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Clinical vs Immunohistochemistry Report

BNT
Posts: 21
Joined: Jul 2018

After my mom's surgery, the surgical pathology/clinical report showed that all the 16 lymph nodes taken out of left and right pelvic side were free of tumor. However when a later review was done with a detailed immunohitochemistry report, the report states that one of the lymph nodes was found with the carcinoma -

"Left Pelvic Lymphnodes : Single lymphnode shows Metastatic Carcinoma ( 1/7 ). Deposit measuring 0.3 cm and without Extranodal Extension." It does not say what type of cancel cells were found in the lymph node.

Have a meeting with the doctor soon on this. Anyone seen something like this - how are the two reports different? What is the meaning/impact of the deposit in the lymph node?

The first report said - "Mixed Endometrial Carcinoma, Endometrioid and Serous Carcinoma ; Nodes negative"

 

 

Any other advice on what questions to ask the doctor?

NoTimeForCancer's picture
NoTimeForCancer
Posts: 2483
Joined: Mar 2013

BNT, your mom is very fortunate to have you out there (here) searching for information for her.  I hope your mom is going to let you go with her to be a second set of ears, take notes, help ask questions.

When a cell is found in a lymph node - it is a different game - probably an aggressive approach - but she can do it and all the ladies will be here to help.  

I would ask exactly what TYPE of cancer?  What is the GRADE?  Stage - again, the lymph activity automatically elevates that.  What kind of treatment (in the least I would suspect chemo), what is the schedule, what type of chemo?  Are there things to eat - not eat?  Things not to do? (I was told no work in a garden or flower beds)  If you have never been exposed to chemo, and its constipating side effects, Miralax is a good tool in the toolbox.

Your family needs to be careful of what you read on the internet.  Dr Google is out of date and this is a great place to ask questions.

Please let your mom know she is not alone.  We are here for ll of you.

BNT
Posts: 21
Joined: Jul 2018

Thank you for your kind words and the advice.

Harmony09's picture
Harmony09
Posts: 71
Joined: Aug 2017

BNT, I agree with NoTimeForCancer, this ups the pre-surgical staging, AND that chemo is doable. I was terrified. However, the ladies and the posts here prepared me for what wasn't as bad as I thought it would be. I have Stage IV, and radiation with chemo is standard protocol. I thought radiation would be a break from chemo, but the fatigue was a little bit more than I expected, but still doable. It all beats the alternative! I also suggest looking at posts from the ladies here that do natural/alternative things in conjunction with medical treatments to support the body, especially the immune system. Treatment really takes a toll on blood counts, which makes you feel yucky and can delay treatment, reducing the efficacy.

Way to go for being on top of the medical reports! Your mom is blessed to have you!

Sincerely,

Stacey

BNT
Posts: 21
Joined: Jul 2018

Thanks, Stacy!!.. This site is really helpful

Northwoodsgirl
Posts: 486
Joined: Oct 2009

I think that your Mom is fortunate that as many lymph nodes were taken and because of the quantity removed they were able to find the cancer in the one node. Now they will treat your Mom with surger, chemo and likely radiation. Count your blessing and keep caring for your Mom. She will likely do very well in terms of survival just knowing that she has cancer in her nodes and she will be treated aggressively and appropriately. 

Lori

Armywife's picture
Armywife
Posts: 191
Joined: Feb 2018

Hi there and welcome!  You are wise to prepare a list of questions for your upcoming doctor visit, and as NoTime said, you'll find "hands-on" experience here.  We will all tell you not to Google too much, and I say that as someone who Googled like a crazy woman but ended up finding my best information right here.  

I also had two different pathology reports.  My original one was read Stage IIIA, Grade 1, and the second opinion, who used the identical slides, read Stage IVB, Grade 2.  I really do think a lot depends on who is reading the slides or scans.  My treatment included chemo, and the doctors were split down the middle on whether to add radiation.  We decided to reserve that for recurrence and pray we never need it, and I am comfortable with that decision.  I'm nine months out from the end of chemo, and I want to encourage your mom that it is, as many above me here have said, Do-Able!  It's not fun, but she will get through it.  Fear of the unknown is powerful, and once you get through a couple of cycles of it, that fear will subside and you just grind it out.  

I highly recommend using icepacks on her hands and feet during chemo infusions to ward off neuropathy.  My care team did not tell me about this, but I learned it here, and  praise God, after getting debilitating neuropathy during the first chemo, I am now completely free of it.  (This is unusual -and a huge blessing.)  Ice those pinkies!

We are here for you!

BNT
Posts: 21
Joined: Jul 2018

Thanks, Armywife. This place has a lot of powerful stories and it really helps.

MoeKay
Posts: 173
Joined: Feb 2004
Your mom's doctor should be able to speak to this issue, but it's my understanding that immunohistochemistry is sometimes used as a follow-up to investigate the rate of micrometastases in lymph nodes of patients that were previously reported as negative with routine histopathology.  It sounds to me like your mom's doctor is being very thorough in evaluating her case, which I suspect can only benefit her by ensuring that she receives the optimal treatment available for her cancer. 
 
Wishing your mom and you all the best!
 
 

 

BNT
Posts: 21
Joined: Jul 2018

Thanks, MoeKay.

From what I understood, it looks like as a procedure, after the surgery they do a single cross section of the lymph nodes. If needed post that, they do multiple cross sections. It was in this second more detailed review that it was caught.

I worry about this since it was a different doctor that asked us to do a review. We were just happy there was nothing in the lymph nodes post surgery in the first report. The onco surgeon told us to go meet a medical onco after the surgery and the medical onco asked for the detailed report. The sugeon had told that it looks all clear from the first report.

Thank god we met the medical onco who asked for the next level report on that.

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