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Understanding Your Pathology Report
When a sample of tissue is removed during a needle biopsy or during surgery, a pathologist will examine it thoroughly. A pathologist is a doctor that examines tissue and cells under a microscope and writes a report to let your doctor know if the cells are cancerous, and provides a detailed description of the sample. This report is intended to be read by your doctor, so it is quite comprehensive and written in medical language.
If the surgeon wants to have the tissue examined while you are in the operating room, it is called a "frozen section". Some initial observations can be reported at this time, but to get a more extensive review, the specimen must be "permanently fixed" which can take 24 hours. The written report usually takes three days to reach your doctor. This is an estimate. Often the pathologist will wish to use special stains or a new section of the tissue which can take additional days. The time needed for an accurate diagnosis does not affect your treatment.
The pathology report describes the sample in great detail and includes:
- Gross Description - A description of what the sample looks like to the naked eye.
- Microscopic Description - A description of what the sample looks like under a microscope and a biological evaluation. If the sample does happen to be cancerous, it will contain information about the size of the cancer, the extent of the disease, and the exact type of the tumor.
- Size - The classification of the specimen in terms of size.
- Invasive vs. Non-Invasive - Once a cancer cell has broken through the membrane of its origin, it is considered to be invasive. Non-invasive cancer is considered in situ because it has stayed within the membrane. Non-invasive cancer cannot spread to your lymph nodes.
- Histopathologic Grade - This indicates the type of cancer, the arrangement of the cells and how aggressive the cancer is.
- Surgical Margins - The pathologist marks the edges of the sample with ink before cutting it so that when it is examined under the microscope, the closeness of the cancer to the edges of the sample can be measured. This tells the surgeon how close the cancerous cells are to the inked border. Sometimes if the margin is too close to a cancer, more surgery may be needed.
- Lymph Node Status - Tumor cells can travel to other parts of the body through lymph nodes and vessels. During surgery, the doctor may remove some of the lymph nodes and vessels to see if the cancer has spread. This part of the report indicates how many lymph nodes were removed and whether cancer cells were found.
- Hormone Receptor Status - Some cancer cells can have a high number of estrogen, progesterone, testosterone, or other hormone receptors. The tumor will grow in response to the presence of the hormone. For instance, if a breast tumor responds to the presence of estrogen and/or progresterone, it is considered positive. If the breast tumor receptors are low in number, the cancer is less likely to be stimulated by estrogen/progesterone and considered ER or PR negative. This is an indication to your doctor which therapies will be more effective.
- HER2NEU Status - This can be measured in two ways and indicates how sensitive the cancer cells are to a particular growth factor, possibly speeding up their growth. This is reported as a positive or negative attribute and can help identify which therapy will best affect the biology of your cancer cell type.
- Lymphovascular Invasion - Cancerous cells can penetrate the blood vessels and/or lymph channels. The rate at which this is occurring can indicate the proliferation of the cancer cells.
- Summary and Diagnosis - Just like it sounds, this is the condensed version of the preceding evaluation, which will be reviewed by your doctor.
Medical terminology can be overwhelming, so ask your doctor to review your Pathology Report with you. Different institutions use different formats for the report, and sometimes the information can be confusing.
Remember that each cancer is different. The pathology report is a personalized description from which future treatments will be based on - including any other clinical information about your general health.
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