three days! Took him to the vet yesterday, drew blood, aspirated, and are awaiting lab results. My vet says it is can it be SO fast??

    • Dr. Dressler on July 26, 2009 at 8:58 am

      Hi Diane,
      some cancers have effects that appear sudden-onset even thought the cancer itself has bee there for a while. First though, get a second opinion. This can be simply from the pathologist who reads your vet’s aspirate slide he or she sent in. Wait for that path report!
      If indeed it is lympho, the swelling could be from fluid around the cancer cells, which can kick in rather suddenly, although the cancer has been there for a while.
      This is one example of decompensation.
      I will address you question in more detail in the webinar. It will be recorded:

      Dr D

  4. Bill on July 13, 2009 at 10:04 pm

    Hi Dr. Dressler

    We have a 11 year old GSD mix.(Taz) About a month ago, he was diagnosed with Osteosarcoma. It is in his left upper arm/shoulder region. Our local vet and a specialist vet both confirmed the finding, through x-rays. We did a full panel of blood work, and no negative results. They wanted to first amputate his leg, said it was the only way to get the cancer. And also informed me that they may not get all of it. We are not for the amputation, and neither is the local holistic vet, as Taz’s mobility is already stressed by ACL surgery on his right rear leg. As well as stiffness and older age. With the mobility problems in his rear, he will just not move well on three.

    We have changed his diet, to A TASTE OF THE WILD, both the meat and fish versions. He also gets cooked ground beef with the dry foods, cooked greens and carrots as well. He is also on Previcox, and Tramadol. Supplements are We Qi booster for immune, Chinese Bone Stasis for tumor support, Probiotics for digestion, VM-100 Complete liquid vitamin by Buried Treasure, Bone Meal (crushed). We add different treats throughout the day as well.

    Through a local wellness doctor, we have also been treating him with a low laser and energy cell machine. And through this treatment have been able to reduce his pain med’s up until two weekends ago. Now I am back to dosing him with the Tramadol, and Previcox. Which has made us very uncomfortable that we seemed to be making progress, only now to be back at square one. Both during and after the treatments, he does put off some nasty odors, probably detox related.

    His energy levels are decent, I could say. Last night we went to go for a ride in the car, and he charged out the door. He still has the intense drive at times, and will want to run. His appetite is not great in the mornings, but is improved at evening dinner time. Stools are normal, no diarhea or loose as in earlier time before changing his diet.

    Another area of concern now is that our wellness doc is not available on the weekends or fridays. It seems as though he does improve during the week while being treated only to drop over the weekend. And then we treat him pretty intensely on Mondays.

    We are going back for another set of digital x-rays to see if any improvement has occured during this time sometime this week. Hopefully today or tomorrow. The one vet keeps harping on me to “help him out of the situation”, and put him down. I really cannot justify that at this time, he still wants to “patrol” if you will the yard and house, just as he did when he was healthy. He is still very alert/aware. But at times the pain can be very intense as we observe him as he walks, lifting or carrying the diseased leg. Some times he will walk on it, but lately he is putting less and less pressure on the leg.

    Thanks for taking the time to read our story. Any and all suggestions will be greatly appreciated.

    • Dr. Dressler on July 26, 2009 at 9:33 am

      this is a bit complicated. Bottom line:
      you are reaching the end of what you can do with “alternative” care. Sometimes we have to bit the bullet and deal with our resistance to “conventional” care if we want to utilize all of the available treatments (pamidronate, samarium, palliative radiation).
      I will address your question in this month’s webinar as it is a good one:

      Dr D

      • Dr. Dressler on July 26, 2009 at 9:35 am

        Bill, also cut out the bone meal. See recent post on fluoride and osteosarcoma.

  5. Yvonne on June 22, 2009 at 12:21 pm

    Dr Dressler,

    My 7 year old maltese had a tumor removed from her back left leg a week ago. Today I got the results that it is a grade 4 mast cell tumor. I am devastated. I talked with my vet & the first thing she said to do is to have a ultrasound done to see if the cancer has affected her kidney/liver.
    Is there anything I should be doing from home to be proactive with this?
    My dog’s are my life………….Thanks for your time & information.

