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Pathology 101

Celina Kleer, MD
Celina Kleer, M.D.

What you need to know about the report that explains how your cancer looks under the microscope

Chances are, the treatment plan for your cancer was determined by the results presented 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. Pathology reports are written using technical medical language, which a patient may or may not see or understand.

We spoke with Rogel Cancer Center Pathologist, Celina Kleer, M.D., director of the Breast Pathology Program, 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 a patient will take to begin the process of getting a pathology report?

To obtain a pathology report, a patient must undergo some procedure. A physician orders the 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 any unusual aspects of the sample or concerns.

U-M pathologist, Dr. Cody Carter, explains in this video how pathologists and other laboratory professionals help to diagnose patients' biopsies. This behind-the-scenes look into the U-M Department of Pathology shows how tissue is prepared to be viewed under a microscope and what pathologists are looking for in order to determine a diagnosis.

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 Rogel 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. What genetic information might be included on a pathology report?

We don’t include genetic information right now in pathology reports. If genetic testing is indicated, this information is included in a special report. The Rogel Cancer Center has uniquely qualified specialists in this area. However, moving forward toward the idea of personalized medicine, some people have their tumors sequenced to find specific genes that have mutated, which may give clues to what treatments will work for what tumor types.

Q. Should patients get a second opinion on their pathology results?

I think second opinions are always worthwhile. Here at the Rogel 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.

Continue reading the Fall, 2013 issue of Thrive.

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Thrive Issue: 
Fall, 2013