Especially at the beginning of breast cancer, the pathology (or "path") report looms very large as an important piece of information. Indeed, until the final path from surgery has been reported, it is impossible for your doctors to develop a treatment plan. Later on, path reports are important if there is something that needs to be biopsed and/or a worry about a recurrent cancer.
Like all your medical records, your pathology report legally is yours. If you want one, you are entitled to receive a copy. For many women, the trouble is reading and understanding it. Certainly, you will want to carefully go over it with your doctor, but here is a good explanation from Cancer Net about how to read and think about a pathology report:
Understanding a Pathology Report Parts of a pathology report
Most pathology reports include the following elements.
Patient, doctor, and specimen identification.
This section lists the patient's name, birth date, and other personal information; the pathologist's and oncologist's contact information; and details about the specimen, including the type of biopsy or surgery performed and the type of tissue obtained.
Gross (obvious) description. This section describes the specimen (or tumor, if it was removed), as seen with the naked eye, including the general color, weight, size, and consistency.
This highly technical section—which serves as the basis for the diagnosis section—details the cancer cells' characteristics, as viewed under a microscope, such as how well they resemble related normal cells (the grade of tumor; see below for more information), whether they are rapidly dividing (the mitotic rate), and whether they have spread (invaded) outside the main tumor mass into the wall of the organ in which they are found.
Tumors of many types may be classified as noninvasive (in-situ) or invasive. Invasive tumors have the capacity to metastasize (spread to other organs). Although noninvasive tumors do not metastasize, they can develop into or raise a patient's risk of a more serious, invasive cancer in the future. For invasive tumors, it is important for the pathologist to note how far the tumor has invaded into the wall of the organ where it started, if that organ is examined.
The microscopic part of the report will also specify the type of cancer. In each organ, many different tumor types can develop, with varying ability to spread to other organs. One important characteristic of each tumor is the histologic grade, which describes how the cancer cells look compared with healthy cells. A tumor with cells that look more like healthy cells is called low-grade, or well differentiated, while a tumor with cells that look less like healthy cells is called high-grade, or poorly differentiated or undifferentiated. In general, the prognosis (chance of recovery) is better for a person who has a tumor with cells that look more like healthy cells. There are different methods used to assign a cancer grade for different types of cancers. Learn more about grading for specific cancer types.
In addition, the pathologist usually will comment on how commonly he or she sees cells that are dividing. Tumors with few dividing cells are more likely to indicate a better prognosis for the patient.
Meanwhile, if cancer cells are present at the margins (edges) of the biopsy, the margins are described as "positive" or "involved." Such results may indicate the need for additional surgery to completely remove the tumor.
The pathologist will also document whether the cancer has spread to nearby lymph nodes (tiny, bean-shaped organs that help fight infection) or other organs. Positive lymph nodes contain cancer, while negative lymph nodes do not. If the tumor has invaded blood vessels or lymph vessels that feed into the lymph nodes, the likelihood of distant spread may be greater. The pathologist will specifically comment on these findings in the report if they are observed.
Combining the tumor size, location, and spread enables the pathologist to assign a stage to the cancer, typically using the TNM system from the American Joint Committee on Cancer (AJCC). The pathologic stage, along with the results of other diagnostic tests, helps determine the clinical stage of the cancer, which usually guides the oncologist in defining the treatment. Learn more about staging.
In many cases, the pathologist performs special tests to further characterize the tumor, the results of which may be listed here, in a separate section, or in a separate report. Such additional tests are especially important in diagnosing lymphoma and leukemia, for which treatment may depend on the results of these tests.
This section provides the "bottom line" and may be found at either the beginning or the end of the report. If cancer has been diagnosed, the section may include the type of cancer (such as carcinoma or sarcoma), tumor grade, lymph node status, margin status, and stage. In addition, it will list any specialized test results, which could indicate the presence of hormone receptors and other tumor markers.
In some cases, the pathology report for an initial biopsy may differ from a later report evaluating the entire tumor after it has been removed. This occurs because the characteristics of a tumor can sometimes vary in different areas. An oncologist's final treatment plan will consider the findings of all the reports to develop a treatment plan that best addresses a patient's particular situation.
Questions to ask the doctor
To better understand what your pathology report means, consider asking the following questions of your doctor:
What is the type of cancer, and where did it start?
How large is the tumor?
Is the cancer invasive or noninvasive?
How fast are the cancer cells growing?
What is the grade of the cancer?
Has the whole cancer been removed, or is there evidence of remaining cancerous cells at the edges of the sample?
Are there cancerous cells in the lymph or blood vessels?
What is the stage of the cancer?
Does the pathology report specify the tumor characteristics clearly, or should I seek another pathology opinion?
Do any tests need to be repeated on another sample or in another laboratory?
Obtaining a second opinion
It may be valuable to seek the knowledge and advice of more than one doctor regarding the diagnosis and treatment plan, which is based on the pathology report and the results of other diagnostic tests. This is called a second opinion. If you pursue a second opinion, obtain the pathology report and other medical records to share with the second doctor, but be aware that doctors work closely with their own pathologists and may prefer to have their pathologist's opinion, in addition to the original pathology report. Additional tests can be performed on the biopsy if deemed necessary or if the results of the original report are in question; the tissue specimen is kept for a long time and is available upon request.
This section describes the specimen (or tumor, if it was removed), as seen with the naked eye, including the general color, weight, size, and consistency.
A pathology report is a medical document written by a pathologist, a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The report specifies a diagnosis, based on the pathologist's examination of a sample of the patient's tumor. The specimen (tissue sample) is obtained through a biopsy. Learn more about biopsies, including the various types.
The pathologist's examination reveals whether the tumor is benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). If it is cancerous, the pathologist may perform additional tests on the sample to learn more about the cancer. Your doctor will receive test results as they become available, so it may take a few days to a few weeks to receive the full report, depending on the studies the pathologist performs.
The pathology report provides specific information about the characteristics of your tumor, which helps the oncologist determine your cancer treatment options. It contains highly technical medical terms because it is a communication between two doctors—the pathologist and the treating oncologist.
However, you are entitled by law to receive a copy, and you can understand it with help from your oncologist. Ask your doctor to explain the pathology report results and what they mean. You may also speak directly with the pathologist for an explanation of the report findings.