High grade dysplasia simply put means that your tumor is precancerous. It MUST come out but as of yet, it is not cancerous. However, there is a chance that while the exterior portion of the mass (the part where they took the biopsy) is precanerous, the inside part may be cancerous. Bad analogy but think of an M & M. It could be that the center of the tumor (chocolate part) is cancerous but the outer part (candy part) shows up as precancerous. I know that we have talked about this but the one thing you haven't mentioned is how high up in the rectum this tumor is. You had mentioned that it is close to the sigmoid area so that's relatively high up.
IF that is correct, then you should be able to have it excised via TEM. If it is lower down, then it could be excised either by TEM or simply by a full thickness transanal excision. Either way, it is perfectly appropriate with a biopsy that does not show cancer to have the mass excised. In addition, you said that the ultrasound performed today showed this mass to be a T1 and that no nodes showed up. Since the ultrasound is fairly accurate for both of those categories, this would put you (IF you had a cancerous biopsy) at a very early stage I and again, for that stage, an excision is a perfectly viable option. It is perfectly fine to want an excision, see what the pathology from that shows and then proceed from there. You have two scenarios. IF, upon a pathological examination, the tumor does prove to simply be nothing more than a precancerous mass, then the excision would be all that was necessary. If, after an excision the tumor turned out to be cancerous and a T1, and clear margins were achieved, then an excision would be a perfectly acceptable option for that stage. Since you have the ultrasound report that unequivocably shows that the mass is a T1, no nodes are present, you really can't go wrong with requesting the excision. If the path report comes back with something other than expected, you can always consider more radical surgery if the situation warrants. Right now, in my opinion, with what you have to go on, I would opt for the excision and treat it as a more thorough biopsy. It certainly doesn't complicate things in any way, shape or form and a good doctor, faced with the situation that has presented itself should NOT want to go ahead and do a radical surgery based on a hunch. Pathology reports don't lie and yours have twice now come back showing no cancer. The recovery from an excision is minor and since from everything you've said, it sounds like this was caught very very early, IF it should turn out that you did need more surgery, waiting an extra week to take the safe route isn't going to compromise, complicate or hurt anything.
6/22/06 IIA rectal cancer
6 wks rad/Xeloda
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 mths Xeloda only - blood clots 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
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