My dad is 93 yrs old, jut got thru a full thyroidectomy, Negative for cancer in thyroid tissue or mets..
ended up with trach that was going to be temporary, until they found a lesion in rt larygnx ventricle & false vocal chord. Biopsy and cat scan done...from visual and cat scan.. determined stage 3..report states invasive poorly differentiated carcinoma with small cell features..positive for cytokeratin,EMA,and CK7......But Negative for P40 -ck5/6 -p16-synaptophsin,s100 and p63. Is this enough information to determine decision for full removal of voicbox ...Is this considered aggressive, not same as small cell, is it??
Is Watchfull waiting and monitoring, would that be out of the question due to his age? Chemo is out due to his age...Isn't small cell cancer rare and aggressive, so how certain is the terminology " with small cell features".. the report doesn't even mention squamous, although doctor says it is. Could it be they need to do another biopsy...it just feels so uncertain on path findings from this biopsy or is this normal? Seems like information is incomplete.
thank you so much
yoly
Biopsy pathology results uncertain or vaque? what does it mean? - 1267250
yoly
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Reply # - November 22, 2014, 12:25 PM
Hi yoly,
Hi yoly,
I'm sorry to hear of your dad's diagnosis and the issues he's facing. These sorts of decisions are difficult enough to make in a younger, fitter patient, but with a 93-year old it really does depend on just how strong he is and how many other health issues he has. He's already endured the thyroidectomy, and another invasive procedure would be difficult. The best people to be able to judge whether that's something he should be put through would be his own medical team.
There's a spectrum of cancers which include small cell; this concept is described here So it isn't necessarily a question of a vague diagnosis, it's just that his cancer may be somewhere in the middle of the continuum, which features of more than one type.
JImC
Forum moderator
Reply # - November 22, 2014, 09:51 PM
Yes, I completely agree with
Yes, I completely agree with Jim that the recommendations are going to need to be very specific for your father, partly because he's 93 (which is a very big factor), and partly because his cancer is extremely unusual and will need to be considered on an individualized basis. If it originated in the throat, it isn't the same as small cell lung cancer. The pathology findings sound very unclear, so we couldn't say anything definitive about what it represents or how it should be treated, I'm sorry to say.
Good luck.
-Dr. West
Reply # - November 24, 2014, 08:18 AM
dear dr west & jim
dear dr west & jim
They now want to do a pet scan...is that better then a cat scan? Cat was done 2 weeks ago..if I may ask ,do the positive and negatives results of the tumor cell pathology help if leaning towards or away from small cell cancer. He has had a "tracheostomy since the thyroidectomy on.Aug 2014 and on the cat scan, impression was thickening of anterior & posterior commissure with increased density involving rt false vocal chord..soft tissue thickening of the infraglottic larygnx & irregularity and nonvisualization of the left cricoid cartilage... ending with.. findings could be partially secondary to post treatment changes, however, during laryngoscopy in May 2014 this neoplasm of uncertain behavior was seen..Surgeon determined it a stage 3...how can be so sure at this point..when a surgeon says he is getting a conference together to review the case of a 93 year old man, can you advise what type of dr's should be on that team, and if a written report of recommended treatment plan be drawn up? Is that something I should ask for in case ,we do want a second opinion?
thank you so much for your time
Yoly
Reply # - November 24, 2014, 08:47 AM
Hi yoly,
Hi yoly,
A PET scan is especially good for the initial staging of a cancer diagnosis, since it indicates where potential metastases may be throughout the body. Its downside is that conditions other than cancer, such as inflammation, can appear and may be indistinguishable from cancer. For follow-up of a known cancer, CT scans are preferred for their high resolution.
As Dr. West said, your father's situation is complex, and even the question of who needs to be present will be best determined by his surgeon, although it would typically include a medical oncologist and a radiation oncologist in addition to the surgeon. When you get a second opinion a copy of your father's medical records will be forwarded to the new doctor; whether they will write up a report detailing the treatment plan is probably a matter of policy at your cancer center (and you can always ask), but it should be described in the notes found in your father's file.
JimC
Forum moderator
Reply # - November 24, 2014, 10:11 AM
I agree. As Jim noted, the
I agree. As Jim noted, the typical members of a tumor board are one or more surgeons, medical oncologists, and radiation oncologists, as well as a pathologist to review biopsy/surgery results and a radiologist to review imaging findings. A PET scan is very appropriate for initial staging. And of course you should feel perfectly welcome to pursue a second opinion, especially in a setting for which there won't be any obvious best strategy.
-Dr. West