Apr 12, 2010 - 2:54 pm
This certainly shows how "iffy" cancer pathology analysis must be! After my UPSC Stage III-c recurred, and I'd finished 10 rounds of weekly taxol, I got a clean CT/PET and was allowed to take a chemo break even though my CA125 was slightly elevated (CA125 was 142.) So we made a plan that I would come in for another CA125 in 8 weeks and see if my body was able to lower my CA125 on its own (which it did!). BUT, if my CA125 went up after my 8 week 'spring break' from chemo, my gyn-onc wanted to try me on Tamoxifen to see if that would lower my CA125. Before I was willing to consider tamoxifen at all, I asked that they review my original hysterectomy pathology to see if my particular cancer was at all hormone-receptive, as tamoxifen works best on hormone receptive cancers, and UPSC is rarely hormone receptive.
So, to be completely thorough, they asked me to get my tissue slides from Hershey Medical where my hysterectomy/optimal debulking surgery was done in October 2008. (Apparently they keep your tissue indefinitely in parafin and they can slice off pieces to re-do the pathology.)
WELLLLLLL, here's the kicker: THIS pathologist found NO papillary serous cells in my tissue slides from my hysterectomy!!! His contention is that, if there were ever any papillary serous cells (and he felt the sample was too small to be diagnostic), all of the papillary serous cancer cells were removed from the tiny polyp removed during my D&C in August 2008. The NEW pathology report says that I had (have?) Endometrioid Carcinoma Stage III. It notes that the cells are "Grade 2 with Grade 3 cytologic atypia" (in other words, still a very aggressive recurrent cancer, just not papillary serous). WHAT??????
My chemo-onc says that, even had we known this from the beginning, the treatment thus far would have been the same. Do you think that's true? Both are Grade 3 cancers, and I imagine that I would have wanted to be JUST as aggressive with my treatments. & even if I knew all of the papillary serous cells had been removed during the D&C (and this pathologist felt the tissue sample was too small to have even MADE a UPSC diagnosis based on it!!) I would have been afraid it had spread and would have wanted all the chemo & radiation I took.
My BIG question now (which I doubt no oncologist will answer), is, did I really have a recurrance?? We thought I had UPSC, which is known to recur distantly, so with a spike in CA125 and 3 lymph nodes lighting up on my PET scan, we rushed back into chemo without any biopsies to confirm the cancer. But, had they known this was endometrioid carcinoma, would they have taken a 'watch-and-wait' attitiude? (& I guess I would've fought a decision like that, so really I guess it doesn't matter!) But it is strange that NONE of these lymph nodes lit up on the PET 10 weeks later afetr 10 rounds of chemo.
For those who of you who have been studying this stuff and know some of this lingo :
And a final note: the pathologist at the hospital where I had my D&C could not identify the cancer type from my D&C tissue; and so my tissue slides were sent to Hershey Medical where they identified it as UPSC from the D&C, and yet they also called it 'endometrioid carcinoma' in the pathology report from my hysterectomy. 3 pathologists from 3 different hospitals and none of them seem to agree. It just shows how individual each person's cancer really is.