  6. Nancy on May 25, 2009 at 7:50 am

    Hi Dr Dressler,
    My 11 1/2 yr old black lab just had a mast cell tumor removed from her hind leg last week. We treated her with a dose of Lomustine and Prednisone prior to surgery to shrink it. I take her back this week to see if stiches are healed enough to come out. My vet said it is a stage 11 tumor and she would like to continue ~ 5 doses of chemo. I want to give her the best chance but feel with her age she may only live 6 months anyway. She is diabetic and arthritic and I want her last days to be happy ones. She is active, happy, eats well, plays with her toys etc. I now check her blood sugar everyday. She was well controlled until the steroids. We are weaning her from them now. She did handle the 1st dose of chemo very well, no real side effects other than the myelosuppression. Do you feel she has a chance of doing ok for the reminder of her life with out giving chemo. I don’t want what we have done so far to be all in vain either. I felt maybe we would give her another dose and then call it quits. Would just giving a dose or 2 be of any benefit if I choose not to go for 5 months worth? THanks for your time and opinion.

  7. donna on March 25, 2009 at 2:36 pm

    I am on my second round of experience with MSTs. My 1st dog passed very quickly after being diagnosed with an MST. Now my beloved Vizsla – Cajun has one too. Cajun has been on a raw diet and high quality kibble with no grain, after my other dog passed away and I believe it has lead to his long life. He is 14 yrs. and eats Bravo raw patties plus chix necks, salmon, etc. all good foods. Now – at the age of 14 he developed an MST on his shoulder and it grew very rapidly. It was diagnosed as stage III and became large and ulcerated. I quickly put him on benadryl – 50mg/3 times a day, my vet prescribed 20 mg prednisone twice a day, chinese herbs – Stasis Breaker and Qi Builder, raw garlic, fish oil and absolutely no carbs or sugar. I have to say that after 2 weeks the mass has reduced at least 50 percent – no ulceration(perhaps the mini-tee shirt helps from him trying to lick it) And he is eating, swimming and doing great. I’ve been told to add IP6 and Transfer Factor – both available from Aloha Medicinals. I am curious if anyone has taken this “holistic” approach and what I can expect next.
    thanks for all your replies!

  8. Gwen on January 8, 2009 at 8:43 am

    Hello Dr. Dressler,

    My 4 1/2 year old Border Collie was diagnosed with High grade malignant lymphoma in June of ’08. I believe it was stage two. She is on chemotherapy, Madison-Wisconsin protocol and is responding really well, with no signs of any tumors. She did not undergo surgury because, as the Vet said, her abdominal cavity was too invaded to successfully remove it all. None of her vital organs were invaded, not even, surprisingly enough, her lymph nodes! I’m just wondering, with her apparent success with chemo., what are the chances she will continue to be in remission, and for how long? Her final treatment is next week, and her energy, attitude and strength are about 85% of normal.

    By the way, the reason we found the tumors in the first place was because her B.M.s had a tiny bit of blood in them and there was a slight ribbony effect to them. It just seemed like there had to be “something in there” to cause that, so I think we were lucky to have caught it so quickly. Although the vet that did the surgery actually recommended euthanasia on the table because the tumors were so invasive.
    We’re sure glad we didn’t go that route!

  9. Dr. Dressler on December 6, 2008 at 5:18 pm

    Kathi, sounds like you are in quite a turmoil, understandably.
    First, you need to become comfortable being your dog’s number one health care advocate. You might want to check out my dog cancer coping guide, available online. You are researching intensively, and you are finding that there are limitations to our knowledge. This is true for everyone. This is the reality, including for us vets. So we find ourselves, in the absence of real clinical data, making decisions based on intuition and even feelings. Coming to terms with this is difficult for some.
    It sounds like you feel like chemo is not the right option for you. You may want to fortify your feelings with faith that your decisions are okay.
    That being said, the tumor sounds not good. Frequent micrometastasis (see the blog on this). Also, please see the blog on mast cell tumors for some more ideas.
    I do not subscribe to immune stimulation therapy being contraindicated for mast cell tumors. I have not been able to find literature that states immune stimulation can stimulate cancerous mast cells. This assumes the cancerous mast cell is able to act like a normal mast cell, and even if that were the case it would be a tough call.
    a. cimetidine, not famotidine (mast cell blog)
    b. intralesional triamcinolone (mast cell blog)
    c. Luteolin, available through SynoRx (Lutimax). Do a search for pubmed and mast cell and lutelin and/or cancer
    d. Ginger (check blog post)
    to start!
    These are not recommendations (as I cannot give them) as every dog is unique but you should check them out.
    Dr D

