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Understanding my surgical and molecular pathology reports


Lisa B-Schulz

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I was diagnosed with adenocarcinoma in my right lower lobe in early November, had surgery in mid-November and am awaiting my post-lobectomy appointment with my thoracic surgeon. The surgical pathology report and molecular pathology reports have been posted to my patient portal but have not yet had anyone explain them to me yet. The surgical pathology report shows that, thankfully, the cancer had not spread to any of the 21 lymph nodes they removed and the report on the tumor itself is as follows: Adenocarcinoma; predominant pattern - Acinar 70%; other patterns: Papillary 15%, Micropapillary 10%, Solid 5%. The tumor grade is Moderately differentiated (G2). The molecular pathology report which was derived from the biopsy I had prior to surgery shows the following: CCNQ Splicing Mutation and ACVR2A-BRAF fusion. 

I understand that the makeup of a tumor is highly individualized, but I’d very much appreciate hearing from anyone that has any insight into what this all means. Thank you!

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Lisa,

Welcome here.

What does all this mean?  The most important words I note is the tumor is adenocarcinoma and cancer was not found in 21 removed nodes. Your information provided from your "molecular pathology" report is using terms I'm not acquainted with. Here is information on lung cancer Biomarker Testing. Read in particular: "What information is included in a biomarker report." GCNQ Splicing Mutation and ACVR2A-BRAF fusion are not driver mutations I'm familiar with. Moreover, the report does not comment on PD-L1 expression. So I can't help you understand your molecular pathology report.

But, your thoracic surgeon job is finished. I do suggest you find a medical oncologist to consult with because this discipline will supervise and direct your CT scan screening protocol, normal after all lung cancer surgeries. Moreover, the medical oncologist should be well versed in understanding Targeted Therapy and or Immunotherapy treatments should these prove necessary if you have a recurrence. 

I do hope you are recovering from surgery. From your description, your cancer was found at an early stage (1A, 1B or 2A) and surgery is indeed the best form of a curative treatment. So now we worry about recurrence and unfortunately, lung cancer has a high probability of recurrence after "curative" treatment. The way we guard against recurrence is a scheduled CT scanning protocol. That finds a recurrence quickly which is very important. Your medical oncologist will be able to decipher your molecular pathology report to tease our the next appropriate treatment, should there be a need. But right now, recover, have a great holiday and find a medical oncologist your are comfortable with.

Stay the course.

Tom

 

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Lisa,

I also had right lower lobe removed in mid November.

There are few subtypes for lung adenocarcinoma: lepidic, acinar, papillary, micropapillary, solid, mucinous and non-mucinous. Lepidic predominant is the most favorable (least recurrence) and acinar predominant is the second most favorable. I don’t know about biomarkers you mentioned. Your surgeon did a very good job taking out 21 lymph nodes. I just wonder do you know all the node numbers for all 21 nodes? Such as 4,5,6..14 etc..

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Thank you for your replies Tom and Minh. I will ask my surgeon about a referral to a medical oncologist when I see him for my post-op follow up this week. Minh, I looked up the post about your pathology report and it looks very similar to mine. I hope you are feeling well now. I am still having some pain (which I am controlling with Tylenol and Advil), but the biggest complaint I have now is not being able to get a good night sleep and feeling exhausted every day as a result.

I have to say that I’m disheartened by the chance of recurrence here. The surgeon went in wanting to take only a segment of my right lower lobe to leave me with more lung in the event of recurrence, but once in the OR found that my lung anatomy did not lend itself to just removing a segment without the possibility of leaving some cancer cells behind so ended up taking the whole lobe. I have been grateful that my cancer was caught early, but it seems like recurrence is nearly inevitable and that’s a sobering thought.

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Hi Lisa, being from Scarsdale you've got some world-class medical knowledge available to you. Where did you have your surgery? I've heard good things about Memorial Sloan Kettering in the city, so you might consider finding a medical oncologist in their practice to explain your pathology report and monitor you. 

I'm originally from Rockland County, worked in the city for many years and moved out to San Diego 7 years ago. I really don't miss the winters! 

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Hi Judy, I would trade my NY winters for San Diego any day! i agree that I am fortunate to have access to world-class medical knowledge and care in the NYC area and did, in fact, have my surgery at Memorial Sloan Kettering. The only doctor I have met with there so far is the thoracic surgeon but agree that based on what I’ve heard from others on this forum, it is time for me to seek out a medical oncologist.

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Lisa,

Initially my MD Anderson surgeon didn’t want to work on me because of my recent aortic valve replacement and triple bypass in April. He recommended radiation. But I requested to have surgery. He was going to do a wedge for lung sparring purpose due to my heart conditions. After a lot of research about recurrence, I took a gamble and asked for lobectomy because it reduces chance of recurrence significantly compared to wedge or segmentectomy.

I am taking Tylenol and gabapentin for pain, and have shortness of breath. I can sleep better with a wedge tall (30 degrees angle) pillow on my back. 

As for lowering long term risk of recurrence, I asked my surgeon for additional adjuvant therapy. He insisted that I don’t need additional treatment based on guidelines and that medical oncologist will tell me the same. My local medical oncologist already told me before the surgery that there will no additional treatment after lobectomy. But I will ask him again in tomorrow appointment just to double make sure.

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Hi  Lisa, my NSLSC was also caught early and I had a lobectomy, 5 years ago this month.  I also was disheartened to read the stats on recurrence. However, I've gotten through 5 years without any issues, and recurrence becomes increasingly unlikely with time. So I'm pretty optimistic and I encourage you to cultivate optimism. Statistics reflect experiences of a large group and each of us is a case of one. An additional reason for optimism is that if a recurrence should occur, there are many (MANY!) new treatments for lung cancer.  Currently available lung cancer survival statiistics,  most often based on 5 year survival rates, are no longer accurate, even for large groups, because they reflect the experience of people who were diagnosed longer (often much longer) than 5 years, and at those  times all these new treatments didn't exist.  

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