Pancreatic Cancer

Pathology Report

Your pathology report is an essential document that provides information about the unique characteristics of your particular cancer. It serves as a guide for your health care team to plan the treatment most likely to be effective for your cancer based on its features.

Your cancer diagnosis is most often based on careful examination of a tissue biopsy from a suspected tumor or of the entire tumor after defini-tive surgery (removal of the tumor with or without lymph nodes). A pathology report is prepared by a pathologist, who is a physician with specialized training in determining the nature and cause of disease. The pathologist examines the specimen with and without a microscope, documenting its size, describing its appearance, and, sometimes, performing special testing (see Table 1). The final diagnosis is based on all the findings of the examination.

Diagnosing pancreatic cancer and identifying all of the characteristics of the tumor are challenging and require the expertise of physician specialists because your treatment is planned according to the final results of the pathology report. Getting a second opinion from another pathologist with extensive expertise in interpreting pathologic findings related to pancreatic cancer can be beneficial, especially if there was difficulty or controversy interpreting the findings. Be sure to seek a second opinion if the pathology report does not contain a definitive diagnosis, if you have a rare type of cancer, or if the cancer has already metastasized (spread). Another interpretation can confirm your diagnosis or may suggest an alternative diagnosis, which could affect your treatment plan.

Table 1. Components of a pathology report

Descriptor What is described or measured How result is reported What finding means
Size Length and width of the tumor Largest dimension of the tumor, as measured in centimeters (1 inch = approximately 2.5 centimeters) Prognosis is likely to be better for smaller tumors; size is a primary factor in the staging of most cancers.
Noninvasive vs. invasive Whether cancer cells are confined to a single cell layer or have spread to nearby (or underlying) tissue Noninvasive cancer is termed “in situ” Prognosis is likely to be better for noninvasive cancer.
Histology The histologic type Adenocarcinoma, adenosquamous carcinoma, squamous cell carcinoma, signet ring cell carcinoma, undifferentiated carcinoma, undifferentiated carcinoma with giant cells, solid pseudopapillary neoplasms, acinar cell carcinoma, colloid carcinoma, hepatoid carcinoma, intraductal papillary mucinous neoplasm, mucinous cystic neoplasms, pancreatoblastoma, carcinoid tumor, well-differentiated neuroendocrine tumor, atypical carcinoid tumor, well-differentiated neuroendocrine carcinoma, gangliocytic paraganglioma Treatments and prognosis vary according to histologic type.
Histologic grade/ How closely the tumor cells resemble normal cells
Grade 1: well-differentiated (cancer cells look mostly similar to normal cells)

Grade 2: moderately differentiated (more cancer cells look abnormal than normal)

Grade 3: poorly differentiated (most cancer cells look very abnormal and are likely to spread)

Grade 4: undifferentiated (cancer cells look very abnormal)
The lower the grade, the better the prognosis; the higher the grade, the more aggressive the tumor.
Surgical margins Presence or absence of cancer cells at the edges of the tumor sample (known as the margin)
Negative (not involved, clear or clean): no cancer cells in the margin

Close: cancer cells near the margin

Positive (involved): cancer cells in the margin
More surgery or other therapy may be needed if the margins are close or positive.
Lymphovascular invasion Presence or absence of cancer cells in the blood or lymph vessels
Absent: no cancer cells present in the blood or lymph vessels

Present: cancer cells present in the blood or lymph vessels

Extensive: cancer cells have spread through blood or lymph vessels
Cancer cells in the blood or lymph vessels (present and extensive) suggest a more aggressive tumor.
Lymph node status Presence or absence of cancer cells in the nearby lymph nodes
Negative: no cancer cells

Positive: cancer cells
Negative lymph node status is generally associated with less extensive cancer and a better prognosis; lymph node status is a primary factor in staging.
 

 

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