Understanding Ovarian Cancer Surgery and Pathology Reports

A Guide to Making Sense of Common Ovarian Cancer Diagnostic Reports

How to read your ovarian cancer surgical and pathology reports. Istockphoto.com/Stock Photo/XiXinXing

How can you understand your ovarian cancer surgery and pathology reports? Radiology reports and scans of various types of ovarian cancer can note that you have an abnormal looking area or a mass or enlargement of an ovary, but they cannot say definitively that you have cancer. For a diagnosis to be certain, a biopsy or at least cytology (evaluation of fluid or tissue removed by needle aspiration) is required.

The two most important reports to consider are the operative (surgical) report if a surgery or biopsy is done, and the pathology report.

You can and should request copies of your operative and pathology reports from your doctor. Here is the straight skinny on how to decode the most important parts.

The Surgical Operative Report

Sometimes an operative report can be very long and rambling and sometimes it can be very brief and to the point. However, only a few points are critical to search for if you are found to have ovarian cancer.

Early Ovarian Cancers

If the cancer was thought to be early and only the ovary or ovaries and uterus were removed, was adequate staging done? This means if the surgeon did not see anything more than an enlarged ovary, did they look around and do washings for cytology, biopsy lymph nodes, omentum (a fatty carpet-like structure overlying the intestine) and several areas of the peritoneum (the internal skin lining of the abdomen)?

Did they look for and biopsy any suspicious looking nodules or other abnormal masses? If the cancer was "mucinous," was the appendix removed?  This article discusses ovarian cancer staging to help you read your report.

The operative report should describe some effort by the surgeon to look around and perform the biopsies noted above.

If it does not and the pathology report does not contain the above-noted biopsies, you did not have adequate staging. This means that the stage of your cancer is uncertain, which means that it will be difficult to determine the best post-operative treatment.

It is possible that the surgeon was caught by surprise and/or the intraoperative (during surgery) frozen section biopsy was not accurate and did not confirm cancer. Regardless, even if it was an honest omission, not knowing the stage makes it difficult to determine the next step. Review your operative report and pathology report to see what was actually done.

Advanced Ovarian Cancers

If more advanced cancer was uncovered, the main thing to glean from the operative report was how much cancer was left behind and where. Look for terms that note optimal or suboptimal cytoreduction or de-bulking. Optimal means that less than one centimeter (marble size) nodules were left behind. Suboptimal means that larger nodules were left behind. Ideally, microscopic disease or "miliary" disease (sand-paper granule size) areas were left behind. It is not always possible to remove all of cancer, but how much was left behind is very important to know.

If the surgery was optimal, then you are in great shape. If the surgery was sub-optimal, and a gynecologic oncologist was not present for the surgery, you may need a second opinion and possibly another surgery. If they make no mention of the difference between optimal and suboptimal, you definitely need a second opinion.

The Pathology Report

The main thing to look for in a pathology report is what kind of cancer do you have? It may be generally classified as ovarian cancer, but there are a number of subtypes. The main distinctions are between epithelial adenocarcinoma (the most common form) and germ cell or sex cord stromal cancer.

The latter two are covered in other areas on this website.

Epithelial adenocarcinoma can be further broken down into other "histologic" cell sub-types, but the treatment plan is usually very similar. The other main point to glean from the pathology report is the "grade" of the tumor, which reflects how ugly and abnormal the cells look under the microscope.

Discovering the stage and grade of ovarian cancer are the two most important variables to find between the operative report, the pathology report and your discussion with the surgeon.

Talking to Your Doctor

Ask your doctor to carefully explain your surgical and pathology reports to you. Here are some questions about ovarian cancer which you may wish to ask. Be your own advocate in your cancer care. Keep in mind that treatments for cancer are continually improving, and you are not a statistic. Surround yourself with people you love and support you in the decisions you make. You are worth it!