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How To Make Sense of Your Colon Cancer Pathology Report


  • A colon cancer pathology report contains information about the disease, such as cancer type, location, degree of invasion, etc.
  • Pathologists derive the information from a tissue sample analysis.
  • A colon cancer pathology report determines treatment options.
  • Early detection can translate to a favorable pathology report. 

Your colon cancer pathology report is a vital document that tells your doctors what type of cancer you have, where it is, how far it has spread in the wall of your colon, and other essential information. Your doctor will determine the optimal treatment for your colon cancer based on the pathology report. 

How Does a Colon Cancer Pathology Report Work?

When a pathologist analyzes a tissue sample looking for cancerous cells, he/she sums up the findings in a colon cancer pathology report. The pathology report describes the cancer in medical terms so other doctors can draw conclusions and form a treatment plan.

Colon cancer patients will most likely never meet the pathologist, but they can learn to interpret what their pathology report says. 

What Is in a Colon Cancer Pathology Report?

Your colon cancer pathology report provides exhaustive information about the cancer. It will contain the following: 

  • A visual description of the tissue sample
  • Details about the site of origin of the sample and how the doctors collected it
  • A microscopic description of the sample
  • Details about the type of cancer cells that may be present in the sample
  • The extent to which cancer has spread in the body
  • Analysis of the lymph nodes for signs of cancer
  • A description of the margins of the cancer-afflicted area
  • A diagnosis 

How do you glean relevant information from your pathology report? You have to make sense of the medical terms doctors use. And for that, you need a guide. 

The Visual Description of the Tissue Sample

The pathologist describes the size, shape, texture, and color of the sample tissue and the tumor. The terms doctors use in the gross description are plain and relatively easy to understand. However, this part of the report isn’t particularly helpful to the patient because it says little about the stage of the disease or possible treatment options. 

The Microscopic Examination

To understand the microscopic description in your colon cancer pathology report, you must learn a few things about the colon. 

The colon consists of several sections. The microscopic description in your report places the cancerous area in one of these sections.

  • Cecum: The beginning of the ascending section of the colon.
  • Ascending colon: The top section of the organ.
  • Transverse colon: The section that goes from the right to the left side of the abdominal cavity.
  • Descending colon: The left side of the colon, reaching from the top bend to the sigmoid colon.
  • Sigmoid colon: The section of the colon that connects to the rectum. 
  • Anus: The exit of the colon.
  • Hepatic and splenic flexures: The two bends in your colon, hepatic flexure on the right and splenic flexure on the left.

The colon is a complex organ. In addition to specifying the affected section of the colon, the microscopic description also details the depth to which cancer has penetrated the colon wall. 

The following layers make up the colon wall: 

  • Mucosa: The innermost layer of the intestinal lining, includes the lamina propria and muscularis mucosa.
  • Submucosa: The layer immediately under the mucosa, includes the veins, arteries, and lymphatic vessels that feed the colon. 
  • Muscularis: Includes three layers of muscle.
  • Serosa: The outermost layer of the colon wall.

Types of Cancer Cells

Ninety-five percent of colon cancer cells are adenocarcinomas. The rest are lymphomas, stromal tumors, or carcinoid tumors.

Adenocarcinoid cells have two subtypes: mucinous and signet ring. These cell subtypes may mean a worse outlook than other adenocarcinoma cells. When doctors talk about colorectal cancer, they are almost always talking about adenocarcinoma cells. 

Tissue samples are often colon polyps that doctors remove through colonoscopy. This part of the colorectal cancer pathology report may describe the polyps. 

Some polyps look like mushrooms hanging off the inner lining of the colon. These are pedunculated polyps and are easier to remove through colonoscopy.

Others are flat. These polyps, called sessile polyps, require surgery to remove. 

Type-wise, polyps can be: 

  • Tubular adenomas are the most frequent.
  • Villous adenomas pose the highest cancer risk.
  • Pseudopolyps can be hyperplastic (overgrown) or inflammatory and are the polyps least likely to turn cancerous. 

Tumor (Histologic) Grade

The histologic grade of the cancer cells tells doctors how deformed they are compared with normal cells. The least differentiated cells are the worst offenders because they spread cancer faster. 

  • Gx: Doctors can’t identify the grade of the cancer cells.
  • G1: These calls are almost normal.
  • G2: These cells are moderately differentiated, meaning they still resemble normal cells. 
  • G3: These cancer cells are poorly differentiated, obviously different from normal cells. 
  • G4: These are undifferentiated cells; they don’t look anything like normal cells. 

Lymphovascular Invasion

Colorectal cancer can spread outside the colon wall and into the surrounding lymph nodes and blood vessels. If doctors notice lymphovascular invasion, cancer has spread to the lymph nodes. If they don’t, it hasn’t spread and remains easier to treat. 

Depth of Cancer Invasion

Starting in the inner lining of the colon, colorectal cancer can spread deep into the colon wall, and through it, to the surrounding tissue.

In the pathology report, the pathologist clarifies the depth of cancer invasion or the stage of the disease. 

  • Stage T1. Cancer in the mucosal lamina propria that has not spread to the submucosa is superficial, early-stage cancer. Such cancers are also called in-situ or pre-cancers.
  • Stage T2. Cancers that invade the muscle layers but not the outermost serosa layer are staged T2.
  • Stages T3 and T4. Cancers that invade the surrounding pericolonic fat tissue are later-stage cancers.

Related: Colon Cancer Stages and What They Mean 

Lymph Node Invasion

Once cancer invades the lymph nodes, it can travel to other organs in the body through the pipeline-like lymphatic system.

During surgery, doctors remove several lymph nodes and analyze them for cancerous cells. The pathology report notes how many of the nodes examined have cancerous cells. 

For example, 2/15 means that the pathologist found traces of cancer in two of 15 lymph nodes analyzed. 

Sample Tissue Margins

Doctors try to make sure that the edges of the tissue they remove through surgery are cancer-free. If the edges are cancer-infected, cancerous cells may have remained in the patient. 

Molecular Markers

Molecular markers present in the blood or other bodily fluids allow doctors to tell how likely it is for cancer to recur. These markers may also hold clues about how well the patient will react to chemotherapy. 

Related: Colorectal Cancer Treatment by Stage

Early Detection and Your Colon Cancer Pathology Report

The earlier doctors detect colorectal cancer, the more favorable your pathology report will be. Regular screening is the key to catching it early.

Home screening is an easy and convenient way to screen for colorectal cancer comfortably and discreetly. Just follow the instructions included in the test kit, send in your specimen, and get your colon cancer test results online. 

eDrugstore Can Help with Screening

We carry home colon cancer test kits that can help you ensure early detection while testing in the comfort of your home. 

Should your colon cancer test results turn out positive, we will provide you with a complimentary doctor consultation to help you determine what to do next.

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