The Colon Club

I see the surgeon tomorrow. But I talked to my primary doc today and she gave me the results of my latest biopsy. Since this is not her expertise she could not really explain it to me. It came back as a tubular adenoma with focal high grade dysplasia. The word villous was also mentioned. The tumor is 3cm in my rectum. This was the second biopsy, the first did not show the high grade dysplasia. If anyone has any insight or information that would be helpful I would really appreciate it. I'd like to be as prepared as possible for my appointment tomorrow. I know the surgeon is convinced it's cancer and I suspect she's going to try to convince me to do more biopsies, but I'm tired of the waiting game I need to know if Ihave cancer or not. 2 docs told me they were certain it was cancer (the surgeon being one of them) the third doc who did the latest biopsies told me he was hopeful it wasn't. Do you know if they could just do an excision and get the whole thing out and then send it to pathology or would that complicate things if it did turn out to be cancer and I needed surgery? It's been a week now since this all started and I still have no answers. Any help anyone can give me would be greatly appreciated. Thanks.

I don't know much about colon dysplasia. Dysplasia means the cells are abnormal. But dysplasia is not cancer.

I had high grade cervical dysplasia which advanced quickly to in situ. Most high grade cervical dysplasia will advance to cancer if not treated (and sometimes even when treated, like mine did). But with colon cancer being slow growing, it may be quite different.

Good luck at your appointment tomorrow.

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.

Jaynee

It's precancerous cells. Like cervical dysplasia, which is precancerous.

that is exactly what all my biopsies said--focal high grade dysplasia although it also said suspicious of malignancy due to the high grade of atypia, so i had it removed via endoscopic resection. Then the pathology came back that there was a grade 3 of 4 T1 cancer inside of it. We were all shocked as it did not have the appearance of a cancerous polyp/tumor at all. I then went on to have a resection with 1 lymph node positive, so glad i went agressive as i would not have known about the lymph node and would not have had chemo or radiation. It could go either way here. I have friends who had very large polyps removed and theirs turned out to be totally benign. Good luck to you.

There was questions as to whether or not my tumor was dysplasia or cancer. I elected to go the cancer route, chemo/rad....and at the time of my surgery it was graded a stage II. Get all the tests possible, which seems to be the path you're taking. I decided to proceed with caution after different opinions and consults. Good luck with your decision, not an easy time.