Head & Neck

Your 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 definitive surgery (removal of the tumor with or without lymph nodes). A pathology report is prepared by a pathologist – a physician with specialized training in determining the nature and cause of disease – after he or she has examined 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 head and neck 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 head and neck cancers can be beneficial, especially if there was difficulty or controversy in interpreting the findings. Be sure to seek a second opinion if the pathology report does not contain a definite diagnosis, if you have a rare type of cancer, or if the cancer has already metastasized. Another interpretation can confirm your diagnosis or may suggest an alternative diagnosis.

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 spread to nearby (or underlying) tissue Noninvasive cancer is termed “in situ” Prognosis is likely to be better for noninvasive cancer
Grade How closely the tumor cells resemble normal cells in the head and neck area
▪ Grade 1: well-
  differentiated (cells look
  mostly similar to
  normal cells)
▪ Grade 2: moderately
  differentiated (more
  cells look abnormal
  than normal)
▪ Grade 3: poorly
  differentiated (most
  cells look very abnormal
  and are likely to spread)
The more the cancer cells look like normal cells, 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 (or “not
  involved,” “clear” or
  “clean”): no cancer cells
  in the margin
▪ Close: cancer cells are
  near the margin
▪ Positive (or “involved”):
  cancer cells are in the
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,” “Present,” “Extensive” Cancer cells in the blood or lymph vessels suggest a more aggressive tumor
Lymph node status Presence or absence of cancer cells in the lymph nodes in the neck 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
Extracapsular spread Spread of cancer beyond the lymph node capsule
▪ Node-positive, but no
  spread: pN+/ECS-
▪ Node-positive, plus
  indication of spread:
A positive spread predicts treatment failure in squamous cell carcinomas


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