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Gastroenterology (Expert Forum)
Follow Up Questions Per Previous Post - Rectal CA, Need Additional Advice
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Follow Up Questions Per Previous Post - Rectal CA, Need Additional Advice
by gibson64, Mar 05, 2006 12:00AM
Looking for any additional thoughts to my previous post...This has been an emotional saga as follows:
Mid-January - First Colonoscopy, prelim diagnosis CA.
Late January - Follow up with Surgeon/biopsy results, his prelim diagnosis, large non-CA polyp.
Early February - Second Colonscopy/comprehensive biopsy. Surgeon felt there was no CA based on look/feel/mobility.
Late February - Biopsy results come back as moderately differentiated adenocarcinoma associated with a tubular-villous adenoma. Surgeon recommends neoadjuvant chemo/radiation followed by resection without doing further staging.
Late February - We went to a renowned surgeon at Sloan-Kettering in NYC for a second opinion. Ultrasound indicated a T1 lesion (early). He recommended resection only because it was so early. Surgery date set for March 31.
Early March - The surgeon calls back and indicates his pathology department has reviewed the biopsy slides and believes it is not CA. His recommendation is to have a gastroent remove the lesion so the entire thing can be biopsied (March 14 date).
Additional info, the rectal lesion is at 12 cm and is 3 cm dia.
Questions are:
1) How can the diagnosis of CA be so varied by different institutions (based on pathology)? Seems to me the "cells" would be cut and dry, it is or it isn't CA. I have to say I trust Sloan-Kettering most since this is all that they deal with.
2) Is there any risk of "making things worse" by removing the polyp through conventional means if it does come back as CA? Or does it not matter since we have surgery scheduled for March 31 anyway?
3) If it comes back as "pre-cancerous" only but they cannot remove the full polyp through conventional means, I presume she should go in for surgery to ensure removal of all of the pre-cancer cells?
4) Finally, we're a little scared about doctors now. If it does come back as pre-cancer and we went with the first surgeon, she would have gone through chemo/radiation and radical surgery for no reason! Conversely, I don't want to be to passive if it really is CA. Do you think it is worthwhile to get a 3rd opinion? I have to say everything I've read on our current NYC surgeon indicates he is world renowned and probably the best we're going to get.
Thanks again.
Mid-January - First Colonoscopy, prelim diagnosis CA.
Late January - Follow up with Surgeon/biopsy results, his prelim diagnosis, large non-CA polyp.
Early February - Second Colonscopy/comprehensive biopsy. Surgeon felt there was no CA based on look/feel/mobility.
Late February - Biopsy results come back as moderately differentiated adenocarcinoma associated with a tubular-villous adenoma. Surgeon recommends neoadjuvant chemo/radiation followed by resection without doing further staging.
Late February - We went to a renowned surgeon at Sloan-Kettering in NYC for a second opinion. Ultrasound indicated a T1 lesion (early). He recommended resection only because it was so early. Surgery date set for March 31.
Early March - The surgeon calls back and indicates his pathology department has reviewed the biopsy slides and believes it is not CA. His recommendation is to have a gastroent remove the lesion so the entire thing can be biopsied (March 14 date).
Additional info, the rectal lesion is at 12 cm and is 3 cm dia.
Questions are:
1) How can the diagnosis of CA be so varied by different institutions (based on pathology)? Seems to me the "cells" would be cut and dry, it is or it isn't CA. I have to say I trust Sloan-Kettering most since this is all that they deal with.
2) Is there any risk of "making things worse" by removing the polyp through conventional means if it does come back as CA? Or does it not matter since we have surgery scheduled for March 31 anyway?
3) If it comes back as "pre-cancerous" only but they cannot remove the full polyp through conventional means, I presume she should go in for surgery to ensure removal of all of the pre-cancer cells?
4) Finally, we're a little scared about doctors now. If it does come back as pre-cancer and we went with the first surgeon, she would have gone through chemo/radiation and radical surgery for no reason! Conversely, I don't want to be to passive if it really is CA. Do you think it is worthwhile to get a 3rd opinion? I have to say everything I've read on our current NYC surgeon indicates he is world renowned and probably the best we're going to get.
Thanks again.
Doctor's Answer
by Kevin Pho, MD, Mar 06, 2006 12:00AM
, Mar 06, 2006 12:00AM
To answer your questions:
1) Although biopsy and pathology is the best test that we have, sometimes there can be discrepancy. Another pathology opinion should be obtained. If there continues to be a non-revealing diagnosis, then I would agree that more tissue sample is needed.
2) The risk of only doing a polypectomy and not removing the colon that contains a lesion is missing any potential cancer. A colectomy via surgery is the more definitive option in removing any potential cancer.
3) With the questionable diagnosis, I would err towards the side of safety and consider surgery rather than a polypectomy.
4) If there continues to be question about the diagnosis, obtaining another opinion is a reasonable option. Although Sloan-Kettering is world-renowned and any other opinion likely wouldn't be more authoritative.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
1) Although biopsy and pathology is the best test that we have, sometimes there can be discrepancy. Another pathology opinion should be obtained. If there continues to be a non-revealing diagnosis, then I would agree that more tissue sample is needed.
2) The risk of only doing a polypectomy and not removing the colon that contains a lesion is missing any potential cancer. A colectomy via surgery is the more definitive option in removing any potential cancer.
3) With the questionable diagnosis, I would err towards the side of safety and consider surgery rather than a polypectomy.
4) If there continues to be question about the diagnosis, obtaining another opinion is a reasonable option. Although Sloan-Kettering is world-renowned and any other opinion likely wouldn't be more authoritative.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
