Understanding Stage 3A Pathology Report for NSCLC - 1288532

Tue, 09/06/2016 - 18:42

Hi!

In April, my mother was clinically diagnosed Stage 3A NSCLC. she received neoadjuvant chemotherapy, three cycles. In August, the surgeon resected the tumor via upper left lobectomy and we received the pathology report. I'm assuming the surgeon could not receive clear margins on my mother. The pathology had eleven specimens submitted.:
-Benign level 6-12 lymphnodes, benign left sixth rib and benign interlobar lymphnode
Upper Left Lobe:
-Visceral pleural invasion present
-Lymphovascular invasion present
-Vascular margin: tumor present at vascular margin involving vessel wall
-Bronchial line margin negative
-Staple line margin negative
-2 of 13 peribronchial lymphnodes positive for Adenocarcinoma

-moderate membranous labeling
Staging AJCC
ypT2A
ypN1

Please help advise prognosis and what this means. We have an appointment with a radiation oncologist tomorrow. Unfortunately, the surgeon was not available to go over pathology due to being out sick and holiday weekend. Thoughts on radiation therapy?

Thanks so much!

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JimC

Hi greekgirl,

I think this is a situation in which only your mother's local medical team can give accurate answers, which is why the general policy on GRACE is to avoid trying to interpret detailed reports of this type. It's pretty clear we don't have enough information to definitively state what is going on. For example, at the end of the report, the AJCC staging is given notes a tumor status of T2A and node status of N1, but the AJCC staging chart would categorize this as stage IIA rather than IIIA. (I'm not suggesting either staging is wrong, just pointing out how a lack of information can make it difficult to know what considerations may be affecting staging).

As you might expect, stage IIA has less chance of recurrence that IIIA, and treatment options are different. Treatment options for stage IIIA are discussed in several GRACEcast videos here.

JimC
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greekgirl3

Thanks, Jim!

The 3A stage was given prior to surgery and chemotherapy. Maybe the surgical stage now put her at 2A, hmmm? Anyway, we are meeting with a radiation oncologist today. Hopefully, he will be able to go over pathology with us.

Thanks so much!