How To Read The Pathology Report Of Liver Cancer
Mar 15, 2023
When they get the pathology report, patients usually do not understand its contents, but they are very eager to know what is their situation, so they will always chase the doctor to consult ...... repeatedly. Today, experts will help you sort out what are the most important contents in the pathology report of liver cancer that deserve attention.
1. The type of tumor cells.
2. Number and size of the tumor.
3. degree of tumor differentiation.
4. cancer thrombus.
5. Microvascular invasion (MVI).
6. satellite nodes.
7. surgical margins.
8. Lymph node metastasis.
The above factors can be used to help predict the likelihood of tumor growth and spread, but the presence of high-risk factors does not absolutely equate to recurrence or progression soon, nor does the absence of high-risk factors mean that vigilance can be relaxed.
For the above highlights, common questions include.
1. What are hepatocellular carcinoma, cholangiocellular carcinoma, mixed cell carcinoma, and metastatic carcinoma?
The liver is composed of many different tissue cells, including hepatocytes, bile duct cells, vascular epithelial cells, etc. Hepatocellular carcinoma is a collective term and the pathology report will describe the cell type from which the tumor originates, while malignant tumors of different origins have great differences in clinical manifestations, treatment methods, and prognosis, subdivided into:
(1). hepatocellular carcinoma: tumors originate from hepatocytes, and there are commonly fine beam type, coarse beam type, pseudo glandular duct type, and doughnut type, etc. Tumors of hepatocellular origin account for most hepatocellular carcinomas.
(2). Cholangiocarcinoma: Tumors originate from bile duct cells in the liver, and adenocarcinoma is the most common.
(3). Mixed cell carcinoma: the tumor has both hepatocellular and bile duct cell components.
(4). Hepatic metastases: Tumors formed by malignant tumor cells that occur outside the liver and spread to the liver through blood flow and other pathways, and the specific pathological type is related to the type of extrahepatic lesions. The most common type of liver metastases in colorectal cancer is liver metastases.
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Cistanche has also been shown to have anti-fibrotic effects. Liver fibrosis is a common complication of chronic liver disease, and it can eventually lead to cirrhosis and liver failure. Cistanche helps to reduce the accumulation of extracellular matrix proteins in the liver, which is a key step in the development of liver fibrosis.
In conclusion, cistanche is a valuable traditional Chinese medicine that has been shown to have multiple beneficial effects on liver health. Its antioxidant, anti-inflammatory, immunomodulatory, and anti-fibrotic properties make it an ideal natural remedy for the prevention and treatment of liver disease.
2. How important are the number and size of tumors?
The number and size of accurately recorded tumors can reflect the severity of intrahepatic lesions and also affect the early to moderate staging of tumors. It is important to note that the number and size of tumors reported by preoperative CT or MRI may be different from those described in the pathology report.
3. What does differentiation mean?
Differentiation is the grade of malignancy of tumor cells, which is judged by the pathologist by observing the abnormal degree of tumor cells under the microscope.
Liver cancer can be classified into 3 grades: highly differentiated, moderately differentiated, or poorly differentiated. In addition, it can also be internationally classified into grade I, II, III, and IV according to Edmondson-Steiner's classification from good to poor differentiation.
Highly differentiated means that tumor cells are more similar to normal cells, while hypodifferentiated means that tumor cells appear more primitive and savage, so hypodifferentiated tumors usually grow or spread more rapidly.
4. What is a cancer thrombus?
If tumor cells invade blood vessels or bile ducts and grow when the tumor enlarges to a certain extent, the tumor can be seen in the ducts through the naked eye in CT, MRI, or surgical specimens, called cancer thrombus.
Once the tumor invades the blood vessels or bile ducts to form a cancerous thrombus, it means that the tumor cells can easily spread to other locations in the liver or distant organs through blood flow or bile ducts. Even if the visible tumor and thrombus are surgically removed, there are still tumor cells already free in the body and the risk of recurrence after surgery is high. However, this does not mean that the tumor has definitely spread or is incurable. The risk of recurrence can be reduced to some extent through postoperative adjuvant therapy.
5. What is microvascular cancer embolism (MVI)?
MVI refers to the invasion of blood vessels visible to the naked eye, while MVI mainly refers to the mass of cancer cells not visible to the naked eye but observed in the lumen of tiny blood vessels under the microscope; MVI suggests that a small number of tumor cells have invaded the tiny blood vessels and patients have a higher risk of recurrence after surgery.
These tiny MVI may be distributed in different locations next to the tumor, and microscopic examination can only take samples from several locations for observation, and the detection rate will be affected if the sampling is incomplete. According to statistics, the incidence of MVI in liver cancer is 15%~57.1%.
