See surgeon Friday for pathology results-what to expect and to ask??

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dontwanttobehere
Posts: 43
Joined: Sat Apr 25, 2015 5:41 pm

See surgeon Friday for pathology results-what to expect and to ask??

Postby dontwanttobehere » Mon May 18, 2015 10:21 pm

Surgery was 5/12/15 and so thankful that is behind me. Feeling better day by day but geesh, I did not feel prepared for how crappy I would feel. Going to see the surgeon Friday to get pathology results. I am interested in what to expect at this visit? Basically he said we'll go over the pathology results. Is his job then over? Do all my follow up questions then get directed to an oncologist? He is a colo-rectal surgeon. I have tried to get an overview without focusing on too many "what ifs". However, I do see that Stage I, III and IV seem to be treated pretty consistently the same. It looks like the Stage II that is the biggest area where there is conflict. Any insight is greatly appreciated. Thank you in advance.
47 y/o; mom to 5,7,16,18 and 20 y/o
4/20/15 had first scope as recommended by OB/gyn due to family history with large mass found at splenic flexure
unable to pass and see the remaining 2/3 of colon
4/22/15 cancer confirmed, MSS, had genetic testing-all negative!
node in lungs, cysts in liver and kidneys ??all benign we hope
5/12/15 left hemicolectomy laprascopically
T3Nb1MX

User avatar
O Stoma Mia
Posts: 923
Joined: Sat Jun 22, 2013 6:29 am

Pathology Report Templates

Postby O Stoma Mia » Tue May 19, 2015 1:32 am

The pathology report is one of the cornerstones determining your final diagnosis. It is used along with any scans that you have already had to determine your TNM code, which in turn is used to determine your stage. Once the doctors (surgeon, oncologist, gastroenterologist ) agree on what your stage is, then they can consult the NCCN "cookbook" of available first-line treatments for your final stage (NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) . The first-line treatment options may be different for rectal vs. colon cancer.

Before going to your Friday appointment, you should read up on TNM staging, since this is what the pathology report is mainly used for. You can review the various TNM codes and associated Stages here:

Colorectal cancer TNM staging

It would also help if you could create a signature to go at the bottom of your posts so that everyone can see what your status is so far. The link for creating and editing a signature is here:

ucp.php?i=ucp_profile&mode=signature

-----------------------------------------------------------------------------------------------
Understanding Your Pathology Report: Colon Cancer
https://www.oncolink.org/cancers/gastrointestinal/colon-cancer/treatments/understanding-your-pathology-report-colon-cancer

Path report -- what information is typically included?
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=49195#p374408

Here's a typical path report template:

    Path Report Template

    Table 2
    Surgically resected specimens of colorectal cancer – Checklist

    Tumor site:
    Cecum
    Ascending colon
    Hepatic flexure
    Transverse colon
    Splenic flexure
    Descending colon
    Sigmoid colon
    Rectosigmoid junction
    Rectum

    Tumor size
    Maximum tumor diameter: cm

    Histologic type
    Adenocarcinoma
    Mucinous adenocarcinoma
    Signet-ring cell carcinoma
    Small cell carcinoma
    Squamous cell carcinoma
    Adenosquamous carcinoma
    Medullary carcinoma
    Undifferentiated carcinoma
    Other (specify):

    Grade of differentiation
    Low grade (well or moderately differentiated)
    High grade (poorly differentiated or undifferentiated)
    High grade component (%):

    Depth of tumor invasion
    No evidence of primary tumor
    Tumor invades submucosa (pT1)
    Tumor invades muscularis propria (pT2)
    Tumor invades through the muscularis propria into the subserosal adipose
    tissue or the nonperitonealized pericolic or perirectal soft tissues (pT3)
    Tumor penetrates to the surface of the visceral peritoneum (serosa)
    (pT4a)
    Tumor directly invades other organs or structures
    (specify:) (pT4b)
    Tumor penetrates to the surface of the visceral peritoneum (serosa) and
    directly invades other organs or structures
    (specify: ) (pT4b)

