Your Pathology Report
The pathology report is one of the most important documents you will receive during your diagnosis. This report creates a profile of the cancer’s traits, including its size and location, and it describes features that provide clues to the aggressiveness of the tumor.
To create the pathology report for your biopsy, a pathologist, a doctor who diagnoses cancer by looking at cells and tissues under a microscope, looks at tissues collected during your initial procedure. The pathology report for your biopsy will provide most of the information for your treatment, but more details will be added once you have your definitive surgery. This surgery, which may be a lumpectomy or mastectomy, should end with cancer-free margins: no cancer found along the edges of the tissue removed during surgery. The pathologist will also gather information from your lymph node biopsy, if you had one.
You may get your complete report all at once or in parts. You may even get a few reports at a time. Most pathology reports are split into three sections:
- Gross description: This section describes the tissue the pathologist received as seen with the naked eye. It often includes information on how the tissue was oriented and prepared before its dissection and submission for processing.
- Microscopic description/Synoptic Summary: This section goes into detail about the cancer itself and how it looked under the microscope. This section is very important in treatment planning. Among the details covered in this section of the report are:
- the size of the cancer
- the number of lymph nodes with cancer, if any
- whether cancer was found in one area or several areas of your breast
- whether the surgeon removed all the cancer, called the margin status
- how the cells look under a microscope, called the histologic grade
- the pathological staging
- any predictive marker testing
- how quickly the tumor is growing, called the mitotic rate/proliferative index
- Final Diagnosis/Impression - This section sums up all the information the doctors learned.
Make sure to get your own copy of your final pathology report from your surgeon’s office.
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The location of the tumor is known as the anatomic site. The word “anatomic” is a medical term that refers to a part of your body: in this case, the part of your body that contains the breast cancer.
Tumors can grow in any part of the breast. If a tumor appears in the breast ducts but is noninvasive, meaning it has not grown beyond the duct and into nearby healthy breast tissues, it is called ductal carcinoma in situ or DCIS. Cancer cells that start in the ducts or in the lobules, structures that make and carry breast milk to the nipples, become invasive if they have spread outside the ducts or lobules into healthy breast tissues.
Breast cancer can spread to areas outside the breast, such as nearby structures called lymph nodes. Breast cancer can also metastasize or spread to different anatomic sites, including organs and locations outside of the breast and nearby lymph nodes. These areas include the bones, liver, lungs or brain.
The size of a tumor is important for you and your doctors to know as you plan your treatment. Generally, smaller tumors are associated with less intense treatment, better results and longer survival. Larger tumors are usually treated more aggressively and are associated with shorter survival and higher risk for recurrence, the chance that the cancer will return or spread to other parts of the body.
This isn’t always the case, though. A small cancer can be very aggressive and a large cancer can be very manageable. Your pathology report will include other features of the cancer that will help determine the aggressiveness of your tumor
Your doctors may be able to get a sense of how large the tumor is during a physical exam or by looking at images from a mammogram or ultrasound. But the only way to know the tumor’s exact size is to measure it after it has been removed during surgery and examined by a pathologist, a doctor who diagnoses cancer by looking at cells and tissues with a microscope.
The pathologist measures the area that contains cancer cells in three dimensions. The largest dimension is considered the tumor size. For example, a tumor that is 3 centimeters by 2 centimeters by 2 centimeters will be called 3 centimeters in size.
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After you were diagnosed with breast cancer, you should have had a number of tests to help your doctors learn more about the cancer and how to treat it.
One of those tests checked the cancer’s hormone receptor status. This test checks whether the cancer cells have receptors for the hormones estrogen and progesterone. Receptors on the surface of breast cancer cells work like satellite dishes. They detect and bring in hormone signals. These signals can direct cells to grow, multiply and repair damage. Learn more about how your doctor tests for hormone receptor status and how it might impact treatment.
After you have lumpectomy or mastectomy, information about surgical margins will be added to your pathology report. The surgical margin is the edge of the tissue that was removed. In other words, it is the tissue that the surgeon cut across to remove tissue from your body. Your surgeon’s goal is to remove all of the cancer in your breast and achieve “clear,” or “negative” margins, meaning they find no cancer at the edge of the tissue they remove. Clear margins are associated with a lower risk of a local recurrence (cancer returning in the same breast). Research shows about 1 out of 4 women who have a lumpectomy go on to have a second breast surgery because the margins weren’t clear after their first surgery.
If you have more than one tumor in the breast, it’s harder to achieve clear margins with a lumpectomy. In this situation, your surgeon may recommend mastectomy instead. Or, your oncologist may recommend neoadjuvant, or pre-surgery, treatment with chemotherapy or targeted therapy, depending on what type of breast cancer you have, to shrink the tumor and make lumpectomy more likely to succeed.
To determine what stage of cancer you have, your surgeon will need to look at the lymph nodes under your arm, called axillary nodes, on the side of the body where the cancer was found. Lymph nodes help the body filter out waste, damaged cells and infection. The axillary lymph nodes are the often the first place breast cancer cells travel to.
Knowing whether there are cancer cells in your lymph nodes will help you and your doctors learn the stage of the cancer and decide what treatments you need in addition to surgery.
Lymph node status is different from lymphovascular invasion (see section above). Lymphovascular invasion means the pathologist saw some cancer cells in the blood vessels or the lymph channels within your breast, rather than in the lymph nodes themselves.
You may have one of two types of surgery to remove the lymph nodes. You can read about these surgeries here.
- the size of the tumor
- whether lymph nodes near the breast contain breast cancer
- whether the breast cancer has spread from the breast to other parts of the body
In general, the higher the stage, the larger the amount of cancer in your body. Learn more about how cancer is staged and what it means for you.