I've been diagnosed with cervical cancer and need detailed help with my path report that declairs the findings.

[GabbyNikko]

My regular GYN has done a couple of in office biopsies and now a cold knife cone biopsy. The end result was him telling be that the deepest point removed tested with micro invasive cervical cancer and he is sending me to a gyn oncologist. I have been trying to decipher the terms listed but I still need some help. Like... When they say Histologic Grade: Grade 2 (Moderately Differentiated), what does that mean? Based on what's given in the report can anyone give me a better idea as to the severity of my carcinoma? More cervical surgery, hysterectomy, radiation, based on the results, what do you think would be the next course of action to "fix" the problem? The report reads as follows...
A. "Cone biopsy of the cervix"
Histologic Type: Squamous Cell Carcinoma, Nonkerantizing
Histologic Grade: Grade 2 (Moderately Differentiated)
Stromal Invasion: Depth is 2.5 mm, Horizontal Extension is 1.5 mm
Endocervical Margin: Involved by Invasive Carcinoma
Ectocervical Margin: Uninvolved by Invasive Carcinoma
Deep Margin: Uninvolved by Invasive Carcinoma
Lymphovascular Invasion: Absent

B. "Endocervical Curettings"
Benign Endometrium of lower uterine segment and blood
Rare benign Endocervical Glands
Negative for Malignancy

Comment:
There is diffuse koilocytosis and parakeratosis. Thers is focal carcinoma in situ and invasive of moderately differentiated carcinoma into the submucosa. There is marked chronic inflamation and squamous metaplasia. Koilocytosis (with CIN 1) extends to the ectocervical margin.However, invasive carcinoma involves the endocervical margin. Additional deeper levels showed similar changes.

Gross Description:
A. "Cone biopsy of cervix" -An unoriented cervical cone biopsy is 2.7 x 2.3 x 1.5 cm. The specimen is inked black and serially sectioned.
1-4 - AS - M
B. "Endocervical curettings" -Pieces of pale tan tissue mixed with mucus are 2 cc in aggregate.
1,2 - AS - M

[Annekathryn Goodman, M.D.]

Hi There,

thank you for posting the complete pathology report.
You have an early cervical cancer.  You need more therapy and you are going to be OK. Your doctor has done an awesome job sorting this out. He is absolutely right to send you to a gyn oncologist.

You underwent a cervical cone biopsy which means that a cone shaped piece of tissue was removed from your cervix. Margins mean the edges of the tissue. Exocervical margin is the edge of the biopsy that faces the vagina. endocervical margin is the edge up the cervical canal towards the cavity of the uterus. deep margin is the edge on the sides.

if you go to google and search cone biopsy and click on images, there are alot of good pictures that can help understand these relationships.
here is the link:

http://images.google.com/images?sourceid=navclient&rlz=1T4FUJB_enUS286US286&q=cone%20biopsy&um=1&ie=UTF-8&sa=N&hl=en&tab=wi

This is important information. Your cancer goes to the inside edge. It is possible that it has been completely removed but there may be more cancer still present.

The next important piece of information is the size of the cancer. so it measures 2.5 mm by 1.5 mm. That is tiny. If there is no other cancer , then you have a microinvasive cervical cancer . The change of spread is close to zero and you can be treated by a larger cone biopsy and you do not need a more radical surgery (such as a radical hysterectomy or the complete removal of your cervix and biopsies of pelvic lymph nodes).  

grade is not very important in determining prognosis in cervical cancer (unlike ovarian cancer where grade is very important). Grade describes the irregular appearance of the cells and ranges from grade 1 (well differentiated) or well organized to grade 3 (poorly differentiated) or poorly organized. In some cancers grade can correlate with aggressive behavior. So a grade 3 has a greater chance of spreading than a grade 1 or 2.  For cervical cancer, this does not seem to be so important.


it would seem to me that the next step for you is another cone biopsy.
best wishes

[Annekathryn Goodman, M.D.]

thank you for your follow up.
I hope that the final pathology report came back clean
best wishes to you

[GabbyNikko]

Thank you so very much for your detailed response. I Posted that message on the 23. On the 24 I met with my onco and he wanted to do a hysterectomy but I said no due to the fact that I wish to have another child. So that same day we scheduled for another cone biopsy for March 4th. I am recovering from this one very well (still don't have the results) but am having a strange meaty discharge (apologies for the grotesqueness) that is unlike any discharge I've ever had  including with my last biopsy. But I'm sure it's nothing much to worry about. So I just sit here and wait the 3 weeks for my doc to go over the the results of this 2nd cone to determine margin welfare and the extended risks of having a child in the state that I'm in. Fortunately though, as I read on about this particular disease, I see more and more how it's kinda non-nonchalant with it being monitored. I have recently become more confidant about this minor hiccup that life has given me. Thank you for you time.
Gabby