Chances are, the treatment plan for your cancer was determined by the results on a pathology report. Before your diagnosis, you probably had a biopsy or surgery where a doctor removed cells or tissue for study under a microscope. Specialists called pathologists spend their days viewing these samples, understanding how they look compared to normal cells and preparing reports which summarize the findings on each biopsy for oncologists and surgeons.
We spoke with Cancer Center pathologist, Celina Kleer, M.D., director of the Breast Pathology Division in the Department of Pathology,to find out the information contained in a report and how your oncologist uses it to decide the best course of treatment for your cancer.
Q: What are the first steps to begin the process of getting a pathology report?
A physician orders a procedure based on a patient’s symptoms, like a lump in her breast, or other unusual findings that might indicate illness or cancer. The procedure could be any sort of tissue sampling, such as a core biopsy or a larger surgery.
Q: What details are included on a pathology report?
A pathology report contains basic patient information, such as name, birthdate, biopsy date, and an assigned pathology accession number. It also contains a gross description of the sample, which is how it looks to the naked eye before it is inspected under the microscope. Then the report gives details of the tissue changes that the pathologist saw under the microscope, which allows for visualization of individual cells. The diagnosis section provides the location of the site, the tumor type and grade, the tumor size, and as much information as the pathologist can provide given the extent of the biopsy. Finally, there is a comments section where the pathologist can note concerns.
Q: What information might a patient learn about his or her cancer?
Pathology reports tell you whether a patient has a malignancy, what type of cancer and whether it is confined or has spread to the lymph nodes or other organs. There are some features of the cancer cells which indicate whether a tumor may behave more aggressively. For example, based on the proliferation of the cancer cells, a pathology report tells you whether a tumor grows quickly, which will alert the oncologists and surgeons to select the most appropriate treatment course.
Q: What is the difference between a pathologist and an oncologist?
A pathologist studies and makes diagnosis of diseases through examination of organs and tissues, including their study under the microscope. In the case of cancer, the pathologist generates a diagnostic report naming the specific tumor that a patient has so that oncologists can plan treatment.
It is important to note that a whole multidisciplinary team (which includes radiologists, oncologists, pathologists, radiation oncologists, surgeons, nurses, geneticists, psychiatrists and social workers) is closely involved in the decision-making and care of cancer patients. Their close communication is essential in providing optimal treatment. For example, in breast cancer, here at the Cancer Center, we present each patient’s case to our breast multidisciplinary tumor board. We show slides on a projector and discuss the diagnosis and treatment plan of each individual patient. Everyone is able to offer his or her expertise.
Q: How does a patient interpret and understand the results of a pathology report?
Patients will hear results from their doctor. Pathology reports contain a lot of medical terms that patients may not understand. The doctor (who may be an oncologist) interprets them and conveys the diagnosis to patients in an understandable way.
Q: Should patients get a second opinion on their pathology results?
I think second opinions are always worthwhile. Here at the Cancer Center, it is easy to get many opinions on a patient’s pathology report. We have a resident physician review a case. Then, the resident reviews the case with a fellow and an attending physician. That’s already three sets of eyes. If there are any doubts about a diagnosis, the case will be reviewed with another pathologist.
This all takes place before the tumor board meeting, where a room full of experts reviews the case and weighs in on treatment options. There are a lot of opportunities for clinicians to raise questions or flags.
Often, smaller hospitals and clinics send cases out for consultation to larger institutions like the University of Michigan. In our pathology department, we evaluate a lot of cases from regional hospitals. If a patient has doubts, a second opinion is a good idea.
From the Fall 2013 Thrive.
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The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.