Is this Cancer or Pre-Cancer??

[IGOT2U]

Hello,
My husband had his 1st colonoscopy at age 52 and was found to have a 40 MM rectal flat polyp which was removed via hot snare. He was told there is a suspicion he has cancer and has been referred to an Oncologist Dr. Jeremy Kortmansky in CT. The waiting is hard not knowing if we are dealing with cancer and at what stage or a pre-cancer. His Pathology is confusing and took longer to get results because I believe the pathologist thought he was looking at 2 different polyps, when it's actually one 40 MM taken out piecemeal. My father just passed in Oct from Stage IV colon cancer after being diagnosed for 6 weeks. So to go through this again is hard and I'm stressed. I appreciate any insight you all might have given your unfortunate experiences.

Here are his Colonoscopy and MRI/Pelvis results.

Colonoscopy Pathology (note: both polyps discussed below are actually from the same polyp. These must have been submitted in multiple segments.)
Rectum polyp biopsy:
Multiple fragments of tubulovillous adenoma with areas of high grade dysplasia and focal areas suspicious for invasive carcinoma (see note)

Rectum polyp, hot snare:
Multiple fragments of tubulovillous adenoma with areas of high grade dysplasia and at lease intramucosal carcinoma (see note)

Note: Discussion with Dr. reveals that part 2 and 4 are biopsies from the same lesion and histologically show similar findings. The polyp reveals multiple fragments of tubulovillous adenoma with high grade dysplasia. In many areas, the architecture of the adenomatous gland is complex with focal cribriforming consistent with intramucosal carcinoma. The sections reveal focal areas of smaller angulated glands and single infiltrating cells in the deeper part of the lesion that are suggestive of stromal invasion, which is at least intramucosal. Some of the single cells in the stroma have the morphology of Paneth cells: however, Innunostain for chromogranin highlights some of these cells suggesting these are likely isolated or small clusters of endocrine cells. Immunostain or keratin also highlights these small clusters of endocrine cells and few other single infiltrating cells. In the deeper part of the biopsy in one fragment near the area of cautery, few mucin pools and floating tumor cells clusters suggesting of superficial submucosal invasion are also identified.

Although definite submucosal invasive carcinoma is difficult to confirm in these biopsy fragments, at least follow up examination with deeper and more biopsies are suggested to exclude an invasive carcinoma. Complete excision of this lesion (possibly with EMR) or resection can also be a consideration, if clinically indicated. The case has been discussed with his Dr.

MRI Pelvis W WO IV Contrast
No definite rectal mass is identified.
There is a 0.7 cm midline prostate cyst, possibly a utricle cyst.
There is a 0.9 cm left superior rectal lymph node. There is no free fluid in the pelvis.
No aggressive osseous lesion.

Impression:
No definite rectal mass identified. There is a nonspecific 9MM superior rectal Lymph node.

[peanut_8]

Hi IGOT2U
Sorry to hear about your situation. Wow, a 40 mm polyp! Sounds like there is a good chance that it is cancer in an early phase. Hopefully it is confined to the polyp itself.

Waiting is never easy, especially with part of the story. It's easy to imagine the worst.

My best advice to you is to find a medical team that you are comfortable with. If surgery is necessary, look for a board certified surgeon. Don't hesitate to get a second or third opinion if you aren't comfortable with what is presented to you.

Once you find out more information let us know. There are lots of really smart, helpful people here with lots of experience in colon cancer willing to offer advice.

Best Wishes,
peanut

[IGOT2U]

Thanks Peanut. My husband just heard the positive in the news that the MRI was all-clear but I can't help but worry and my research doesn't give me any clarity. I know I just have to wait and pray.

[IGOT2U]

My reply to you Peanut disappeared! Thank you. I know we just have to wait and see but I was hoping my Google searches would help me find something that clarified what we are dealing with. My husband see's everything half full which is great but I've learned so much over the past 6 months that I'm terrified. I will wait and pray!

[mypinkheaven]

Although definite submucosal invasive carcinoma is difficult to confirm in these biopsy fragments, at least follow up examination with deeper and more biopsies are suggested to exclude an invasive carcinoma. Complete excision of this lesion (possibly with EMR) or resection can also be a consideration, if clinically indicated. The case has been discussed with his Dr.

