Meningioma: Stages and Grades

Approved by the Cancer.Net Editorial Board, 10/2022

ON THIS PAGE: You will learn about how doctors describe meningioma and factors that help decide treatment options. This is called the stage and grade. Use the menu to see other pages.

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What is staging?

Staging is a way of describing where the tumor is located, if it is cancerous, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the tumor’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of tumors.

If meningioma has been diagnosed, additional tests will be done to learn more about the tumor. As described in Risk Factors, people with neurofibromatosis type 2 are more likely to have more than 1 meningioma. In this situation, a patient will have a variety of tests, including magnetic resonance imaging (MRI), to find out if or how much the tumor has spread within the brain and spine.

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Determining treatment and prognosis for meningioma

There is no formal staging system for meningioma because brain/spinal cord tumors cannot be staged the same way as tumors in other parts of the body. For meningioma, doctors use the 6 factors described below to determine the treatment options and prognosis:

Tumor histology and grade. As described in Diagnosis, a sample of the tumor is removed for analysis. Tumor histology includes the type of tumor, the grade, and additional molecular features that predict how quickly the tumor can grow. Together, these factors will help your doctor understand how the tumor will behave. These factors may also help determine a person’s treatment options.

Grade describes specific features in the tumor that are linked with specific outcomes. For example, doctors may consider whether the tumor cells are growing out of control or if there are a lot of dead cells. Tumors with features generally linked with growing more quickly are given a higher grade. For most tumors, the lower the grade, the better the prognosis.

In general, a meningioma is classified into 1 of 3 grades:

  • A grade I tumor grows slowly.

  • A grade II tumor grows more quickly and is often called atypical meningioma.

  • A grade III tumor grows and spreads very quickly and is often called anaplastic or malignant meningioma.

Age. In adults, the age that a person is diagnosed with meningioma is one of the best ways to predict prognosis. In general, the younger the person, the better the prognosis.

Extent of tumor residual. Resection is surgery to remove a tumor. Residual refers to how much of the tumor remains in the body after surgery. The prognosis is better when all of the tumor can be surgically removed. It includes 3 classifications:

  • Gross total. The entire tumor was removed, although microscopic cells may remain.

  • Subtotal. Large portions of the tumor were removed.

  • Biopsy only. Only a small portion, used for a biopsy, was removed.

Tumor location. Tumors can form in any part of the central nervous system (CNS). A tumor can cause more damage to some areas than others. Some tumors are harder to completely remove than others because of where they are located.

Functional neurologic status. The doctor will test how well a patient’s CNS is working by using one of several available assessment tools. One commonly used tool is called the Karnofsky Performance Scale. A higher score indicates a better prognosis.

Metastatic spread. Meningioma very rarely spreads to other parts of the body.

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Recurrent meningioma

A recurrent tumor is one that has come back after treatment. If the tumor returns, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

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Tumor markers

The factors described above are the best ways to determine the prognosis for a person with meningioma. Researchers are currently looking for tumor markers that could make meningioma easier to diagnose and allow the staging of adult CNS tumors. Tumor markers are substances found in higher-than-normal amounts in the blood, urine, or body tissues of people with certain tumor types. The goal is that someday it could be possible for doctors to use blood and/or other lab tests to help determine how quickly a brain tumor will grow and spread, develop more effective treatments, and more accurately predict prognosis.

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Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Information about the tumor will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.