Table 3.

Severity grading for benign and malignant neoplasms

Grading rubric for SJLIFE
Subsequent neoplasmsCTCAE v4.03 grading rubricGrade 1Grade 2Grade 3Grade 4Grade 5
Benign neoplasms

Neoplasms benign, malignant, and unspecified (including cysts and polyps) Other, specified

  1. Asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated

  2. Moderate; minimal, local, or noninvasive intervention indicated; limiting age-appropriate instrumental ADL

  3. Severe or medically significant but not immediately life threatening; hospitalization or prolongation of existing hospitalization indicated; disabling; limiting self-care ADL

  4. Life-threatening consequences; urgent intervention indicated

  5. Death

Low-grade or benign neoplasms where surgical intervention is not indicated; observation or minimally invasive biopsy only (e.g., meningioma followed by MRI only or gastrointestinal polyps diagnosed and resected during colonoscopy)Any low-grade or benign neoplasm requiring surgical intervention more than a minimally invasive biopsy. Excludes CNS or cardiothoracic surgical interventions (e.g., fibroadenomas, thyroid adenomas, gastrointestinal polyps requiring surgical resection)Any low-grade or benign neoplasm requiring CNS or cardiothoracic surgical intervention (e.g., meningioma or myxoma requiring intervention)Life-threatening consequences; urgent intervention indicatedDeath
Malignant neoplasmsAsymptomatic or mild symptoms; clinical or diagnostic observations only; low-grade neoplasms where intervention is not indicated (e.g., cervical dysplasia/CIN and teratoma incidentally identified on imaging)Moderate symptoms; minimal, local, or noninvasive intervention indicated; limiting age appropriate instrumental ADL; low-grade, non-metastatic neoplasms (e.g., cervical carcinoma in situ, cervical lymph node paraganglioma, basal cell carcinoma, squamous cell carcinoma, parotid carcinoma)Severe or medically significant, but not immediately life-threatening; hospitalization or prolongation of existing hospitalization indicated; disabling; limiting self-care ADL; high-grade neoplasms where single-treatment therapy required (surgery, radiation with or without chemotherapeutic agent; e.g., breast cancer if in situ, prostate cancer, meningioma requiring intervention, bladder carcinoma, thyroid cancer, carcinoid, squamous cell carcinoma cervix, glioma, astrocytoma, GIST)Life-threatening consequences; urgent intervention indicated; high-grade neoplasms where multimodal therapy required or more than one chemotherapy agent used (e.g., MDS, AML, ALL, Hodgkin lymphoma, non-Hodgkin lymphoma, non–in situ/invasive breast cancer, osteosarcoma, Ewing sarcoma, primitive neuroectodermal tumor/PNET, soft tissue sarcoma, renal cancer, anaplastic CNS tumor, glioblastoma, carcinoma of head/neck, liver cancer, lung cancer, mesothelioma, melanoma)Death
  • Abbreviations: ADL, activities of daily living; ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; CIN, cervical intraepithelial neoplasia; CNS, central nervous system; GIST, gastrointestinal stromal tumor; MDS, myelodysplastic syndrome; PNET, primitive neuroectodermal tumor.