I would definitely discuss EMR with the doctor. I think what's troublesome are the areas that were intramucosal - not quite confined to the polyp, but invading the mucosal layer. Best of luck to you and your hubby!

[IGOT2U]

Thanks PinkHeaven. He was told they would have to go in someway or another (initially after colonoscopy was told another in 3 months to confirm clean-edges) but we will see what is recommend Monday. This 1st appointment is with an Oncologist not a Ontological Surgeon.

[LPL]

Hi IGOT2U

So sorry to hear what happened to your father.
And now this worry regarding your husband's polyp - I really understand when you say you are stressed.
I noticed that your husband's polyp was quite big - maybe this article can be of interest for you?
Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence
From (2016) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781909/
Have they taken any blood tests, like for example the biomarkers CEA and CA19-9 ?
Members with better knowledge then me have replied to you and I just want to wish you & your husband
Good Luck at your appointment with the oncologist. /LPL

[IGOT2U]

Thanks for your reply LPL and link to the article. They have not yet taken those blood tests. He does have blood work scheduled tomorrow before our appointment and I will inquire about these 2 specific tests. Hopefully we will learn much more tomorrow. My husband has no symptoms whatsoever which makes this hard to believe.

[Andrea1976]

Sorry to hear. I had a malignant polyp. My was pedunculated - mushroom like. So it was completely removed during colonoscopy and completely biopsy done.

Your husband's was flat - most likely sessil polyp. The bad that it wasn't removed in one piece since they can't tell clear margins. If the cancer cells are only "in situ" then it might be ok just completely remove during colonoscopy. If it's stage 1 than it will require surgery. Because it's not pedunculated with clear margins and 1 piece. You can look at on NCCN guidelines.

Good luck!

[IGOT2U]

Thank you all for your replies to my post. My husband and I met with an Oncologist yesterday. He believes cancer is only in the polyp and likely he is just Stage 0! He had bleeding one week after his colonoscopy and was back in the hospital with bleeding for 2 days. He is fine now and came home a week ago tomorrow. We meet with his Gastro dr. tomorrow and will find out when he'll schedule a Trans Anal Ultrasound. They wanted him to heal a little 1st. Then depending on what that test tells them, there is high hope for a minimally invasive Trans Anal Excision to confirm whether or not it spread to the colon wall. He had a CEA Test but don't yet have results. The Oncologist expects this test to be normal. We are very hopeful! I will keep you all in my thoughts and prayers as well. I've have clicked on many of your profiles and you've all been through so much. I am thankful for all you've shared.

[Andrea1976]

That's great news!!! If it's only stage 0 than it's really pre-cancer and it can't spread. If it's invasive cancer contained in the polyp - that's what I had than it's stage 1 and it can spread. With flat polyp stage 0 - you don't need surgery. If it's stage 1 and flat polyp - you need surgery and check lymphnodes. It should be clear based on pathology report.

[IGOT2U]

I know, it seems like it is great news - right?? I guess they took it out piecemeal during colonoscopy and they aren't sure but said it looks like stage 0 but not to hold him to that. We'll have more waiting to do on the ultrasound + excision then path. The one lymph node that showed up in MRI they think might just be reactive from his colonoscopy and how much they removed. I do feel more positive and have to hold on to that right now. Hubby isn't worried so I shouldn't be either. It's his 52 birthday tomorrow and we've already started celebrating! It's just sad that my father had to pass from this ugly disease for us to all get tested.

[Andrea1976]

It will all depend on complete pathology. I also had superficial invasion to submucosa. We are not talking about submucosa of colon but of the polyp. But the polyp is connected to the colon. That's why in cases of invasive cancer the pathology is really important to indicate surgery or not. If a superficial invasion to submucosa is confirmed than it's invasive polyp cancer. That's what I had and it's considered stage 1 colon cancer - very early cancer. I think I was giving statistics from 1% to 6% of lymph node involvement so I decided not to have the surgery since my polyp was already removed with 2 cm clean margins. I would send your pathology to cancer center for 2nd opinion. That's what I did.

Good luck!