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Pathology - Hematology

Most cancers are detected by procedures that allow a blood sample to be tested by a hematology specialist; or a tissue sample to be sent to a pathology laboratory for evaluation under a microscope.  Cancers of the blood, such as leukemia, are normally detected through blood samples.  Other types of cancer will require a fine or core needle sample, and/or endoscopic, incisional, bone marrow, or excisional biopsies.  It is common for the pathology or hematology report results to take several days to be delivered to the patient, in the US.  The pathology report or blood test results will set the foundation for your treatment decisions and the oncology treatment suggestions that you will receive.  It is extremely important to the proper care of your cancer.  

When a tumor sample is sent to a pathologist, the first question he needs to answer is if it is indeed a neoplasm and if it is from the organ site listed in the surgical report.  If it is, he further questions whether it is benign or malignant.  For almost every malignant tumor, there is a benign counterpart.  The next step is to determine what the structure of the tumor is - epithelial, astocytic, myxoid, etc..  Next the pathologist must try to determine the stage of the tumor involvement - has it metastasized, is there perineural involvement, etc..  The pathologist must also determine whether the surgeon was able to achieve clean margins - a clear area of tissue around the sample that is non-cancerous.  

It is important to note the confusion that may result in the pathology of rare cancers.  Practicing pathologist, may, or may not, have seen your cancer before.  I was told that my cancer had only been seen once before in the laboratory that processed my pathology sample, and not by the current staff.  Many rare cancers have variants.  Some rare cancers cannot be seen with a small sample, such as needle biopsies.  These situations further complicate the job of the pathologist.  It is for these reasons that a pathologist may conservatively label a lesion "atypical," "suspicious," or "can’t rule out".  It is always wise, in the case of known or suspected rare cancers, to ask for an independent pathology report or blood test report from another facility.  It is also wise to ask that a sample of your tumor be kept for further testing, if needed.  The laboratory will store your sample for you in an appropriate medium. If for any reason it is suggested that you have further testing done for your cancer, that sample will be available.  

Your Pathology Report

I highly recommend that you obtain a copy of your pathology report.  Not only will it help you to make informed decisions of your future cancer treatments, but it is always easier to have a copy to take with you to any specialists you may be seeing in the future.  I keep all four of my reports in a notebook along with other medical reports done during my cancer treatments.  The report will most likely include:

» Your name and associated individual identifiers (age, patient number, etc.).

» A patient disease history which usually explains why the biopsy was done.

» A gross description of the specimen removed and received by the pathologist, which may include size, feel, weight, and margin descriptions.

» The diagnosis which usually includes the histology, stage, grade, spread, neural involvement, and any pertinent tumor markers.

» The name and signature of the responsible pathologist, along with the name and address of the lab.

The elements of this pathology report will enable you or your oncologist to do further research on your rare cancer.   It will help you to know if further testing for tumor markers or genetic markers needs to be done on your tumor sample.  I strongly suggest that you discuss the elements of this report with your oncologist and ask every question that you would like answered.  If your oncologist does not have an answer, ask them how you should proceed in order to get your questions answered.  To read more online, visit these pages:  

Breast Cancer Organization - understanding your pathology report.

Cancer & Careers Taking Charge Series - reading your pathology report

John Hopkins - what happens to your tissue specimen in pathology?