For your eventual meeting with an oncologist, you could show your oncologist your DH's risk profile based on information you have from the path report, CT scans and lab reports, and then ask for explanations of these factors and ask what kind of first-line adjuvant therapy would be best for this type of risk profile.
High risk factors
1. T4a tumor
2. Perineural invasion (PNI)
3. Tumor budding
4. Tumor deposits (four)
5. Elevated CEA (131 ug/ml)
6. Partial blockage
Low/moderate risk factors
2. Clear margins
3. 0/14 lymph nodes involved
4. Lymphovascular invasion (LVI)- not present
5. Integrity of tumor: Single tumor segment (no fragments)
6. Moderately differentiated tumor (I.e., low grade tumor)
Not discussed/ not clearly identified
1. MSI status
2. HNPCC status - FAP status (hereditary cancer
) Familial Adenomatous Polyposis (FAP) and Hereditary Nonpolyposis Colorectal Cancer (HNPCC),
3. Tumor perforation.
4. Level of bowel obstruction
5. Location of tumor: location of lower edge of tumor; location of upper edge of tumor. Was the tumor 'astride' the recto-sigmoid juction?
6. Any polyps present in the resected specimen?
7. Any biopsy results from the three other large polyps that were found during colonoscopy?
8. Unusual number of shotty lymph nodes in adjacent sigmoid mesentery
9. Soft tissue growth extending into adjacent sigmoid mesentery.
Before your meeting with the oncologist, you can review your path report and compare its content with the elements found in a typical colorectal cancer pathology report template:Colorectal Cancer Structured Reporting Protocol