Understanding high grade dysplasia

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Understanding high grade dysplasia

Postby Mortie » Sat Aug 27, 2022 8:48 am

I am new to colon issues and feel almost unworthy to ask this as I read of the trials and courage of so many on this forum. I have no history of colon issues and have been having regular colonoscopies since I turned 50 (I am now 70). I have had some polyps but all were benign and removed. My last colonoscopy was different. My Gastro called to tell me that a portion of my upper colon near my liver showed “high grade dyspasia.” This was confirmed by two pathologists.

She has scheduled me for a second colonoscopy on Sept 8 (my last one was two weeks ago.) She believes that there is a 98% certainty that it is and will remain dysplasia which i take it will be fully removed at the next procedure an re-biopsied.

I know Dr. Google can be debilitating but I did go for a consult. Now i am very scared that it will be cancer. My Gastro seems quite certain it is not but I can’t help but worry. Yes I know even worse case scenario it was found early but what does it all mean? Your thoughts would be so welcome.

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Re: Understanding high grade dysplasia

Postby roadrunner » Sat Aug 27, 2022 2:01 pm

I’m a little confused by your reference to “a portion of your upper colon” in this context. Was a polyp removed and examined? If so, what size was it? What was its nature, e.g., tubular or villous? If not a polyp, what were the clinical signs that attracted attention? Was there ulceration or an inflammatory condition? Perhaps it would be helpful to share the pathology report description.
7/19: Rectal cancer: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Thoracic CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear

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Re: Understanding high grade dysplasia

Postby Mortie » Sat Aug 27, 2022 7:15 pm

Thanks for your response. I will get the report but it wasn't a polyp. My Doctor explained that it was an inflammatory condition if that is helpful.

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Re: Understanding high grade dysplasia

Postby Jacques » Sun Aug 28, 2022 2:24 pm

I agree with roadrunner. Your pathology report is a bit confusing. Normally, when a biopsy is taken there is some visible abnormality that is being biopsied, like a polyp, or a mass, or a lump, or a lesion, or a tumor, etc. But in this case, the object of the biopsy is said to be a whole segment of the colon.

This seems to be a bit unusual to me, and it seems to suggest something non-cancerous but nonetheless troublesome that needs to be attended to.

For a patient 70 years old, it could be some sort of deterioration of the inner mucous layer of the colon, something similar to the way that our skin becomes wrinkled as we grow older, or the way that eyes develop cataracts as we grow older. It might be something like diverticulosis, which is rather common in older people. Or it might be related to something like ischemic colitis, where a section of the colon develops a shortage of blood supply, perhaps due to a long-standing build-up of cholesterol in the blood vessels feeding that part of the colon.

All of the above is pure speculation on my part, but what I am really trying to say is that I think it would be very important for you to get to the bottom of this and demand a proper diagnosis before any attempt is made to remove the dysplasia via a simple colonoscopy procedure. The medical issue that you have may need a different kind of treatment from what a gastroenterologist can do with a simple colonoscope. It may require treatment by a different kind of expert specialist who would be able to do some sort of endoscopic micro-surgery with the assurance that a fragile colon will not be perforated by the procedure.

What concerns me right now is this statement of yours:
She [gastroenterologist] believes that there is a 98% certainty that it is and will remain dysplasia which I take it will be fully removed at the next procedure and re-biopsied.

This seems to suggest that the gastroenterologist may try to remove or scrape off the layers of tissue that seem to show dysplasia, but in my opinion, this type of micro-surgery should be done by a different type of professional, a surgeon specializing in endoscopic microsurgery.

Again, this is just my personal opinion, but you may want to discuss some of these things with the gastroenterologist before you sign the consent form for your next colonoscopy.

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