Suspicious for malignancy

The term suspicious for malignancy is used by pathologists to describe findings that strongly suggest cancer but lack enough clear evidence to make a definitive diagnosis. When this term appears in your pathology report, it means the pathologist sees some features of cancer in your tissue sample but needs more information or additional testing before confirming a diagnosis.

When do pathologists use the term suspicious for malignancy?

Pathologists use the term suspicious for malignancy when a tissue sample has certain features that typically occur in cancer. However, not all the features needed for a conclusive diagnosis are present. This situation may happen when:

• The tissue sample is very small, as is common with some biopsies.

• The cells look unusual or abnormal, making them difficult to classify as cancerous or non-cancerous.

This term is especially common when examining cytology specimens, such as those obtained through a fine needle aspiration biopsy (FNA). An FNA often provides only a small number of cells, which can limit the pathologist’s ability to definitively identify cancerous features. In these cases, pathologists frequently use the term suspicious for malignancy to convey their strong concern for cancer while recognizing that more tissue or additional tests are needed to make a certain diagnosis.

Using this term indicates the pathologist’s concern about the possibility of cancer, while acknowledging that more evidence is needed before making a definite diagnosis.

Can something described as suspicious for malignancy be benign?

Yes. Sometimes, tissues described as suspicious for malignancy can turn out to be benign, meaning they are not cancerous. Certain benign conditions or changes in the body can mimic cancer when viewed under a microscope, making it challenging for pathologists to distinguish between cancerous and non-cancerous conditions based on limited initial information.

The term suspicious for malignancy highlights the need for further tests or follow-up to confirm or rule out cancer.

What additional tests might be performed?

If your pathology report says your tissue is suspicious for malignancy, your doctor may recommend additional tests to clarify the diagnosis. These tests might include:

• Immunohistochemistry (IHC): This test uses special stains that identify specific proteins in the cells, helping pathologists determine exactly what type of cells are involved and whether they are cancerous.

• Molecular tests: Tests such as fluorescence in situ hybridization (FISH) or next-generation sequencing (NGS) look for genetic changes commonly seen in cancer, which can confirm or exclude a cancer diagnosis and guide treatment decisions.

• Additional biopsy or surgery: A repeat biopsy or surgery can provide a larger tissue sample, giving pathologists more cells to examine closely under the microscope. This extra tissue often helps them reach a clear diagnosis.

These additional tests are critical to distinguishing between benign and malignant conditions, ensuring accurate diagnosis and appropriate treatment planning.

What should happen next if my report says suspicious for malignancy?

If your pathology report uses the term suspicious for malignancy, your doctor will discuss the next steps with you. Possible next steps may include:

• Performing additional tests such as immunohistochemistry or molecular testing.

• Repeating the biopsy procedure to gather more tissue.

• Surgery to remove the suspicious area completely for thorough examination.

The ultimate goal is to confirm whether cancer is present and, if so, identify its type and stage. This allows your healthcare team to create a personalized and effective treatment plan.

Questions to ask your doctor

If your pathology report mentions the term suspicious for malignancy, consider asking your doctor these questions:

• What does this finding specifically mean for me?

• What additional tests or procedures do I need next?

• If cancer is confirmed, what treatments will be available?

• How soon will we have a definite answer?

Understanding what suspicious for malignancy means can help you feel more prepared, informed, and involved in your healthcare decisions.