If you’ve recently received a kidney cancer diagnosis, you likely have access through your patient portal to your personalized pathology report. A pathology report is a detailed document written by a pathologist—an expert who examines tissue under a microscope. The report you receive after a kidney cancer diagnosis will explain exactly what the pathologist found after examining your kidney tissue. It’s one of the most important tools your care team uses to guide your future treatment.

If you’re not a scientist or trained medical professional, a pathology report can be difficult to parse and understand. Here’s some guidance on how to read it: 

Your personal patient details

This section of the report confirms your full name, your date of birth, and the date your pathology report was read. It’ll also cover the type of specimen the pathologist examined (e.g., partial nephrectomy, radical nephrectomy, core biopsy) and where the sample came from (e.g., right kidney upper pole)

Diagnosis or “Final Diagnosis”

This is the headline of the report. It typically includes:

• The type of kidney cancer, such as:
  • Clear cell renal cell carcinoma (the most common type of kidney cancer)
  • Papillary RCC
  • Chromophobe RCC (a rare subtype)
  • Oncocytoma (benign)
• The tumor size
• The tumor grade (e.g. how aggressive the cells look under a microscope)
• Whether cancer was found at the edges of the removed tissue (e.g. margins)
  

What to look out for when reading this section:

• Your exact cancer type
• If the term is benign, malignant, or indeterminate

Tumor Size

You’ll see your tumor size measured in centimeters. The tumor size helps to determine the stage, as well as how aggressive the cancer may be. It may also guide your earliest treatment options.

Tumor Grade 

Kidney cancers are graded on how abnormal the cells look.

• Grade 1: cells look almost normal; slow-growing
• Grade 2–3: moderate aggressiveness
• Grade 4: cells look very abnormal; more aggressive

Margins

Margins describe whether all visible cancer was removed during surgery. You’ll see words like:

• Negative/clear margins: no cancer at the edges 
• Positive margins: cancer reaches the edge; this means you may need closer monitoring or additional treatment

Pathologic Stage (pTNM)

This is the formal staging system. It has three parts:

T – Tumor

How large the tumor is and whether it has grown outside the kidney.

Examples:

• pT1: confined to kidney, <7 cm
• pT2: still inside kidney but >7 cm
• pT3: growing into nearby veins or fat
• pT4: spreading beyond the kidney

N – Lymph Nodes

Looks for spread to lymph nodes.

• N0: no lymph node involvement
• N1: cancer found in 1 or more nodes

M – Metastasis

Whether cancer has spread to distant organs.

• Often listed as M0 (none seen) unless a biopsy confirms otherwise

Now ask these questions to your doctor

After you’ve had a chance to process the report, make sure you’re prepared to ask your doctor what your specific diagnosis means for you. These are helpful questions to bring to your next appointment, or to ask via your patient portal:

1. What type of kidney cancer do I have?
2. What is the grade and what does it mean for me?
3. Was the entire tumor removed? (Were the margins clear?)
4. What stage is my cancer?
5. Do I need additional treatment or just surveillance?
6. How often should I get scans going forward?
7. Does my tumor have any high-risk features?
8. Should I consider genetic or molecular testing?

Remember that you can always reach out to an oncology nurse practitioner at Outcomes4Me to help you better understand your diagnosis.