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Can you tell me about criteria for cancer,stromal invasion and microinvasion? How can a cancer have no stromal invasion? It seems contradictory.
Cancer: A tumor is cancerous if there is "obvious stromal invasion". (I think). How then, can a person have a "mucinous carcinoma with no stromal invasion"?
(I've been reading journals and studies. They often talk about mucinous carinomas without stromal invasion (MCNI) and mucinous carcinomas with Microinvasion (MCMI) and the mucinous carcinomas with invasion (MCI).
If you have no stromal invasion, how can it be called mucinous carcinoma?
2. Microinvasion: I understand that the criteria for microinvasion varies. (some say 5mm, some say 2-3 mm). My tumor has "microinvasion" of 5mm (6mm and 10mm?).... with no differention, lots of mitotic figures...and other aggressive features. If your "microinvasion" is greater than 5 mm, doesn't that mean that it is (by definition) a frankly malignant carcinoma?
My pathology report says, "There are a few microinvasive foci composed of irregular malignant looking acini infiltrating stroma...none are larger than 10 mm in maximum linear dimension. Therefore it fits the criteria for intramural foci of microinvasion."
Why do I ask? My diagnosis: Mucinous, 1 ovary, 17 cm, microinvasion 5mm, 6mm, 10mm???, mural nodule of sarcomatous carcinoma (6mm), highly suspicious cells (highly atypical) in 5mm peritoneal fluid (not enough for diagnosis).
I had TAH BSO performed by regular gynecological surgeon. No washings. no biopsies, no thorough look around. Appendix not even looked at. The other ovary had a benign follicular cyst (2 cm) with endosalpingosis.
They say I have borderline mucinous. It's all ok. Go back to your normal life. I tried. It's almost 4 months post-op. I feel like my abdomen is getting bigger (I run a fair bit.) I have that lump in throat feeling. I get full fast, burp a lot. My tummy is like jelly this time, not big and hard like it was before surgery.
The pathology seems to contradict the diagnosis!
My doctor is gone until end of November. I have two little girls. I'm 42. I'm scared and I don't have anyone who knows anything to talk to. My diagnosis is baffling me.
I live in Canada (BC).
(I've been reading journals and studies. They often talk about mucinous carinomas without stromal invasion (MCNI) and mucinous carcinomas with Microinvasion (MCMI) and the mucinous carcinomas with invasion (MCI).
If you have no stromal invasion, how can it be called mucinous carcinoma?
2. Microinvasion: I understand that the criteria for microinvasion varies. (some say 5mm, some say 2-3 mm). My tumor has "microinvasion" of 5mm (6mm and 10mm?).... with no differention, lots of mitotic figures...and other aggressive features. If your "microinvasion" is greater than 5 mm, doesn't that mean that it is (by definition) a frankly malignant carcinoma?
My pathology report says, "There are a few microinvasive foci composed of irregular malignant looking acini infiltrating stroma...none are larger than 10 mm in maximum linear dimension. Therefore it fits the criteria for intramural foci of microinvasion."
Why do I ask? My diagnosis: Mucinous, 1 ovary, 17 cm, microinvasion 5mm, 6mm, 10mm???, mural nodule of sarcomatous carcinoma (6mm), highly suspicious cells (highly atypical) in 5mm peritoneal fluid (not enough for diagnosis).
I had TAH BSO performed by regular gynecological surgeon. No washings. no biopsies, no thorough look around. Appendix not even looked at. The other ovary had a benign follicular cyst (2 cm) with endosalpingosis.
They say I have borderline mucinous. It's all ok. Go back to your normal life. I tried. It's almost 4 months post-op. I feel like my abdomen is getting bigger (I run a fair bit.) I have that lump in throat feeling. I get full fast, burp a lot. My tummy is like jelly this time, not big and hard like it was before surgery.
The pathology seems to contradict the diagnosis!
My doctor is gone until end of November. I have two little girls. I'm 42. I'm scared and I don't have anyone who knows anything to talk to. My diagnosis is baffling me.
I live in Canada (BC).
