I may have worded it wrong, but this is a quote from the surgeon:
Had recent flex sig
Impression:
To cecum. There is a 2 cm clean based ulcer in the rectum, just 2 cm above the anorectal verge. Unable to retroflex due to tightness of the rectum. There is a 2 mm nodule just above the ulcer which was removed. The ulcer was biopsied but very friable with oozing which limited the amount of tissue sampling.
Path showed:
FINAL PATHOLOGIC DIAGNOSIS
A) RECTUM, BIOPSY
- PROMINENT LYMPHOID AGGREGATE
- NO EVIDENCE OF MALIGNANCY
B) RECTUM, BIOPSY
- SUPERFICIAL STRIPS OF RECTAL EPITHELIUM WITH HIGH-GRADE DYSPLASIA
- NECROSIS AND ULCER DEBRIS
Given the ulceration and necrosis I am still concerned of recurrence.
I have reviewed with him the findings and recommendation for ERUS and FNA biopsy. He agrees to proceed, will have GI arrange.
He is also awaiting MRI 4/18/22
He has been on W&W, and had little confidence in his previous colorectal surgeon. For the new year, he asked for a different surgeon and the new one seems much more aggressive. One big problem with the previous one is he seemed unethical because in the November or December meeting he pretty much stated that there could be cancer which they wouldn’t be able to verify without a biopsy, however since he was unwilling to undergo surgery there was no point in scheduling a biopsy.
This is false since DH understands W&W only as a *potential* alternative to surgery. If surgery is necessary he has been on board. However, from previous visits (including that one) the wall thickening showed no obvious reasons to be concerned.
The 3/21 meeting with the new surgeon discovered a mass that turned out to be a cyst. She seemed almost certain that this was an urgent matter that needed immediate attention. And the biopsy report from the 3/25 colonoscopy found a small polyp that was not malignant, next to the cyst. But the cyst biopsy showed HGD. So there is a lot of confusion.
They messed up his MRI schedule and rescheduled it for this afternoon. But that along with Wednesdays ultrasound should tell us more.
The new surgeon didn’t seem alarmed by the HGD. She seems more focused on the bleeding. But DH has been taking supplements that might work as blood thinners (which he has since stopped until after the Ultrasound). Additionally, he is sure he scraped that mass trying to give himself an enema the day the surgeon evaluated him on 3/21. So he feels like the ulceration and necrosis could have been self inflicted, and the HGD should be more concerning. I’m wondering if HGD is easy enough to assess or if it’s possible that what they see could be some inconsistency caused by EBRT almost 2 years ago, and looks like HGD. Possibly something new that’s being discovered early?
BTW he increased his cimetidine to 2x200mg twice a day for 5 days before and 2 days after the ultrasound.
So the results of the colonoscopy (3/25) seemed good at first with only a cyst. The lab reports (4/1) mentioned HGD. Everyone is a little confused.
The surgeon said that for now the goal is to find out more. She definitely recommends surgery if cancer is found on either of 2 samples. One is a fine needle biopsy, and the other is a cut to collect a deeper sample below the surface where they originally scraped.
If no cancer is found then they will discuss the next steps. I’m preparing for a 2nd opinion from UCSF in either case.