Tumour differentiation (well / moderately / poorly differentiated)
How much the cancer cells still resemble the normal tissue they came from. Well-differentiated tumours look almost normal and tend to grow slowly; poorly differentiated ones have lost their identity and behave aggressively. It is the basis of grade.
Pathologists assign differentiation from gland formation, nuclear appearance and mitotic rate; it underlies grading systems such as Gleason (prostate), Nottingham (breast) and WHO grade for neuroendocrine tumours (well-differentiated NETs versus poorly differentiated neuroendocrine carcinomas, which are treated like small-cell cancer). Well-differentiated mucosal gastric cancers qualify for endoscopic resection; poorly differentiated thyroid cancer loses iodine uptake. Dedifferentiation over time (liposarcoma, thyroid, prostate to neuroendocrine) marks transformation to a more aggressive state.
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