I had a borderline serous tumor removed almost 2 years ago. But I was staged. 1C (some cells found in the third washing -- not so bad). Borderline tumors should be staged only because at the time of the operation the initial pathology isn't always correct. It wasn't until 10 days later when the path came back from the slides sent out that my gyn oc confirmed the borderline diagnosis. he told me if he didn't stage me initially, and the borderline wasn't correct, he would have had to go back in. Therefore, he staged me the first time.
No two surgeries, midline laparotomy for removal of tumor in April (it was football sized) then hysterectomy in June via horizontal bikini line. They didn't know what they were operating onthe first time, believe it or not, until they opened me up. I had lost a baby at 23 weeks only three days before this surgery so the cyst/tumor had kind of been "missed" as they they struggling to keep my cervix closed (had had an emergency stitch and been put in bed rest in hospital.) I had already had a weak cervix due to previous treatments for abnormal smear tests so everyone assumed this was why I had gone into labour early, little did we know this montrous tumor thing was practically pushing the baby out!
So anyway I'll try and dig out my lab report later but I think I had 3 pelvic washings and 2 LITRES of fluid was drained out of my abdomin- the lab report said I had a "Belly full of mucin"
The advice I got from the experts was 3 monthly checks for 2 years with a ca125 test at each of these appointments.Then go down to annual checks. I don't know if my tumor was sensitive to the ca 125 but they checked it a month ago anyway and it was very low. I had my appendix removed when I was 16. Did you have your omentum aken out? Mine is still in which I think should really have been removed.
Quite frankly I'm scared stiff about something re-occuring but I've had such a rough time this year I just have to make myself believe it will be OK...
So anyway I'll try and dig out my lab report later but I think I had 3 pelvic washings and 2 LITRES of fluid was drained out of my abdomin- the lab report said I had a "Belly full of mucin"
The advice I got from the experts was 3 monthly checks for 2 years with a ca125 test at each of these appointments.Then go down to annual checks. I don't know if my tumor was sensitive to the ca 125 but they checked it a month ago anyway and it was very low. I had my appendix removed when I was 16. Did you have your omentum aken out? Mine is still in which I think should really have been removed.
Quite frankly I'm scared stiff about something re-occuring but I've had such a rough time this year I just have to make myself believe it will be OK...
I just re-read your post. Am I understanding you correctly? You had 3 surgeries! Two seems like a LOT. But three!!?!
I think about having a re-staging surgery and appendectomy (is your appendix still in?)...but I'm SO don't want another operation.
What is your follow up?
I think about having a re-staging surgery and appendectomy (is your appendix still in?)...but I'm SO don't want another operation.
What is your follow up?
Thanks to you all for your information.
Heffmeister, I am very interested in knowing how much fluid from peritoneal washings is submitted to the lab for testing. Can you find any info about that on your lab report? Thanks so much.
In my case, according to the operative report, the first thing doc did once in my abdomen was drain the 5ml of peritoneal fluid (red in color)that was found, and send it to the lab for pathology. At the end of surgery I was "abundantly washed" a couple of times.
All the lab recieved was 5ml of peritoneal fluid, but sometimes this is referred to as "peritoneal washings." Doesn't seem like "washings" to me. Anyway, not enough cells in the 5ml (1teaspoon) of peritoneal fluid for doc to determine anything.
My follow up is once a year for pelvic exam. That's it. Of course I'm told to go see me general practictioner if I'm experiencing any abdominal distension etc. It's so hard to know when to go in!!! I feel worse these last few weeks than I did a month ago (I think).
My research tells me borderline is a big umbrella encompassing a lot of different things. Prognosis can vary depending on what kind you have. Borderline tumors WITHOUT microinvasion or implants have a really good prognosis (98%).
My tumor has "microinvasion" of 5mm (in many medical journals, this would NOT be considered microinvasion, but a frankly malignant tumor). I also have intraepithelial carcinoma but according to what I've read, that doesn't really influence prognosis - not like this microinvasion thing.
Other factors that affect prognosis are stage (very little staging done in my case) and cell features (my cells in the invasive area are "highly atypical, no differention, high mitotic figures....anaplastic sarcomatous." Not so good.
