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Questions about cancer in final pathology report Questions about cancer in final pathology report

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Unread 04-19-2010, 05:30 PM
Questions about cancer in final pathology report

I had a LAVH in March after having a biopsy show complex atypical hyperplasia. The surgery went well, and I'm recovering at what seems to be a normal pace.

The surgery was done by a gyn/onc, and the frozen slides done during surgery did not show cancer, but the final pathology report did.

At my 2-1/2 week post op, the surgeon told me that the final pathology showed cancer and that there will be follow up appointments that will be required over the next few years. I was not expecting cancer to be found, so I was a little surprised and wasn't prepared to ask any questions at that appointment. My surgeon doesn't have the best bedside manner, and tends not to offer info unless you specifically ask for it.

The report says it was staged at 1A, and grade 1 but it also says there was some myometrial invasion (way less than 50%).

I'm not freaking out, since I feel like I dodged a bullet by finding it and taking care of it so early (I'm 39). But, my question is this: Since the frozen slides did not show cancer, no lymph nodes were sampled during the hysterectomy (and BSO). Would or should she go back for lymph nodes to make sure the cancer hasn't spread beyond the uterus, or is it not necessary since it is stage 1/grade 1?

Also, what is typically done during these follow up appointments that I will have to initially have every 3 months?

These are questions that I'll be asking the surgeon at my next appointment in a few weeks, but I'm curious to know of others experience in this area.
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Unread 04-19-2010, 06:11 PM
Re: Questions about cancer in final pathology report

My GYN onc says there is controversy among GYN oncs as to whether to take nodes in that case (grade I, stage 1 with <50% invasion). Some take nodes from everyone, regardless. At the followups they screen for abdominal symptoms, do a pelvic exam, including usually a pap smear of the vaginal cufF, which is where ca is likely to recur, if it does. Usually caught so early it does not recur and no further treatment is needed. Sorry you got such news. It always seems shocking I think. At least you are caught early and that's good to hear.
Unread 04-19-2010, 06:22 PM
Re: Questions about cancer in final pathology report

I did not have lymph nodes taken either. My oncologist said that it was not necessary. I think it is strictly a matter of opinion and you need to just trust in the judgment of the surgeon that you chose. I have to admit that I sometimes second guess myself and wonder if it was the correct route to choose but I do trust my oncologist.

You have to be comfortable with your decision!
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Unread 04-19-2010, 06:51 PM
Re: Questions about cancer in final pathology report

In general they always take "suspicious" looking lymph nodes, and if someone has completely normal looking lymph nodes and the myometrial invasion is less than 50%, they do not. (OH and the other situation where they take out normal appearing lymph nodes is if there is a higher grade of cancer, or a more aggressive histological form )

The frozen section that is done in the OR is a very gross inspection of the uterus where they basically cut it in half and check the tissues that appear grossly abnormal.
If the cancer is small and not visible to the naked eye and they have no evidence of a cancer, then they would not really know even where to look
The actual pathologists job is very painstaking taking thin slices of tissue and make them into slides, that part takes a lot longer , so they really do not look at the uterus under a microscope until they are back at the lab.

My invasion was greater than 50%, so my completely normal lymph nodes were all removed and under microscopy two mets were found.

It really does sound like you missed the bullet, although I am sure this was very hard stuff to hear, especially when you were not expecting it

Unread 04-19-2010, 07:15 PM
Re: Questions about cancer in final pathology report

Thanks for the info, all. I'll ask the surgeon at my next appt, but won't be surprised, or worried if she says it is not necessary.

I do trust the judgement and skill of my gyn/onc surgeon. She has excellent credentials. I just find her difficult to communicate with at times.

and Janet - whoo-hoo on the marathon training! I ran my first 1/2 marathon last fall. I'm eager to get running again after I've healed up enough - I feel like I've lost a lot of ground recuperating from this surgery.!
Unread 04-19-2010, 08:19 PM
Re: Questions about cancer in final pathology report

I have seen something like 9 doctors in the past year or so and to be honest, I guess this is a difficult situation, but I think only 2 have I really felt to be good at communicating.
Sometimes when difficult things are being discussed, such as telling someone that they have cancer, might be a difficult conversation anyways.
Running.....I had to recuperate from surgery, chemo and radiation, and so I am sure if I can get back to it so can anyone. You will be back to it in no time.
Unread 04-19-2010, 08:47 PM
Re: Questions about cancer in final pathology report

Janet - thanks for the encouragement on getting back to running.

I'm debating on whether to switch Drs. Friends and family are encouraging me to switch due to some communication breakdowns that have occurred. On one hand, I do trust her skill and knowledge, but on the other hand, getting info is difficult, and I'm not sure if I want to deal with that for several years of follow-up.

I didn't expect them to find any cancer and therefore the need for so much followup; I thought I would only have to deal with her for the surgery and a couple of follow-up appointments, so I was kind of "grinning and bearing" our clashes in communication styles, but I don't know if I can do that long-term.
Unread 04-19-2010, 10:20 PM
Re: Questions about cancer in final pathology report

k2zena -

I had stage 1 grade 2 cancer. I have had no further treatment like chemo or radiation. I have had follow-ups every 3 months for these first years and if nothing shows up will drop to 1x every 6 months for 3 years.

My gyn-onc does abdominal, internal and rectal exams. Along with vaginal vault smear (Pap smeaf of the vagina cuff). The rectal exam is because they can feel the top of the vagina better than just doing an internal exam.

My gyn-onc did take lymph nodes but I believe that was because my cancer was found during a D&C and hysteroscopy and I think he was concerned cancer cells went into my abdominal cavity during that procedure.

for you as you go through this journey.

Unread 04-20-2010, 07:37 AM
Re: Questions about cancer in final pathology report

that sounds like a good plan...
I do not feel I have good communication with my gyne/onc, but I trust her
more than anyone for her skills at looking in the vagina every 3 months, and being able to spot something of concern.
As far as other issues that have come up, I have not been impressed with her approach, but I have other doctors to deal with them, so I carry on.

You are right though, pick the one with the best skills for your surgery and the one who you can communicate best with for the long run.
Unread 04-20-2010, 03:15 PM
Re: Questions about cancer in final pathology report

Hi, I also did not have lymph nodes dissected and had a dx of stage 1b endometrial cancer. My gyn/onc said the nodes looked good so none were sampled. I also had no further treatment only close follow up - every 3 months for two years, then every 4 mo for one year and finally twice a year to year 5. During appointments a vaginal cuff smear was taken and internal exam done. Early on I was to report anything unusual - abdominal discomfort, spotting, etc.as soon as it may occur.
Since your gyn/onc apparently is not a good communicator I can understand your desire to seek another. If you remain uncomfortable with her, I hope you find another excellent in their field and more communicative.

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