Surgery is over!

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O Stoma Mia
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Re: Surgery is over!

Postby O Stoma Mia » Fri Jan 19, 2018 11:30 am

KathyLynn wrote:I had my appointment with the radiologist this morning
He said that I could have radiation with chemo, standard for rectal cancer because of this ITC
Or, I can just have them keep an eye on me with three month appointments.
It’s my call. It is really easy to say no treatments, I’m done! But I’m not sure
...
Should I start a new post to see if there is any members that had ITC. And what treatment they had?

The topic of Isolated Tumor Cells (ITC) has come up before on this forum. For example, this thread:

Lymph negative but one marked as 'i+'
http://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=54224&p=430156#p430156

You can scroll through the posts in this thread and see some past members with ITC and what treatment they had.

Alternatively, as you suggested, you could start a new thread now and see if there are other members who also had this same condition.

KathyLynn
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Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Fri Jan 19, 2018 2:11 pm

Thanks again!
I’ll start a thread soon
I’m anxious to what John Hopkins will say
Also another opinion at GBMC


KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

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O Stoma Mia
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Re: Surgery is over!

Postby O Stoma Mia » Fri Jan 19, 2018 11:12 pm

In 2016, there was a Gastrointestinal Pathology Society (GIPS) forum on ITCs entitled,

"The N of TNM in Isolated Tumor Cells".

In that forum they presented the results of a survey of 70 pathologists asking them how they would code colorectal ITCs in the TNM system They found that a majority of these pathologists (51%) would code them as N1, not as N0. Thus, a majority were already staging patients of this category as Stage III.

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O Stoma Mia
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Re: Surgery is over!

Postby O Stoma Mia » Sat Jan 20, 2018 1:02 am

Would you be able to update your signature to show more about your pathology risk profile?
e.g., Tumor type, Tumor grade, Lymphovascular invasion, Perineural invasion, Proximal, distal, and circumferential margins, Lymph nodes positive/lymph nodes removed, Size of tumor, Location of tumor, Distance from anal verge, MSI status, etc. And do you have a baseline CEA?

I know you have mentioned some of these things in previous posts, but I think it would help to have all of this information in one place in your signature, and it would help in assessing your overall risk situation.

KathyLynn
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Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Sat Jan 20, 2018 8:41 am

I will update my signature
I’m out of town, so it maybe a day or two
I remember that my pathology report was considered a really good report, from all Drs except for the ITC

Thanks!!
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Sun Jan 21, 2018 1:50 pm

O Stoma Mia wrote:Would you be able to update your signature to show more about your pathology risk profile?
e.g., Tumor type, Tumor grade, Lymphovascular invasion, Perineural invasion, Proximal, distal, and circumferential margins, Lymph nodes positive/lymph nodes removed, Size of tumor, Location of tumor, Distance from anal verge, MSI status, etc. And do you have a baseline CEA?

I know you have mentioned some of these things in previous posts, but I think it would help to have all of this information in one place in your signature, and it would help in assessing your overall risk situation.



I think I have most of the information.

Thanks
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)

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O Stoma Mia
Posts: 1269
Joined: Sat Jun 22, 2013 6:29 am

Re: Second Opinions

Postby O Stoma Mia » Tue Jan 23, 2018 10:49 am

KathyLynn wrote:...
I’m anxious to hear what John Hopkins will say
Also another opinion at GBMC

When you go in for your second opinions, I think it might be helpful if you could review the meaning of the coding pN0(i+). In this expression, the lower-case "ï" has a special meaning. The "ï" is an abbreviation for immunohistochemistry, otherwise known as IHC.

You can further appreciate the context when you understand that IHC is not the default method for analyzing lymph nodes. The default staining method for pathology is called the H&E method (hematoxin and eosin) and is what is used routinely for preparing and processing specimen slides for review under the microscope. I think the IHC method is used for lymph nodes only in special cases or when a doctor requests it.

In your pathology report, you were told that they found Isolated Tumor Cells and that the coding was pN0(i+). The lower-case ï"in this coding is meant to say that they had to use the special IHC method in order to find any Isolated Tumor Cells; these cells weren't visible otherwise.

The following quote may explain the situation a little:

...To avoid confusion, patients identified with occult disease should now be classified as pN0(i+) if detection is
negative by hematoxylin and eosin (H&E) staining but positive by IHC ...


What this means is that when your pathology analysis was done with the standard, default H&E staining method, they couldn't detect any ITCs at all. In order to detect any ITCs they had to do a second analysis on different slices from the same lymph nodes. If they hadn't done this second analysis, you would have been staged as pT2N0M0 straightaway and told simply that you were Stage I -- and for Stage I the standard-of-care is "No further treatment".

You may want to ask why they decided to do the extra IHC analysis on the lymph nodes. Is it standard procedure in this hospital? Is it because the doctor requested it? I think normally they wouldn't do the extra IHC analysis, unless they had a reason. (That's just my personal opinion)

KathyLynn
Posts: 50
Joined: Thu Aug 31, 2017 3:40 pm
Facebook Username: Hillcrestkathy

Re: Surgery is over!

Postby KathyLynn » Tue Jan 23, 2018 5:57 pm

You are amazing, I just want to Thank you for everything that you have done for me. Really, thank you!
I have so much more information from you, I’m ready for my next two appointments!
As far as having two reports, my doctor works at one hospital, GBMC. The oncologist/radiologist is at university of Maryland. So there was two different hospitals looking at my slides. And John Hopkins will too
Tomorrow is my appointment with oncology at GBMC
I’ll be in touch soon

KathyLynn
8/2017. RC
11/27/2017. Robotic LAR
12/2017 Moderatley differentiated, 3.0 cm in greatest dimension
Macroscopic tumor perf: not identified. All margins of resection and proximal neg for tumor. Distal anastomotic ring: Neg for tumor
Lymphovascular and perineural invasion: not identified. Tumor deposits: not identified
Lynch : Negative Margin proximity: proximal: 27.0 cm. Distal: 2.0 cm. Radial: 2.5 cm
#of possible lymph nodes: 33. 0/15
1/13/2018. T2N0M0 with isolated tumor cells (ITC)


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