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Making Sense of a Cancer Pathology Report
A pathology report has important information about your cancer. Learning more about your cancer can help you make good treatment decisions.

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woman listening and thinking Making Sense of a Cancer Pathology Report

A number of tests can suggest that you have cancer. But to find out for sure, your doctor will take a tissue sample (biopsy) and send it to a pathologist. The pathologist will study the sample, make a diagnosis and write a report of the results. This report will help your doctor understand the cancer and suggest the best treatments.

If you have cancer, ask your doctor for a copy of your pathology report. The report was written by one doctor for another doctor, so it may contain words you don't know. The information below can help you understand some of the terms.

What's in a pathology report?
Different labs may use different types of reports, so the one you get may not use exactly these terms or sections. But this will give you an idea what to look for on your report and what it means.

Your personal information. At the top, the report will list your name, date of birth, sex and other information, such as your doctor's name and the date of your biopsy. Check these facts to make sure they are correct.

Clinical history. This may include information such as the signs and symptoms that led to the biopsy, the type of procedure that was done and the diagnosis your doctor made before the biopsy.

Clinical (or pre-operative) diagnosis. This is the diagnosis your doctor made BEFORE the biopsy was done. It may not be the final diagnosis.

Gross description. This is what the tissue sample looked like to the naked eye. It may include the size, weight, color and anything else the pathologist noticed. It may also talk about how the sample was prepared to be viewed under the microscope.

Microscopic description. This describes how the cancer cells looked under a microscope. This section is often long and technical. Important details about the tumor in this section may include:

  • Size. In most cases, the smaller the tumor, the better the outcome. A large tumor is more likely to have spread. Size is measured in centimeters (1 inch = 2.54 centimeters).
  • Invasiveness. Cancer may be invasive or noninvasive (also called in situ). Noninvasive cancer is found only in one area. Invasive cancer has spread into nearby tissues. Invasive cancers are more likely to spread to other organs (metastasize).
  • Grade. The grade is based on how much the cancer cells look like normal cells and how fast they are growing. Grade may be described or listed as a number. "Well differentiated" means the cancer cells look a lot like normal cells. These cancer cells are often are slow-growing. "Moderately differentiated" means the cells look somewhat abnormal. "Poorly differentiated" means the cells are very abnormal (that is, unlike the tissue they came from) and tend to grow fast and spread aggressively. Though different number scales can be used to grade cancer cells, a low number is usually better. Your doctor can explain the grading scale used for your type of cancer.
  • Margin. When a tumor is removed for biopsy, the surgeon also takes some of the normal tissue around it, called a margin. If the surgeon got all the cancer, the margin will be negative, or clear of cancer cells. If the cancer cells are found in the margin, the margin is positive. This means you might need another surgery to remove more tissue to make sure the margin is clear.
  • Lymph node status. If your doctor also removed some nearby lymph nodes, the report will tell whether cancer cells have spread to them. Negative means no cancer was found in the lymph nodes. If the result is positive, cancer was found in the lymph nodes. This means the cancer has spread. Lymph node status may be shown as a number. For example, "4/12" means cancer was found in 4 of the 12 nodes examined. In general, the fewer lymph nodes involved, the better the outcome, though people with cancerous lymph nodes can still be cured.
  • Lymphovascular invasion. This describes whether the cancer cells have invaded the blood vessels or lymph channels. Lymphovascular invasion may be a sign the cancer is more aggressive.

Special tests or markers. This will give the results of any special tests that were done to learn more about the cancer. This information can help guide treatment.

Diagnosis (summary). This is the most important part of the report. It sums up the findings from the other sections and says what type of cancer was found.

Pathologist's signature. This is the name of the doctor who was responsible for your biopsy.

What should I do with my pathology report?
Discuss the findings in your report with your doctor. Don't be afraid to ask questions. Your doctor can help you understand what you need to know about your cancer. Learning more can help you make good treatment decisions.

The pathology report is an important part of your medical record, so it's a good idea to keep it in your files. It may also be useful if you decide to seek a second opinion before treatment.
By Lila Havens, Contributing Writer
Created on 01/27/2009
Updated on 06/01/2012
  • National Cancer Institute. Pathology report: questions and answers.
  • National Cancer Comprehensive Network. Cancer staging guide.
  • Cancer.Net. Understanding a pathology report.
  • Illei PB, Westra W. Principles of oncologic surgical pathology. In: Abeloff MD, Armitage JO, Niederhuber, JE, Kastan MB, et al, eds. Abeloff's Clinical Oncology. 4th edition. Philadelphia, PA: Elsevier Churchill Livingstone; 2008.
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