Questions - post dx

[dscoochie]

Dr. Lupo,
I was diagnosed yesterday with Papillary Cancer.

Could you please help me with these questions?

Here are the FNA results from October:

Consistent with Hurthle Cell Lesion
- Hurthle cells present
- Follicular cells present
- Macrophages present
- Colloid present

Here are the Left Thyroid Lobectomy Pathology results from yesterday:

Papillary carcinoma of the thyroid with:
- histologic subtype - classical papillary
- tumour diameter - 1.8cm
- no extrathyroidal extension
- no lymphvascular space involvement
- surgical margins, negative for malignancy
- perithyroidal lymph node, minute (1) - negative for malignancy
- unremarkable parathyroid gland

And now, my questions:

Why is the FNA so completely different than the Pathology?

Is removing the rest of the thyroid what you'd recommend, and does it
make sense to wait three months before a second surgery (the surgeon
said the area must heal first before he goes in again).

From what I can understand, it looks like he just removed one lymph
node – can spreading occur to ones he didn't remove and therefore
weren't tested?

Does this say that a parathyroid was removed?

Does this say that the cancer was "encapsulated" (contained, and
didn't spread)?

Sorry for the long message.

Thanks, and thanks again.

[Mark Lupo, M.D.]

Not sure why the FNA is so different from surgical path...there is about a 2-3% (and in some centers/studies, perhaps more) false negative rate with FNA.

Would go for completion thyroidectomy -- surgeons vary greatly on how long to wait for this.  Would want to have some pre-op imaging (CT or physician performed ultrasound) to see if any lymph nodes need to come out during second surgery.

Encapsulated means it did not spread beyond the capsule of the tumor.  

There is about a 25-40% chance of finding a small cancer on the other side.

Parathyroids sometimes are removed during thyroid surgery -- that means one is gone and there are three (hopefully) remaining...

[BUTTERFLYLOVER]

Hey there I understand all the confusion in 2003 I was diagnosed with papillary carcinoma. I was very blessed that my insurance company changed and I had to go to a different doctor. The first appointment he just kept looking at me while I was telling him all these problems I was having and he goes something is wrong with your neck. Two months later I had already had two operations. I do not believe you have to wait three weeks, for the second surgery. I had mine within a week apart. Even after my surgeries and the high dose of Synthroid 600mg daily I still do not feel like I did before all my problems. I have a pinky size peice of thyroid left, they were hoping it would all work a little well it did but caused my cancer index to go up. Being on such a high dose causing the cancer index to be normal but most of the time I feel horrible. It is hard to explain to people what you are feeling when they can not see what is going on in your body. All I can say is ask a bunch of questions...I find it easier for me not to get to wrapped up in it because it just makes the depression worse...i believe encapsulated means contained however I would ask about residual tissue this is what will help cancer to spread...we are lucky that this type of cancer is not a death sentence...it just can make days not so sunny.