  10. Kathi on December 2, 2008 at 4:40 pm

    Hi Dr. Dressler,

    My dog was recently diagnosed with Mast Cell Tumor Grade III. My vet said to just wait and see. After much research on-line I chose to contact Cornell University to schedule an appointment with an oncologist for further testing. The tumor which was located on the perineal groin (just a little to the left of her tail) was completely removed by my vet on Oct 22nd and I just went for the oncology appt on Monday Nov 24.

    The tumor was a clean removal (7mm margin with no cancer cells along the outside of the mass) and the testing (blood work, urine, ultrasounds, bone marrow, lymph nodes) all came back clean with no signs of metastisis (spreading). There was a concern with a mildly enlarged left inguinal lymph node but upon aspiration there was an insufficient amount of sampling and with two hypoechoic nodules on the spleen but they were non characteristic of Mast Cell and they were aspirated and showed no signs of Mast Cells. According to these results this would be a stage 1 – 1 tumor in the skin with no lymph node involvement (which is a very good thing however it was classified as a Grade III which is considered a very aggressive form.) I’m assuming that this would be the stage as I had to specifically ask ‘does this mean it would be a stage 1’ and the dr had to look over some information to determine if that is correct.

    My dog is showing no signs of having a disease. She is eating normal, maintains a normal level of activity, doesn’t have any stomach issues and is eliminating feces without any problems (color & texture is fine).

    The doctor at Cornell put her on Pepcid AC (famotidine 10mg) 1 tablet per day and Benadryl (diphenhydramine 25mg) 2 tablets per day. She suggested that we start Chemo with lomustine (CCNU) orally and 21 days later vinblastine an injection. I questioned about prednisolone as I have read that vets often prescribe this steroid even before they perform surgery. The doctor added this to the protocol – Prednisolone 20 mg 2 per day for 2 weeks, 1 per day for 2 weeks and then 1 every other day. I have started the Pepcid, Benadryl, and the Pred for the last week.

    The next day (Nov 25th) on the phone when I received more results she told me she made a mistake about the dosage for the Benadryl & it should be 2-25mg tablets 3 times per day (total of 150 mg per day). I was worried about once a day. I don’t want her to be tired all day long. I still haven’t started doing 3 doses of Benadryl only the orginal once a day at bedtime. I asked the Dr. yesterday (Dec 1st) about Loratadine (Claritin) instead of Benadryl as it is non drowsy but she put me on hold and looked up in her books and told me she could not find that drug as being approved for animals.

    The Prognosis, according to the doctor, is without treatment median survival is 6 months or less and with the Chemo protocol approximately 50-60% for dogs with respond and median survival is 6-12 months. I’m having a hard time understanding why I should start Chemo when there are no systemic signs of the cancer and the margins were clean. It seems like the protocol was the same regardless of the stage.

    I asked yesterday (Dec 1st) about the original biopsy report to find out the Mitotic Index because the information I researched suggested that this could play a role in the prognosis. She did not have that report but said she thought she remembered it being high and that she thought she remembered that the features of the biopsy were not characteristic of mast cells which was why it was grade III. I tried to get a copy from my vet today but their copier was down and they would not let the original leave the building. From everything I’ve read the Grade can be somewhat subjective. I don’t have the scientific background to understand everything but I’d like to make sense of what I can.

    I’ve asked at Cornell about changing my dog’s diet and immunotherapy but the dr. claimed that this does not apply to Mast Cell Tumor but to other types of cancers. She agreed that my dog should take an omega 3 fish oil but no other supplements. Does this sound right to you? I really have no clue how much to give to a 42 lb dog. Does it have to be for animals or can it be for humans? I found a holistic vet about an hours away that I plan to try to contact again tomorrow. I want to do everything and anything to fight this!

    Now I have to make a decision as to whether to do chemo or not. My brain is hurting from all the thinking I’ve been doing. I want to make the best educated decision for my dog. One minute I think I have to do it and the next minute I think she seems fine and why make a healthy dog sick. I need more advise and I’m not sure who to turn to.

    I’d really appreciate hearing from you!!!


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