Читать книгу Overcome the Challenges of Cancer Care - M. D. Rosenberg - Страница 16

The tissue from a biopsy is sent to a pathologist. Pathologists are doctors who specialize in diagnosing or identifying tissue. When we ask, “What is that mass?” a pathologist may help solve the mystery.

Pathologists do this by looking at the tissue under a microscope and staining the tumor with special dyes. These dyes stain certain proteins. For example, a woman’s breast tumor may stain positive for the estrogen receptor (ER) or progesterone receptor (PR)—proteins related to female hormones. This staining gives us information about how a cancer may behave and how to treat it.

Pathologists also comment on how abnormal the cells look. They do this by assigning a grade to the tumor. Tumor grading is typically on a scale of 1 to 4, but the scale depends on the tumor type. The more abnormal the cells look under a microscope, the higher the grade a pathologist will assign the tumor. In general, high-grade tumors behave more aggressively. They tend to invade normal structures near the tumor and may even spread more often.

One example of the importance of tumor grading is in brain tumors (gliomas). In a low-grade glioma (grade 1) cancer cells appear more like normal brain cells under the microscope. Patients often have a very good prognosis (depending on the exact cancer type). Grade 4 gliomas are brain tumors that look very abnormal under a microscope. These tumors tend to grow rapidly and require aggressive treatment and often have worse long-term outcomes. Certain cancers have special grading systems. For example, in prostate cancer, tumor grading uses the Gleason score (see the glossary for details).

Finally, as technology has improved, more and more tumor samples are getting sent out for genetic analysis. Genetic testing looks for mutations in the DNA of a cancer. We look to see whether these changes make the cancer vulnerable to a certain treatment. This approach is being used across a range of cancers.

Although patients want answers right away, the results from these tests take a few days. Patients should expect to wait at least two to five days after a biopsy to get results. There are some special genetic tests that may take longer (sometimes weeks). The doctors should discuss that with you and your family before any biopsy or surgery. If there is any question about time frame of results, ask!

After the pathologist checks tissue from the biopsy, they decide what type of cancer it is—if any. Many cancers have fancy scientific names. The details aren’t critical, but understanding the general type of cancer is important. Even if you don’t remember all the details, I encourage you to write down any fancy scientific names and have them easily available for future doctor visits.

Patients and family members should write down and remember the name of the cancer from the biopsy. (We’ll go over a system of organizing this information later on.) Not knowing the type of cancer they have is a mistake many patients make.

Note that it’s common for biopsy results to come back inconclusive. This doesn’t mean that anyone messed up. Sometimes we need more tissue to make a diagnosis. If this happens, don’t be discouraged; discuss with the team what the next steps should be.