Prognosis

A prognosis is a doctor’s best estimate of how a disease might progress and your likelihood of recovery. Doctors commonly discuss prognosis with patients after diagnosing cancer, although the term can apply to any medical condition.

If a disease is expected to respond well to treatment and is likely to be cured, it’s usually described as having a “good” prognosis. Conditions with a good prognosis typically do not directly cause death. In contrast, a disease described as having a “poor” prognosis is more likely to recur (come back), metastasize (spread) to other parts of the body, or potentially result in death.

What factors affect prognosis?

Many factors can affect a disease’s prognosis. Important ones include:

• Type of tumour: Some tumour types respond better to treatment than others.

• Size of the tumour: Smaller tumours generally have a better prognosis.

• Location of the tumour: Tumours in certain locations might be easier to treat than others.

• Stage at diagnosis: Early detection often leads to a better prognosis.

• Spread (metastasis): Whether cancer cells have spread to other body parts significantly affects prognosis.

• Your age and overall health: Younger patients or those in better health often have a better outlook.

What are prognostic factors?

Prognostic factors are specific features identified in tissue samples or medical tests that help predict how a disease is likely to behave. One of the main roles of a pathologist—who examines tissue samples under the microscope—is identifying and documenting these factors in your pathology report. Your doctor uses this information to plan treatment and explain your disease clearly to you.

Important prognostic factors commonly found in pathology reports include:

• Histologic type: The specific type of cancer cells identified under the microscope.

• Tumour size: Generally, smaller tumours indicate a better prognosis.

• Tumour grade: How abnormal the cancer cells look and how quickly the tumour is likely to grow.

• Differentiation: How closely cancer cells resemble normal, healthy cells. Well-differentiated tumours usually have a better prognosis.

• Invasion: How deeply the tumour has grown into surrounding healthy tissue.

• Perineural invasion: Whether tumour cells have spread along nerves.

• Lymphovascular invasion: Whether tumour cells are present within blood vessels or lymph vessels.

• Mitotic activity: How quickly the cancer cells are dividing and multiplying.

• Margin status: Whether cancer cells are found at the edge (margin) of the tissue removed by surgery. Tumours with clear margins generally have a better prognosis.

Questions to ask your doctor

If your doctor mentions prognosis or prognostic factors, you might want to ask:

• What is my prognosis, and what does it mean for my treatment options?

• What specific factors are influencing my prognosis?

• How do these prognostic factors affect my likelihood of recovery or recurrence?

• Are there any lifestyle or treatment options that can improve my prognosis?

Understanding what prognosis means and what influences it helps you actively participate in your healthcare decisions and treatment planning.