Understanding Your Cancer Pathology Report

Published on: October 01, 2001

The tissue diagnosis is the gold standard upon which treatment is based. Thus, understanding the diagnosis and the pathology report can help you choose options and be comfortable with your choices. The report can be obtained from your doctor or the hospital medical records department.

Pathology reports vary in format but will include your name, birth date, identification numbers, type of surgery, tissue removed, and date. If the tissue removed is a small sample or "biopsy." Many of the items discussed here may not be applicable. If larger amounts of tissue are removed, most of the following will be present:

The gross description contains the physical attributes-color, weight, size, etc.- of the tissue removed, while the microscopic description describes features, which support the diagnosis.

The diagnosis is located at the beginning or end of the report. It states the tumor type (carcinoma or sarcoma) and cell of origin (adenocarcinoma for glandular tissue, lymphocytic lympohoma, etc.). The histologic grade is based on how closely the tumor resembles normal, non-neoplastic tissue. This is described as "well," "moderate," or "poorly differentiated." If a numerical grading system is used, the higher the numerical grade, the more poorly differentiated the tumor is.

Tumor size is important since smaller is better. The edges of the tumor may be "circumscribed" (discrete) or "infiltrative" (irregular). It may be more difficult to completely remove an infiltrative tumor. A tumor that spreads into adjacent tissues is called "invasive" in contrast to one that is localized or 'in situ". If lymph nodes are removed, the spread of a tumor to a lymph node is referred to as a "positive" lymph node: if there is no spread, it is called a "negative" lymph node.

Tumor stage refers to how advanced the tumor is in the entire body. The most widely used staging system is the America Joint Commission on Cancer (AJCC), which is designated "p" in the pathology report since it is based solely on the pathology findings. (In contrast, the clinical "C" stage may include laboratory tests results, x-ray findings or other data.) "T" refers to tumor size and the degree of invasion, "N" to the extent of lymph node spread outside the original tumor site. Features which are not known at the time of the pathology report are recorded as "X". The pTMN together form the "stage", with p Stage I representing the most minimal spread and p Stage IV the most advanced.

Most diagnostic sections contain statement about tumor margins. If a tumor is present in the edges of the tissue surgically removed, the margins are said to be "positive" or "involved", and additional treatment may be necessary. Otherwise, the margins are "negative," "not involved," "clear" or "free from tumor." There may be hormone receptors, special markers, tests or comments which further clarify the diagnosis or contain recommendations.

Finally, every report will be signed by the pathologist responsible for its content. The pathologist, a medical doctor with extensive, rigorous training, is an expert in the diagnosis of disease. If you need more information, he or she will be delighted to answer your questions.

Editor's Note: Kay H. Woodruff, MD, is a pathologist and a member of the College of American Pathologists. She practices at Doctor's Medical Center in Pinole and San Pablo, California, and is medical director of the J.C. Robinson M.D. Regional Cancer Center located on the San Pablo campus.

Original appeared in Coping Magazine, January/February 1999, page 39. Reprinted by permission of Coping magazine