Aa
Change in TNM
Hi Dr. Lupo,
My initial pathology of papillary thyroid cancer was T1a N0 MX. The first pathologist found isolated psammoma bodies in one of the 5 pre/paratracheal lymph nodes and performed levels on it and did not find any papillary cancer cells. The other four were clean. He confirmed this with another pathologist and deemed it to be N0.
I wrote to you about this and as per your suggestion, I got a second opinion from Dr. LiVolsi on my pathology. Most of her input matched my original pathology, but there were two differences. One, is Dr. LiVolsi found two foci on each lobe that were 2mm size. Thus, it went from unifocal to multifocal. Second, Dr. LiVolsi also detected isolated psammoma bodies in that one lymph node, but concluded that it should be given an N1 classification. She mentioned that because psammoma bodies were present in that one node, it implied that cancer was present in that node at some point, and that meant lymph node metastasis. So, now I am still at stage 1, but now am T1 N1 MX.
Dr. LiVolsi did not find extrathyroidal extension. She determined mine as "usual" papillary cancer with 1 cm size and not the aggressive types. Also, my initial pathology did not find lymphvascular involvement. I am a 42 yo male.
My questions are:
1. Should I go for RAI now that lymph nodes mets has been established? If so, what will be the recommended dose?
2. How will this N1 status change my prognosis? Will it become worse?
3. What are the implications of lymph nodes mets? How does it compare to N0 status.
Thank you so much for your answers.
My initial pathology of papillary thyroid cancer was T1a N0 MX. The first pathologist found isolated psammoma bodies in one of the 5 pre/paratracheal lymph nodes and performed levels on it and did not find any papillary cancer cells. The other four were clean. He confirmed this with another pathologist and deemed it to be N0.
I wrote to you about this and as per your suggestion, I got a second opinion from Dr. LiVolsi on my pathology. Most of her input matched my original pathology, but there were two differences. One, is Dr. LiVolsi found two foci on each lobe that were 2mm size. Thus, it went from unifocal to multifocal. Second, Dr. LiVolsi also detected isolated psammoma bodies in that one lymph node, but concluded that it should be given an N1 classification. She mentioned that because psammoma bodies were present in that one node, it implied that cancer was present in that node at some point, and that meant lymph node metastasis. So, now I am still at stage 1, but now am T1 N1 MX.
Dr. LiVolsi did not find extrathyroidal extension. She determined mine as "usual" papillary cancer with 1 cm size and not the aggressive types. Also, my initial pathology did not find lymphvascular involvement. I am a 42 yo male.
My questions are:
1. Should I go for RAI now that lymph nodes mets has been established? If so, what will be the recommended dose?
2. How will this N1 status change my prognosis? Will it become worse?
3. What are the implications of lymph nodes mets? How does it compare to N0 status.
Thank you so much for your answers.
MEDICAL PROFESSIONAL
The updated pathology makes this T1N1 tumor -- still stage I, still excellent prognosis. no clear benefit from I-131 with this technical "upstaging" from N0 to N1a due to a psammoma body. If the multifocal tumors are all <1cm, then no likely benefit from I-131. Would discuss this in detail with your treating physician.
* mcg
Dr. Lupo,
Thank you for the input. My thyroglobulin level is now undetectable and my TSH is 0.95. My doc wants to get my TSH in the 0.1-0.5 range. My synthroid dose has been upped to 150 mug.
Thank you for the input. My thyroglobulin level is now undetectable and my TSH is 0.95. My doc wants to get my TSH in the 0.1-0.5 range. My synthroid dose has been upped to 150 mug.
Sorry should be "tumors." not "rumors.". :)
Just a couple of edits from above: the new path placed me at pT N1 M0. The report also said all the rumors were confined to the thyroid.
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