6. Is the satellite nodule a tumor?
Satellite nodules are also described as sub foci, and as the name suggests, they are mainly small cancerous foci visible to the naked eye or microscopically within the normal liver tissue surrounding the main large tumor. It is thought that satellite nodules originate from MVI and can be diagnosed when MVI and satellite nodules are not easily distinguishable.
The presence of satellite nodules indicates that the tumor begins to spread outward, which may lead to incomplete surgical removal of the entire tumor; therefore, satellite nodules are also associated with postoperative recurrence.
7. What does it mean if my report mentions MVI and satellite nodes?
These results suggest whether the patient has a high likelihood of postoperative recurrence. Most recurrences of hepatocellular carcinoma occur within 2 years after surgery, and for high-risk patients, physicians may schedule a closer follow-up review. In case of unfortunate recurrence, the tumor can still be effectively controlled and the patient's prognosis can be improved by early detection and timely treatment.
8. What is the cut-off margin? What does a positive cut edge mean?
In order to remove the tumor as cleanly as possible, the surgeon will remove the tumor and the surrounding liver tissue together at a certain distance from the tumor. The pathologist further examines the specimen to confirm if there are any residual tumor cells in the liver tissue at the cut line location. If tumor cells are visible at the cut edge, or if the cut edge is positive, it means that there may still be a tumor in the liver that has not been cut cleanly.
In most cases, the surgeon will ensure adequate cut margins in order to achieve radical tumor treatment. Only in a few cases will there be a positive cutting edge, such as when the tumor invasion is so extensive and numerous that the tumor cannot be completely removed; or when the tumor is closely related to the surrounding important blood vessels, bile ducts, and other tissues so that sufficient cutting edge cannot be guaranteed in order to protect the important ducts and organs. In the case of a positive cut margin, patients should communicate with their doctors and consider follow-up treatment options.
9. How to see if there is metastasis in the lymph nodes?
Whether there is metastasis in lymph nodes is an important factor affecting tumor staging, among which the number of lymph node metastasis is more critical.
Lymph node metastasis is rare in hepatocellular carcinoma, and lymph nodes may not be included in the resected specimen. In contrast, liver cancer of bile duct cell origin is more likely to have lymph node metastasis. The surgeon will remove specific locations or suspicious lymph nodes and send them to the pathologist to determine if there is metastasis.
The pathology report includes the exact size and location of the lymph nodes removed, e.g. para portal, paracolic, etc. The number of lymph nodes is expressed as a simple fraction, e.g., 3/12, where the denominator of 12 means that 12 lymph nodes were examined and the numerator of 3 means that 3 of the lymph nodes had metastases.
10. What does the reported mention of liver fibrosis and cirrhotic nodes mean?
Most liver cancers are associated with viral hepatitis, with chronic viral hepatitis B and C account for the majority of cases. Chronic hepatitis causes repeated inflammation and repair processes in the liver, resulting in fibrosis and slow hardening of the liver, forming intrahepatic nodules of varying sizes, a process that usually lasts for 20 years. Some cirrhotic nodules may become malignant and form liver cancer. Therefore, patients with liver cancer are often accompanied by cirrhosis. Cirrhosis can affect the normal physiological functions of the liver.
For patients with hepatitis, the pathology report will also describe the degree of the inflammatory activity of hepatitis and the degree of liver fibrosis, graded from mild to moderate according to G0 to G4 and S0 to S4, respectively. These findings suggest that patients need to be concerned about the changes in liver function.
11. What are the heterogeneous hyperplastic nodules and intraepithelial neoplasia mentioned in the report?
The formation of hepatocellular carcinoma is a process of gradual cellular change from normal to abnormal, which manifests itself in specific forms at different stages, and these forms can be called precancerous lesions. The report will describe the various morphologies seen. If the diagnosis of malignancy is already clear, patients do not need to pay much attention to precancerous lesions.
12. What are the special tests, such as AFP, CD34, CK19, and CD10?
Besides observing the morphological structure of tumor cells through the naked eye and microscope, pathologists need to use special tumor markers to assist in the diagnosis of liver cancer, called immunohistochemical tests. These markers are mainly used to diagnose the origin of the tumor and therefore are mainly for the physician's reference and patients usually do not need to know about them.
A word of caution: In rare cases where the type of tumor is difficult to determine through routine testing, additional immunohistochemical markers may need to be used to clarify the diagnosis. Performing additional immunohistochemical tests may require a supplemental fee for the patient and may also delay the release of the pathology report.
In conclusion, a pathology report is very important information for patients in the diagnosis and treatment of tumor, remember to keep it properly and understand the key points in the pathology report also facilitate patients and doctors to fully communicate their condition, arrange treatment and follow up.
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