When your lung was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathology report tells your treating doctor the diagnosis in each of the samples to help manage your care. This FAQ sheet is designed to help you understand the medical language used in the pathology report.
1. What is "in-situ carcinoma"?
In-situ carcinoma is a pre-cancer. The normal lung breast is made of air passages (bronchi) that end in a group of blind-ending sacs (acini) where your blood gets oxygenated. Carcinomas start out in the bronchi or acini and when they have not broken out of these structures and are confined to the inner lining of these structures, they are considered "in-situ carcinoma." Once in-situ carcinoma has broken out of the ducts or lobules it is referred to as "invasive" or "infiltrating" carcinoma.
2. What does it mean if my pre cancer is called "squamous cell carcinoma in-situ" or "atypical adenomatous hyperplasia"?
These are the precancers that precedes invasive squamous cell carcinoma and adenocarcinoma, respectively. If they are seen on biopsy, it may mean that there is invasive carcinoma elsewhere in the lung that was not sampled on biopsy. If an excisional biopsy or lobectomy shows only squamous cell carcinoma in situ or atypical adenomatous hyperplasia , the prognosis is excellent, although there may be other noncontiguous areas (skip areas) of the precancer.
3. What is "squamous metaplasia"?
When the air passages are irritated, the lining cells change their shape so that they are stacked on top of each other, a reaction called "squamous metaplasia". When the irritation disappears as for example when you stop smoking or a pneumonia clears, the lining returns to their normal state. Squamous metaplasia is not considered a pre-cancer, but if the irritation persists it can progress to "squamous dysplasia".
4. What is "squamous dysplasia"?
Dyplasia is an early form of precancer. It is often broken down into "mild dysplasia", "moderate dysplasia", or "severe dysplasia". The more severe the dyplasia the more it is similar to "squamous cell carcinoma in-situ". If it is seen on biopsy, it may mean that there is in-situ or invasive carcinoma elsewhere in the lung that was not sampled on biopsy.
5. What if my report on carcinoma in-situ or atypical adenomatous hyperplasia mentions "margins" or "ink"?
When an excisional biopsy (wedege or lobectomy) is performed, the pathologist coats the outer aspect of the specimen with ink, sometimes different colored ink. If precancer extends to the ink, it may mean that it has not been completely removed, depending on what additional specimens the surgeon may have removed. Typically additional treatment (surgery or radiation) is used to get rid of the residual precancer. Management of precancerous lesions at a margin is best discussed with your treating physician.
6. What does it mean if my report also says any of the following terms: "scarring", "emphysema", "emphysematous changes", or "inflammation"?
All of these terms are non-cancerous things that the pathologist sees under the microscope and usually are of no great importance when seen on a biopsy where there is cancer.
7. What if my report mentions any of the following: "granulomas", "methenamine silver (GMS)", "acid fast bacilli (AFB)", or "Periodic Acid Schiff (PAS)".
Granulomas are structures seen under the microscope that are often, although not necessarily, an indication of certain types of infection. These types of infections can be detected with special stains (ie. GMS, stains for AFB, and PAS) that the pathologist can apply to the slides. While most granulomas are infectious, other causes will be considered by your physician, including sarcoidosis, allergic reactions, and dust induced lung disease (pneumoconiosis).