What the words in your biopsy or surgical histopathology report actually mean — explained in plain language.
Receiving a pathology report is one of the most anxious moments in a cancer journey. The report is full of medical terminology that can be impossible to interpret without guidance. This guide explains the most common terms you will encounter in a head and neck cancer pathology report.
This guide is for education only. Always discuss your specific pathology report with your surgeon — the implications depend on your individual case, not just isolated terms.
Squamous cell carcinoma (SCC) — the most common type of head and neck cancer, arising from the lining cells (squamous epithelium) of the mouth, throat, or larynx. Over 90% of oral and throat cancers are SCC.
Adenocarcinoma — arising from glandular tissue. More common in salivary glands and the sinuses.
Adenoid cystic carcinoma — a specific salivary gland cancer known for slow growth, perineural spread, and a tendency for late recurrence.
Mucoepidermoid carcinoma — the most common malignant salivary gland tumour, ranging from low to high grade.
Grade describes how abnormal the cancer cells look under the microscope — essentially, how different they are from normal cells.
Well differentiated (Grade 1) — cells look relatively normal. Generally slower growing, better prognosis.
Moderately differentiated (Grade 2) — intermediate appearance and behaviour.
Poorly differentiated (Grade 3) — cells look very abnormal. Generally more aggressive behaviour.
Margins describe the tissue at the edge of the surgical specimen — the boundary between what was removed and what was left behind.
Clear margins / Negative margins / R0 resection — no cancer cells at the edge. The most important prognostic factor after surgery. Aim of every cancer operation.
Close margins — cancer cells present within 5mm of the edge. May or may not require further treatment depending on site and other factors.
Involved margins / Positive margins / R1 resection — cancer cells present at the cut edge. Significantly increases risk of local recurrence. Usually requires adjuvant radiation or re-operation.
pN0 — no cancer in lymph nodes examined. Good prognostic sign.
pN1, pN2, pN3 — increasing degrees of lymph node involvement. Affects staging and adjuvant treatment decisions.
Extranodal extension (ENE) — cancer has broken through the capsule of the lymph node into surrounding tissue. A high-risk feature that strongly indicates the need for adjuvant chemoradiation.
Lymphovascular invasion (LVI) — cancer cells seen in blood vessels or lymphatics within the specimen. Indicates higher risk of spread.
Perineural invasion (PNI) — cancer cells spreading along nerve sheaths. Associated with higher local recurrence risk, particularly in adenoid cystic carcinoma.
T (Tumour) — size and extent of the primary tumour. T1 is smallest, T4 is most advanced.
N (Nodes) — lymph node involvement. N0 = no nodes, N3 = extensive nodal disease.
M (Metastasis) — distant spread. M0 = no distant metastasis, M1 = distant spread present.
The combination of T, N, and M gives the overall Stage (I–IV). Stage I and II are early; Stage III and IV are advanced.
Ki-67 — a marker of how rapidly cells are dividing. Higher Ki-67 = more rapidly growing tumour.
p16 positive — a surrogate marker for HPV infection in oropharyngeal cancers. Associated with better prognosis.
Depth of invasion (DOI) — particularly important in oral cavity cancers. Deeper invasion increases staging and the recommendation for neck dissection.
Your pathology report determines whether adjuvant treatment (radiation or chemoradiation) is recommended after surgery. This decision is made at a multidisciplinary tumour board meeting involving your surgical, radiation, and medical oncologists.
WhatsApp your pathology report to our coordinator — Dr. Narayana will review and respond within 4 hours.
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