Ovarian Cancer: Decoding and Interpreting Operative and Pathology Reports

Radiology reports and scans of various types 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 to make a diagnosis. The two most important reports to consider are the operative 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.

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 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?

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 intra-operative (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.

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 sub-optimal cyto-reduction 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 the 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.

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

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