Pathological Exams

The most common diagnosis and accurate methods of diagnosing cancer include microscopic examination of either tissue or cells. Cells examined are usually obtained from fluid around the suspected site of cancer. Tissues examined are usually removed from the primary or metastatic tissue of a cancer.

There may be several tissue samples, biopsies, and/or surgical resections for one cancer. When staging a cancer, it is important to review all pathological reports.

  • There are many kinds of biopsies to remove tissue for a cancer diagnosis.
    • An aspiration biopsy is obtained by using a needle to suction fluid, cells, or tissue into a syringe.
    • An incisional biopsy removes only a portion of the tissue.
    • An excisional biopsy attempts to remove the entire tumor.
    • A bone marrow biopsy is the removal of bone marrow from one of the body's larger hollow bones such as the femur or pelvic bone.
  • Surgical resections involve removing more tissue than a biopsy from the body. Surgical resections are usually performed to remove the entire primary cancer, however, sometimes extent of the disease precludes entire removal.
    • This includes the primary site of the cancer including margins of normal tissue and/or regional lymph nodes.
    • The pathologist can often determine staging of the primary site and lymph nodes by examining the primary cancer, surrounding tissues, and regional nodes when there is a "total" resection of the cancer.
    • The pathology report contains the histologic type of cancer and usually the grade of the cancer (how closely the cancer cells resemble normal tissue).
  • Surgical resections can also remove metastatic sites of cancer such as liver metastases.
    • Pathologists don't usually stage metastatic disease unless a metastatic site has been removed.
  • The information from a total resection takes precedence over biopsy reports and operative notes.
    • The final diagnosis of the histological type takes precedence over preliminary reports and frozen sections.
    • The microscopic description takes precedence over the gross description.
  • The most important information in a pathology report, which is required for accurate staging of resected specimens, includes
    • Source of the specimen
    • Primary site
    • Tumor size (tumor size is relevant for many sites, but not all)
    • Histologic type of cancer
    • Grade of tumor (grade is relevant for many sites, but not all)
    • Extent of the cancer within the organ of origin and beyond
    • Regional lymph node involvement, including
      • Type (name of nodes),
      • Total number of regional lymph nodes removed
      • Size (size of the lymph node mets)
      • Location and number of positive (nodes containing tumor) lymph nodes removed
  • The gross description of the specimen should include the total size of the tumor.
  • Both the gross and the microscopic descriptions should state whether the surgical margins are involved by tumor.
  • The pathology report should contain information about the primary site and the spread of the cancer in surrounding tissues. It is important to note all areas, organs, or structures involved with cancer.

Updated: March 4, 2024