I'm not comfortable with my follow-up. I feel like the doctors don't want me to know I wasn't properly staged (my surgeon said borderline tumors AREN'T STAGED!!!!) I'm not trying to nail anyone to the wall. I just want the facts. What they are telling me does NOT jive with what I read in all the doctor's medical journals. Really truly, I know there is nothing they can do at this point but just watch and wait (though once a year follow-up is hardly "watching"). I don't like them telling me one thing when it looks like something else.
Heffmeister, I am very interested in knowing how much fluid from peritoneal washings is submitted to the lab for testing. Can you find any info about that on your lab report? Thanks so much.
In my case, according to the operative report, the first thing doc did once in my abdomen was drain the 5ml of peritoneal fluid (red in color)that was found, and send it to the lab for pathology. At the end of surgery I was "abundantly washed" a couple of times.
All the lab recieved was 5ml of peritoneal fluid, but sometimes this is referred to as "peritoneal washings." Doesn't seem like "washings" to me. Anyway, not enough cells in the 5ml (1teaspoon) of peritoneal fluid for doc to determine anything.
My follow up is once a year for pelvic exam. That's it. Of course I'm told to go see me general practictioner if I'm experiencing any abdominal distension etc. It's so hard to know when to go in!!! I feel worse these last few weeks than I did a month ago (I think).
My research tells me borderline is a big umbrella encompassing a lot of different things. Prognosis can vary depending on what kind you have. Borderline tumors WITHOUT microinvasion or implants have a really good prognosis (98%).
My tumor has "microinvasion" of 5mm (in many medical journals, this would NOT be considered microinvasion, but a frankly malignant tumor). I also have intraepithelial carcinoma but according to what I've read, that doesn't really influence prognosis - not like this microinvasion thing.
Other factors that affect prognosis are stage (very little staging done in my case) and cell features (my cells in the invasive area are "highly atypical, no differention, high mitotic figures....anaplastic sarcomatous." Not so good.
I'm not comfortable with my follow-up. I feel like the doctors don't want me to know I wasn't properly staged (my surgeon said borderline tumors AREN'T STAGED!!!!) I'm not trying to nail anyone to the wall. I just want the facts. What they are telling me does NOT jive with what I read in all the doctor's medical journals. Really truly, I know there is nothing they can do at this point but just watch and wait (though once a year follow-up is hardly "watching"). I don't like them telling me one thing when it looks like something else.
Hi, I grew a massive borderline mucinous tumor that was operated on this year. I had two op's to removed the ruptured tumor then when the pathology was done a full hysterectomy. I am 32 with two little girls too so just wanting you to know you are not alone! I don't know much about your technical questions I do have a copy of my lab report somewhere if you anted to compare. In had both ops done by a regular gyn but with a special interest in oncology (he was guided on what to do on the hysterectomy by a professor in gyn/onc). He did stage me properly at the first operation however and took lots of biopisies and washing. I then also got a 2nd opinion from a professor in gyn/onc in London (I live in UK) who reviewed my slides and agreed with the borderline diagnosis but re-classed me a 1 c due to the rupture. Maybe you should seek a second opinion too? What follow up are you having by the way?
My wife was diagnosed in Jab 2010 with a rare form of ovarian cancer-Granulosa cell cancer, so we know what it is like to have this uncertainty hanging over your head.
The pathology of borderline mucinous tumors make up only 10% of ovarian cancers,vary widely and can present looking like cells from appendix, colon, cervix..... Of that 10% there are many variations. The good news is that most are slow growing cancer as opposed to epithieal ovarian cancer(80%) which is an aggressive form of ovarian cancer.
Since there were microscopic cells found in your pelvic washings it is imperitive for proper staging and further treatment if need be that you have a gyn/oncologist due the 2nd surgery. Studies have shown that treatment from a non gyn/oncologist has sub optimal outcomes. Trying to interpret a pathology report especially from a borderline tumor can make you extremely confused because there are so many variables. Invasion be it macro or micro, outcomes will all depend on proper cytology (pathology)to determine from where it originated, is it a primary or secondary cancer. Again, this is why it is so important to have a gyn/onc do the surgery.
