question about pathology report

[Andrea]

Hi. I feel so dumb asking this b/c I think I know the answer, but yet I am confused. So my mom had her lobectomy which removed upper right lobe and they took out lymph nodes, one or two lit up on PET scan, hence IIIA.

Now we are waiting for pathology reports. What exactly are we waiting for though? We know the tumor in the upper right lobe was cancer and we know from the mediastonoscopy that the lymphs were cancer.

My only thought is that the pathology will tell if additional lymphs are cancerous? I am so confused about what we are waiting for

[Hebbie]

Well, I don't know if this will provide any answers or not, but during my surgery to remove my upper right lobe, a quick pathology was done on 3 or 4 lymph nodes in the mediastinum and they came back "clear". My doctorproceeded to do the lobectomy and also proceeded to remove 12 additional nodes - basically all the nodes he could find and remove!!!

When I awoke from surgery, I was told that the nodes were clear, I was Stage I and would not be having any follow up treatment. 3 weeks later, I went for a surgical follow up and was told that the final pathology report on those additional lymph nodes showed 4 positive nodes. Hence, the restaging to IIIA.

Now, I don't tell you this to scare you, I just want you to know what they are looking for in the final pathology report. Of course -- your mom had a PET Scan going in -- I did not.

I am assuming that they removed her "positive" nodes when they removed the lobe? Did they do a complete lymph node dissection? There are some doctors out there who believe that if you do a preliminary testing on a few nodes that come out clear, they don't need to remove anything further with the lobe. Of course, if my doctor had felt that way, I would have been left with 4 cancer nodes in my chest. Scary thought!

Sorry this got so long winded -- but it doesn't sound like your mom should be in for any surprises and I hope her recovery is a quick one!!! Make sure she is doing those breathing exercises!!!

Heather

[Snowflake]

Andrea,

Here I am, feeling really dumb right along with you... I'm not sure how long pathology reports take to "come in", but I know (from hearing disjointed hallway conversations between my doctors - WHY do they do that??) that in surgery they could tell that some of my lymph nodes were positive (closest to the tumor) and that that moved me to a Stage II...a day or so later, learned that one of the medistinial pair had come up positive, as well, making me a IIIa... Of course, being drugged out of my mind, I didn't think they were talking about me...until two weeks later when I met my oncologist and he knocked me upside the head with the news!

I would guess that the pathology report answers more questions for the doctor, like if the cancer was typed correctly along with staging. I believe it also helps the oncologist decide on treatment...and for some reason, big cancer centers want "a piece" of it when they look into the second opinion stuff... I had to have a piece of my tumor sent to Houston when I wasn't even allowed to see the little monster! Now, THAT'S not fair! It's not like I wanted to take it home in a jar, just SEE it..

Sounds promising that the doctors are on top of the situation!

Best wishes,

Becky

[Andrea]

Thank you It is all coming together now! I remember reading from the mediastonoscopy report that they removed like 4 lymph nodes and one was positive, so they knew she was IIIA, closed her back up for chemo before surgery.

I also know that they did remove lymphs this time, but not sure how many. I guess they need to see if more lymphs are positive than we intially thought and then do more chemo. I believe they said no matter what, radiation was likely to be on the safe side.

Also interesting what you said about tumor sample, my mom's oncologist is at a different hospital than the surgery and he wants a sample. His office mentioned this on Tues and surgery was Thurs before. I was wondering if they keep the tumor that long. From what I understand her oncologist is big into doing his own testing.

[john]

A report in ALCASE said that Medianoscopy is the best way to test the mediastinal lymph nodes. PET is not as good.

As Hebbie said, a complete disection of the lymph nodes is the best not just a sampling.

The path report will show the actual cell type (Adeno, LCNEC, squaumous, BAC, etc). The pathologist will also give a grade to the cancer. The grade tells how fast the cells divide (the mitotic rate).

I am not sure what additional tests and stainings they will do. For some clinical trials they will test for HER2, P53 etc to figure out if there is targeted therapy that can be used

[Andrea]

Thanks for the info! The original pathology from the mediastonoscopy said it was non small cell with adenocarinoma features, highly undifferentiated, Grade A tumor (which I beleive is fastest growing). Apparently Grade A spreads the fast, but does better with chemo, or so the surgeon told us that day to make us feel better

I am assuming they took out more lymph nodes and are testing all of those. I won't call them and bug them yet about the report, but I'd rather save my nagging for ct-scan time

[john]

There was a study (the study is in the lastest ALCASE newletter).

Lovenox with taxol increased survival.

Lovenox is for the blood clots. Blood clots are very common in lung cancer and I think other cancers