Jacques wrote: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
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.
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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:
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.
Ref.  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.
MLH1, MSH2, MSH6, PMS2 – Intact nuclear expression
Tumor invades through the muscularis propria into the perocoliclic adipose tissue.
MistyBlu wrote:My meeting with the oncologist was not bad. He explained everything and said to come back in one week to tell him which option I choose. This is based on the fact that some of the cancer cells may have escaped and got into the liver. I have the following options:
#1 – Do Nothing. He says out of 100 people in my situation, 65 are cured and 35 have a reoccurrence.
#2 – Take Xeloda for 6 months 21 days on and 7 days off I believe.
#3 – Take a combination of Xeloda/Oxaliplatin for three months
Based on my condition he said he is not offering FolFox because that’s for more serious conditions and is not warranted in this situation.
Here’s my diagnosis as best I can summarize,
PT3NO, No obstruction, No Perforation, 0/19 lymph nodes negative, LVI and PNI negative. And lastly, I’m poorly differentiated.The ONC says I’m in a gray area. I’m still planning to get a second opinion at MSK in the next week or so. I’m leaning right now towards Option #2. (Option #1 is out.) And I read that Oxaliplatin for advanced cancer. I don’t do well on anti-nausea which is part of this treatment and if I can’t be certain that it has an advantage I’d rather not.
boxhill wrote:Wow, I didn't realize that hand/foot could be permanent.
Sounds like its a really good thing that you have the MSK consult scheduled. More clarity would help.
NHMike wrote:I have hand and foot in my hands. But it is very mild. It is a bit worse in cold weather but it doesn’t stop me from doing what I did before diagnosis
Rock_Robster wrote:NHMike wrote:I have hand and foot in my hands. But it is very mild. It is a bit worse in cold weather but it doesn’t stop me from doing what I did before diagnosis
Hi Mike, sorry to hear you’re still dealing with this. Just to check - you definitely mean hand & foot syndrome, not neuropathy?