    Margins of resection
    Proximal/distal margin
    Cannot be assessed
    Invasive carcinoma present
    Invasive carcinoma absent
    Distance of invasive carcinoma from closest margin:
    mm
    Circumferential (radial) margin
    Not applicable
    Cannot be assessed
    Invasive carcinoma present
    Invasive carcinoma absent
    Distance of invasive carcinoma from non-peritonealised margin:
    mm

    Regional lymph nodes
    Number examined:
    Number involved:

    Tumor deposits
    Not identified
    Present (number: )

    Response to neoadjuvant therapy
    Not applicable (no prior treatment)
    Complete regression
    Minimal residual tumor
    No marked regression

    Extramural venous invasion
    Not identified
    Present

    Pathologic staging (pTNM)
    TNM descriptors
    (required only if applicable)
    m (multiple primary tumors)
    r (recurrent)
    y (posttreatment)

    Primary tumor (pT)
    pTX: Cannot be assessed
    pT0: No evidence of primary tumor
    pTis: Carcinoma in situ, intraepithelial or invasion of lamina propria
    pT1: Tumor invades submucosa
    pT2: Tumor invades muscularis propria
    pT3: Tumor invades through the muscularis propria into pericolorectal
    tissues
    pT4a: Tumor penetrates the visceral peritoneum
    pT4b: Tumor directly invades other organs or structures

    Regional lymph nodes (pN)
    pNX: Cannot be assessed
    pN0: No regional lymph node metastasis
    pN1a: Metastasis in 1 regional lymph node
    pN1b: Metastasis in 2 to 3 regional lymph nodes
    pN1c: Tumor deposit(s) in the subserosa, or nonperitonealized pericolic
    or perirectal tissues without regional lymph node metastasis
    pN2a: Metastasis in 4 to 6 regional lymph nodes
    pN2b: Metastasis in 7 or more regional lymph nodes

    Distant metastasis (pM)

    Not applicable
    pM1: Distant metastasis
    Specify site(s):
    pM1a: Metastasis to single organ or site (e.g., liver, lung, ovary,
    nonregional lymph node)
    pM1b: Metastasis to more than one organ/site or to the peritoneum

    Additional pathologic findings

    None identified
    Diverticular disease, ulcerative colitis, Crohn’s disease, familial
    adenomatous polyposis, other forms of polyposis, synchronous
    carcinoma(s) (complete a separate form for each cancer), etc.
    Specify:
    Polyps present (specify type and number):

    Comments

    Reference:
    Recommendations for the Reporting of Surgically Resected Specimens of Colorectal Carcinoma
Last edited by O Stoma Mia on Wed May 24, 2017 11:20 am, edited 1 time in total.
Useful Links:

How to Create a Signature
https://coloncancersupport.colonclub.co ... 97#p421597

How to Find a Board-Certified Surgeon
viewtopic.php?f=1&t=52349&p=410280#p410280

How to interpret a Pathology Report
viewtopic.php?f=1&t=51436&p=399172#p399172

Understanding TNM Staging
http://www.cancer.net/cancer-types/colo ... cer/stages

cathy123
Posts: 665
Joined: Sat Nov 08, 2014 3:36 pm

Re: See surgeon Friday for pathology results-what to expect and to ask??

Postby cathy123 » Tue May 19, 2015 6:25 am

Only thing I would add is to make sure you get a copy of your report so you don't have to rely on your memory. I wouldnt say the surgeons job is over as you shoukd still have checkups on some frequency, but the oncologist should be your primary advisor on whether and what chemo to do.
Cathy

Diagnosed 10/14 low rectal cancer age 43
Clinical T2NXMX
Radiation/xeloda 12/14-1/15
LAR with temp Ileo 3/15
pT2N0M0, lymphatic invasion 0/37 nodes
4 xelox, 1 xeloda only
Reversal 9/15
Mom to 9&11 year olds

dontwanttobehere
Posts: 43
Joined: Sat Apr 25, 2015 5:41 pm

Re: See surgeon Friday for pathology results-what to expect and to ask??

