Understanding post-surgery pathology report - 1265794

Mon, 09/08/2014 - 03:04

I have had multiple lung nodules at least since 2005 when they discovered by CT. None of them increased in size until my last scan in June. Two of them increased from 0.6cm to 1cm each. I had my surgery 10 days ago and the pathology report is appended below.
My surgeon described my condition as multi-focal lung cancer. I would appreciate if someone can read the pathology report and explain it to me in plain English. I would also like to know if chemotherapy may be useful for people with multi-focal cancer if the cancer is early stage. I thank you in advance.

--------------
Post surgical resection findings and treatment options...

I had my first ever surgery (VATS) exactly a week ago and I received the pathology report yesterda. Two adenocarcinomas (one in right upper lobe and antother in right middle lobe) each 1 cm in size were removed. These are now defined as adenocarsinomas and not adinocarcinoma in situ as had been thought from in the pre-surgery needle biopsy studies.

The post surgery pathology report is shown below. Is there anybody here who has had similar diagnosis? Please help.

Surgical Pathology Report
FINAL PATHOLOGIC DIAGNOSIS
A. RIGHT MIDDLE LOBE LUNG, WEDGE RESECTION:
- INVASIVE WELL DIFFERENTIATED ADENOCARCINOMA (SEE SYNOPTIC REPORT
AND COMMENT).
- SURGICAL MARGINS NEGATIVE FOR CARCINOMA (CLOSEST IS 1.0 CM FROM
RESECTION MARGIN).
- TUMOR SIZE: 1.0 CM IN GREATEST DIMENSION.
- TUMOR INVADES VISCERAL PLEURA.
- 9 BENIGN LYMPH NODES (0/9) FROM PARTS C-F.
- PATHOLOGIC STAGE: mpT4 N0 (BECAUSE OF SEPARATE TUMOR NODULE IN A
DIFFERENT LOBE OF IPSILATERAL LUNG - PART B).
- ADDITIONAL PATHOLOGIC FINDINGS: ATYPICAL ADENOMATOUS HYPERPLASIA.

A. LUNG, WEDGE BX, INCLUDING OPEN - RIGHT MIDDLE LOBE WEDGE
RESECTION:
Specimen: Lobe(s) of lung: Right middle lobe
Procedure: Wedge resection
Specimen Integrity: Intact
Specimen Laterality: Right
Tumor Site: Middle lobe
Tumor Focality: Separate tumor nodules in different lobes, sites: Right
middle lobe (abo

Forums
Revision log message
Created by FeedsNodeProcessor

JimC

Hello bonaya,

Welcome to GRACE. I am sorry to hear of your diagnosis. Though a detailed analysis of your pathology report is beyond the scope of what we do here, I can offer some insights and direct you to information which I hope will help you.

Essentially, the report states that the nodules found in the tissue resected represent an invasive form of adenocarcinoma (which has the tendency to spread) rather than adenocarcinoma in situ, which tends to remain in place, often growing only very slowly. These terms describe the opposite ends of a spectrum of lung cancers formerly (and often still) referred to as bronchioloalveolar carcinoma (BAC). One of the features of BAC is that even in its invasive state it can be very slow growing.

In your case, your nodules remained the same size for several years before some of them grew. Even those which were seen at 1.0 cm in June were still that same size at the time of surgery in late August. The report further states that none of the nodes sampled were cancerous. So your cancer may still be characterized as indolent.

In answer to your question, chemotherapy is certainly something which can be effective in your situation, but your doctors may also want to question whether treatment is appropriate at this point. If they are considering systemic treatment, they may also wish to test the cancer cells for the presence of driver mutations such as EGFR, for which there are targeted therapies available.

GRACE founder Dr. West, an expert in BAC, has written quite a bit here about the management of BAC. You may want to take a look at these posts:

http://cancergrace.org/lung/2011/02/07/redefining-lung-cancer/#more-5108
http://cancergrace.org/lung/2011/11/29/bac-today/#more-5794
http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

Please let us know if you have further questions.

JimC
Forum moderator

Dr West

I would call to your attention the algorithm that Jim provided in the last link, which highlights that even if a cancer is called multifocal, that doesn't mean it needs to be treated or will lead to problems in the near future. In addition, here are a few other links that I would focus on when you're talking about a cancer that was able to be followed for years before it demonstrated any appreciable changes:

http://cancergrace.org/lung/2006/12/06/the-risk-of-overtreating-bronchi…

http://cancergrace.org/lung/2013/12/14/lc-overdiagnosi/

Good luck.

-Dr. West