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.
A "malignant adenoma" is called adenocarcinoma. Does the pathology report actually say adenocarcinoma? If not, it is not cancer yet.
The term cancer is unfortunately overloaded in many medical contexts. I suspect what you are confused about on the pathology is alternatively called "carcinoma in situ", "pre-cancer", and sometimes "non-invasive cancer". At the end of the day, this type of neoplasm can be removed before it becomes adenocarcinoma. As long as it is removed, it will not become cancer.
Regardless, I would advise genetic testing to make sure he/she doesn't have a pathological mutation, like Lynch Syndrome.
Also, the term lymphovascular implies both the lymphatic system and the vascular system. Tumor circulating cells in your blood can spread to distant organs purely through blood circulation, so lymph node invasion is not a hard requirement. It can be either or both or neither. Some metastasis has no known explanation.
In fact, I have liver metastases from rectal adenocarcinoma and no visible lymphatic invasion. Cancer metastasis is complex and a subject of research. It isn't as well understood as Google may indicate.