Good luck
Kevin
The pathology of borderline mucinous tumors make up only 10% of ovarian cancers,vary widely and can present looking like cells from appendix, colon, cervix..... Of that 10% there are many variations. The good news is that most are slow growing cancer as opposed to epithieal ovarian cancer(80%) which is an aggressive form of ovarian cancer.
Since there were microscopic cells found in your pelvic washings it is imperitive for proper staging and further treatment if need be that you have a gyn/oncologist due the 2nd surgery. Studies have shown that treatment from a non gyn/oncologist has sub optimal outcomes. Trying to interpret a pathology report especially from a borderline tumor can make you extremely confused because there are so many variables. Invasion be it macro or micro, outcomes will all depend on proper cytology (pathology)to determine from where it originated, is it a primary or secondary cancer. Again, this is why it is so important to have a gyn/onc do the surgery.
Good luck
Kevin
Hi there
My wife also has Mucinous Tumour and I have spent a long time trying to understand stromal invasion.From what I have read (and I am by no means an expert so please ask the same question on the expert forum too...) this is what I understand.
Mucinous tumors seem to have a quite standard lifecycle. When found early, mucinous tumors seem to be less invasive and when they are found late they are more invasive. If you take a look at the survival rates and patterns you find that the less invasion there is the better the survival rates this also equates to the lower stages having very good survival rates and Stage 3 and 4 having a less favorable rate as these tumors tend to have significant stromal invasion.
Mucinous tumors seem to develop from benign (where most Mucinous tumours are found) through borderline (where the majority of the rest are found) to malignant. In each phase of this development there are "atypical" cells - i.e. cells that, like other cancer cells that replicate in an uncontrolled manner. The difference is that in benign tumors there is no invasion, in borderline there is evidence of microinvasion and in malignant they have become invasive. I am not sure why Mucinous tumors are found early in most cases, but I believe that it is that they grow to a larger size more quickly than other types, allowing them to be found before they become malignant.
Your description of your pathology would seem to fit the diagnosis. Microinvasion would suggest a diagnosis of borderline disease.
As for your other symptoms, I would not wait around to see your doctor. Go and find another Doctor who can take a look at you. The easiest answer could be that your fullness etc are simply signs of the stress you are under, but you should always look to get a thorough examination.
I know this is a hard time, and I can sympathise when things don't make sense. I have been through this in detail and so many things seem contradictory. This is mainly down to use of medical terminology which can be hard to get your head around. In your situation though, the growth was found early and the prognosis for this kind and stage of disease is very good. Keep that in your thoughts as you wait for your appointment with a doctor.
My wife also has Mucinous Tumour and I have spent a long time trying to understand stromal invasion.From what I have read (and I am by no means an expert so please ask the same question on the expert forum too...) this is what I understand.
Mucinous tumors seem to have a quite standard lifecycle. When found early, mucinous tumors seem to be less invasive and when they are found late they are more invasive. If you take a look at the survival rates and patterns you find that the less invasion there is the better the survival rates this also equates to the lower stages having very good survival rates and Stage 3 and 4 having a less favorable rate as these tumors tend to have significant stromal invasion.
Mucinous tumors seem to develop from benign (where most Mucinous tumours are found) through borderline (where the majority of the rest are found) to malignant. In each phase of this development there are "atypical" cells - i.e. cells that, like other cancer cells that replicate in an uncontrolled manner. The difference is that in benign tumors there is no invasion, in borderline there is evidence of microinvasion and in malignant they have become invasive. I am not sure why Mucinous tumors are found early in most cases, but I believe that it is that they grow to a larger size more quickly than other types, allowing them to be found before they become malignant.
Your description of your pathology would seem to fit the diagnosis. Microinvasion would suggest a diagnosis of borderline disease.
As for your other symptoms, I would not wait around to see your doctor. Go and find another Doctor who can take a look at you. The easiest answer could be that your fullness etc are simply signs of the stress you are under, but you should always look to get a thorough examination.
I know this is a hard time, and I can sympathise when things don't make sense. I have been through this in detail and so many things seem contradictory. This is mainly down to use of medical terminology which can be hard to get your head around. In your situation though, the growth was found early and the prognosis for this kind and stage of disease is very good. Keep that in your thoughts as you wait for your appointment with a doctor.
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