New Member : Stage 2

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Lee
Posts: 6207
Joined: Sun Apr 16, 2006 4:09 pm

Re: New Member : Stage 2

Postby Lee » Sat May 27, 2017 5:44 pm

Dlroadruck wrote:Deb M,
I got the chance to ask my doc yesterday about the information that is NOT on the report. He said that the pathologist told him verbally the information that is not on the report (LVI AND PNI). He said he thought the info was going to be added to the amended report but it's not. He said the path must have forgotten. :roll: I am incensed and have very little faith in the report at this point. Grrrrr...I'm trying to stay calm about all this but it gets harder EVERY day!


I would be VERY WORRIED and PISSED at this point too.

Maybe getting a 2nd opinion at a major cancer treatment center may be in order. Sometimes with stage II, too many variables. And like you, at this point I would not trust the report either.

Hope you get answers soon.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: New Member : Stage 2

Postby Beckster » Sat May 27, 2017 8:12 pm

Dlroadruck wrote:Deb M,
I got the chance to ask my doc yesterday about the information that is NOT on the report. He said that the pathologist told him verbally the information that is not on the report (LVI AND PNI). He said he thought the info was going to be added to the amended report but it's not. He said the path must have forgotten. :roll: I am incensed and have very little faith in the report at this point. Grrrrr...I'm trying to stay calm about all this but it gets harder EVERY day!


I would be pissed off too! I would have a second opinion on the pathology report. If he forgot, he might have overlooked other factors. You need to be your own advocate...it is there job to give you a complete report! The below website will give you the different centers throughout the USA.

https://www.cancer.gov/research/nci-role/cancer-centers
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

User avatar
Jacques
Posts: 678
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: New Member : Stage 2

Postby Jacques » Sun May 28, 2017 2:33 am

If you are in the U.S. and are interested in which data elements are required in a colon resection pathology report, you can go to the College of American Pathologists (CAP) web site, and download their 2016 template for Colon and Rectum pathology, which is found in a file named cp-colon-16protocol-3400.

Click on the link below to go to the CAP Cancer Protocol Templates page where all of their pathology templates are listed then scroll down to the ‘Gastrointestinal’ section

http://www.cap.org/web/oracle/webcenter/portalapp/pagehierarchy/cancer_protocol_templates.jspx?_afrLoop=13281812409078#!%40%40%3F_afrLoop%3D13281812409078%26_adf.ctrl-state%3Dtxucf3q0j_4

After you access this part of the web page, you will find two downloadable versions available for the 2016 template for the Colon and Rectum pathology report -- a PDF version and a Word version.

These documents indicate the required data elements for pathology reporting of colon and rectum specimens. Optional (non-required) elements are indicated by a plus sign (+). The elements without a plus sign are required. There are over a dozen required elements for a colon resection report.

According to CAP, the required elements in the template have been mandated by the American College of Surgeons since 2004:

Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the required data elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs


If you look through the document that you download, you can see which elements are required and which elements are optional. Note: MSI testing is one of the optional data elements, so it will not be in your report unless the surgeon specifically requested it when the specimen was submitted. But the main required data elements should all have been reported on in the report, even if only to say something like “Cannot be determined”. This is part of the 2004 mandate, as I understand it.

When you talk to your doctor about the OncotypeDX results, you might want to bring up the issue of the completeness of the pathology report. You might also want to ask about the procedure for obtaining a second opinion on the current pathology report. There are several pathology labs around the country that will do a second opinion, for a fee. The question is whether they need to see the whole original specimen, or can they give an opinion with only the summary slides that have already been prepared. I don't know what the procedure is for pathology report second opinions for resected colon specimens.

- - -

Note: If you get a second opinion from one of the National Cancer Institute Designated Centers, you might get a pathology report that exceeds the CAP standard in rigor and detail. For example, the Stanford Cancer Center has an in-house, default colon/rectum pathology report template that is much more elaborate than the CAP standard:

http://surgpathcriteria.stanford.edu/gitumors/colorectal-adenocarcinoma/printable.html

.
Reminder: In any event, I think you should request, explicitly, to have your tumor specimen tested for MSI, because if it turns out that your tumor is MSI-H, then this has implications for whether certain first-line chemo options will be of much use:
... Importantly, treatment recommendations differ for patients with MSI-high tumors. Studies have shown that patients with stage II disease do not benefit from adjuvant chemotherapy with fluorouracil (5-FU), in part because patients with MSI-high colorectal tumors tend to have an overall favorable prognosis compared with patients who have MSI-low or microsatellite stable (MSS) tumors. In fact, patients with MSI-high stage II disease actually have inferior overall survival (OS) outcomes when treated with adjuvant 5-FU compared with surgery alone.[21]

Ref. [21] Sargent DJ, Marsoni S, Monges G, et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol. 2010;28:3219-26.


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