Oncology literacy 101: Diagnosis

Make use of Sr Rowan Robinson’s beginner’s guide to becoming more fluent in the language of cancer.

When my mother was diagnosed with ovarian cancer many years ago, our family was dragged into a world that spoke a new language. A language that we didn’t understand or want to have to learn. 

As a young girl, I remember being bewildered by the assortment of healthcare providers and the secret code in which they communicated. 

My mother started her treatment being ill-prepared for the journey ahead and too frightened to ask too many questions in case she was labelled a ‘difficult patient’. 

Nowadays we have information at our fingertips (perhaps too much) and we can better prepare ourselves with a basic understanding of terminology, giving ourselves the confidence to ask questions and be prepared for more detailed discussions with our doctors and nurses.

The biopsy

If you’ve recently been diagnosed, the chances are that you have already met an impressive number of healthcare providers. It’s often the surgeon (a medical doctor who has additional qualifications to perform surgery) who removed a sample of tissue (a biopsy) from your body. 

This biopsy would’ve been sent to a laboratory and studied under a microscope, by a pathologist (a specialist doctor who examines tissues and fluids and assists the healthcare team in making a diagnosis).


Our bodies are made up of several different types of tissues, each with its own function. Think about your muscle, bone or even blood as examples of how varied our tissues are. 

On closer inspection under a microscope, you would see that our tissues are made up of collections of specific types of cells. Each having a distinct function and lifespan. 

Most cells are programmed to duplicate themselves in a controlled way at the right time to replace old or injured cells. After a finite number of times copying themselves, the cells would naturally die of old age. This cell duplication is called mitosis. 

Under the right conditions, the parent cell makes a copy of itself, checks that it has done so correctly before dividing into two cells, creating an identical daughter cell. Both parent and daughter cells continue to perform their function as needed and only copy themselves again when required to do so. If a cell hasn’t copied itself correctly, it fails one of the safety checks and if the mistakes are too severe to be corrected, the cell is instructed to commit suicide. 

The formation of cancer

For a pathologist, cells are usually easily identified. For example, breast cells taken from a breast biopsy. However, the pathologist may be presented with a tissue sample made up of cells that look extremely abnormal. Cells that haven’t made good copies of themselves and the daughter cells aren’t identical replicas of the parent cells anymore. 

For reasons unknown, these badly copied cells have managed to escape the safety checks during mitosis. As a result, badly copied cells have managed to undergo mitosis to create even more badly copied cells. This abnormal and uncontrolled growth has led to the formation of a cancerous (malignant) tumour. 

Name of cancer

The type of cancer will be named after the tissue in which it first originated. In some rare cases, the pathologist is unable to identify the origin of the mutated cells and then a diagnosis of ‘carcinoma of unknown primary site’ is made.

Grade of cancer

The pathologist will also grade the tissue sample. Grading systems depend on the type of cancer. However, generally a sample of tissue is evaluated based on the degree that the tissue has become abnormal or how much it still resembles the original tissue. 

If the abnormal cells still resemble the parent cells and haven’t been copied too badly, the tumour is referred to as being well-differentiated (grade I or low grade) or moderately-differentiated (grade II). If the abnormal cells have mutated or changed so much that they aren’t easily recognised, it’s referred to as being poorly-differentiated (grade III) or undifferentiated (grade IV or high-grade) with little resemblance to the original tissue. High-grade tumours tend to grow more rapidly and spread more easily than low-grade tumours.

Nowadays being able to say that the cancer cells originated in the breast, or in the colon, isn’t specific enough, as there are different sub-types of cancers. 

To make a precise diagnosis, the pathologist will perform tests on the tissue sample, looking at the biological features (biomarkers) or changes in the genetic material of the cells making up the tumour. Biomarkers can be present (positive) or absent (negative) in the cancer and this information is used to help guide treatment options.


Next is to check how far the disease has progressed. The cancer may still be localised or may have started spreading to other organs in the body (metastasis). 

There are different ways of staging but often the size of the tumour, whether the cancerous cells have started spreading to the regional lymph nodes and whether there is any evidence that the cancer cells have migrated off to other distant organs is considered.


Once a diagnosis is made, the patient is usually referred to an oncologist (a doctor who has further specialised in the diagnosis and treatment of cancer). He or she will use the information gathered, including the tumour grade and stage, as well as other factors, such as your age and general well-being to determine a prognosis. The prognosis is the likely outcome or course of a disease which includes the chance of recovery or recurrence.

Your oncologist is the best person to discuss your disease with and recommend treatment options. This sounds like a frightening conversation to have and many patients say that they are so overwhelmed by the situation that they don’t hear or understand what was said. It may be helpful to take a trusted family member or friend to the consultation, to take notes and remind you of questions that you wanted to ask so you can understand your diagnosis properly.

Remember there is also a team of oncology nurses and navigators who are there to support you and answer any additional questions you may have.


American Joint Committee on Cancer (2010). AJCC Cancer Staging Manual. 7thEd. New York, NY: Springer.

Korn, W.M. (2020). “What are biomarkers and precision medicine in oncology?”. Available from: https://conquer-magazine.com/issues/special-issues/may-2020-biomarkers-genetic-testing. [3 July 2020].

Vogel, W.H. (2011). “Diagnostic evaluation, classification and staging”. In: C.H. Yarbro, D. Wujcik, & B. H. Gobel, Cancer nursing: principles and practice, 7thEd. Massachusetts: Jones & Bartlett., pp. 166-197.

Sr. Rowan Robinson is an oncology/haematology nurse and educator with over 20 years’ experience. She currently leads a team of oncology nurse navigators at the Cancer Care Division of Netcare Ltd. She is passionate about caring for patients with cancer and finding ways to improve their journey within the healthcare system.

MEET THE EXPERT – Sr Rowan Robinson

Sr Rowan Robinson is an oncology/haematology nurse and educator with over 20 years’ experience. She currently leads a team of oncology nurse navigators at the Cancer Care Division of Netcare Ltd. She is passionate about caring for patients with cancer and finding ways to improve their journey within the healthcare system.

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