Dom1991 wrote:A young relative has recently been diagnosed with a large malignant predunculated adenoma in the sigmoid colon. The polyp was completely excised in one clean cut during the colonoscopy which discovered it, and the colon lining was tattoed. The pathology report showed that the cancer had invaded into the bottom half of the polyp stalk, but showed there was a clear margin between the boundary of the cancer and the colon wall lining where the polyp was excised. Would this mean the polyp is a level 3 on the haggitt level? Presumably if it was level 4 then there would be no margin at the bottom of the stalk since the cancer would have passed through the submucosa line of the bowel wall, so would be found at the very bottom of the stalk?
The pathology report was shown to the top pathologist in the hospital and the first thing he said was that they will not die from this. I know nothing in medicine is 100% but i suppose i should take some comfort in this as i doubt the pathologist would make a statement like that unless they were fairly confident.
If there is a margin at the bottom of the stalk but the cancer has still invaded into the stalk, how likely do you think it is that the cancer would invade the lymphovascular system? Would the cancer not have to pass the clear margin at the bottom of the stalk to reach the lymph nodes?
The relative is having a CT and MRI scan next week as a matter of course, and then the doctor has agreed to do a small surgical resection to be absolutely sure that there will be no recurrence. We know the hospital team personally so I suspect that we are being given ultra conservative treatment options.
Any advice much appreciated.
Dom1991 wrote:Hi guys,
thanks so much for your replies it's much appreciated. I need to get hold of the pathology report as i believe i now have a solid base of understanding to read it. One thing which is confusing me is the distinction between the sub mucosa of the predunculated polyp, and the submucosa of the colon wall. Are these separate or the same thing. I guess I don't really understand what the stalk of a polyp really is biologically, and if there is any actual barrier at the bottom of the stalk where the colon wall is. If there is a clear margin of no cancer at the bottom of the excised stalk, then i don't understand how the cancer jumps past this margin? I am guessing it's through lymp vessels or blood vessels which must presumably come into the stalk? Is there a lower chance of the cancer spreading through the vessels inside the stalk, as opposed to say, the vessels below the colon wall.
Thanks again for all advice.
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