Postby dontwanttobehere » Tue May 19, 2015 12:48 pm

Thanks for all the links and your comments. It is exactly what I was looking for. I have read and printed the links to have with me at appointment.
47 y/o; mom to 5,7,16,18 and 20 y/o
4/20/15 had first scope as recommended by OB/gyn due to family history with large mass found at splenic flexure
unable to pass and see the remaining 2/3 of colon
4/22/15 cancer confirmed, MSS, had genetic testing-all negative!
node in lungs, cysts in liver and kidneys ??all benign we hope
5/12/15 left hemicolectomy laprascopically
T3Nb1MX

orcasres
Posts: 836
Joined: Mon Jul 01, 2013 10:23 pm
Location: Orcas Island, WA

Re: See surgeon Friday for pathology results-what to expect and to ask??

Postby orcasres » Tue May 19, 2015 2:02 pm

I want to emphasize getting a copy of the report. I was diagnosed from a CT scan and was into surgery within a week to remove the tumor in my colon. My surgeon let me know I was stage 2 before I left the hospital, but he wanted me to have genetic testing and to see an oncologist. I had the genetic testing (negative for Lynch) and then saw the oncologist and he really urged me to do FOLFOX. I did not really understand why he did that until I read the pathology report for myself (tumor was medullary which is very rare and there was lymphovascular invasion). I did all 12 rounds, 8 with oxi. Good luck on Friday. Lois
63 yo F
Colon resection Sept. 2010
pT3N0M0 Stage 2A
Medullary Tumor 6.5cm long
Lymphovascular invasion
Lynch negative
12 FOLFOX 11/2010 to 5/2011 8 w/Oxi
NED so far

User avatar
O Stoma Mia
Posts: 923
Joined: Sat Jun 22, 2013 6:29 am

Re: See surgeon Friday for pathology results-what to expect and to ask??

Postby O Stoma Mia » Wed May 20, 2015 2:09 am

I see that you have a signature now. That's good. It will help people understand your situation. You can add the TNM code and the staging information later on when you have the information.

I have a couple of suggestions for your signature:
  • Change 'hemicolectomy' to 'left-hemicolectomy via DaVinci method', to make it more specific.
  • Add 'MSS (Microsatellite Stable) = Lynch negative'.
  • Add 'no ileo' if, in fact, you did not have an ileostomy+bag installed.
  • Add 'node in lung; cysts in liver and kidney' if there is still room in your signature.

For other questions to ask on Friday, I would suggest:
  • Ask for a printed copy of your earlier colonoscopy report and the biopsy report from that.
  • Ask for a printed copy of the surgery report, which should tell if there were any problems with the DaVinci method
  • Ask if they found any polyps during the colonoscopy, and if so what kind -- the serrated ones that look like mushrooms, or the sessile ones that lie flat along the colon wall? It can make a difference, since CT colonoscopy of the right 2/3 of your colon may not be able to clearly identify small malignant sessile polyps since they would be thin and flat. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875919/
      CTC-3D-automated had low accuracy for polyps on folds and small, sessile or flat polyps
  • Ask how much of the colon was removed -- how many cm?
  • Ask how far down the lower cut was. Was it in the rectum or anywhere near the sphincter?
  • Ask if they anticipate any problems with adhesions at the anastomosis junction -- i.e., a situation where one side of the junction fuses with the other side so that the passageway becomes very small and difficult for the passage of stool.
  • Ask about the likelihood of incisional hernias developing along the incisions used by the DaVinci method. This is because of the nature of your job and the possibility that you might provoke a hernia in your normal line of work. (I think it may take many months for the incision site to return completely to normal and to the point where you can do strenuous abdominal exercises.)

Good luck on Friday!

Image

The average colon is about 1.5 m long. Lengths of the various parts are:

* Ascending colon: 25 cm
* Transverse colon: 45 cm
* Descending colon: 15 cm
* Sigmoid colon: 40 cm
* Rectum: 12 cm
* Anal canal: 5 cm
The splenic flexure is thus at around 72 cm from the anal verge.
-----------------------------------------------------------------------------------------------------------------------------------
Useful Links:

How to Create a Signature
https://coloncancersupport.colonclub.co ... 97#p421597

How to Find a Board-Certified Surgeon
viewtopic.php?f=1&t=52349&p=410280#p410280

How to interpret a Pathology Report
viewtopic.php?f=1&t=51436&p=399172#p399172

Understanding TNM Staging
http://www.cancer.net/cancer-types/colo ... cer/stages


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