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  • Cold Knife Cone excision lab results

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    Old 05-15-2013, 04:46 PM   #1
    lyda721
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    Question Cold Knife Cone excision lab results

    Appreciate help in clarifying clean margins vs stromal invasion implications in cone biopsy.

    the lab results...

    TUMOR SITE
    Left superior quadrant 12 to 3 o’clock
    Right Inferior quadrant 6 to 9 o clock
    Right superior quadrant 9 to 12 o clock

    Tumor size
    Cannot be determined (involves multiple quadrants

    Histologic Type
    Squamous cell carcinoma

    Histologic Grade
    G2 Moderately differentiated

    Stromal Invasion
    Approximately 2 mm
    Horizontal extent can not be assessed (involves multiple quadrants)

    Margins
    Not involved by Invasive carcinoma
    Not involved by Intraepithelial squamous neoplasia

    Considering the Margins are not involved does this means that the cone excision removed the tumor completely or does the Stromal invasion of 2 mm mean that it may have spread to other tissue and I'll likely need a hysterectomy ?

    I'm seeing my oncologist in 1 week but I was able to obtain the results from the lab and I am anxious to understand their meaning.

    Thanks

     
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    Old 05-29-2013, 11:43 AM   #2
    lyda721
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    Re: Cold Knife Cone excision lab results explained IA1

    So the results can be summarized as:
    • Clear Margins
    • Squamous cell carcinoma with 2mm Stromal invasion.
    • LVSI (lymph vascular invasion) not identified

    I was under the wrong impression that a clear margin meant that the cone procedure would be all I needed. The microinvasion of 2 mm changes that.

    Based on those results 2 doctors provided 2 different opinions.

    Doctor 1 (who performed the cone surgery). Recommends an hysterectomy based on the guidelines of a IA1 treatment of a patient that does not want any more children. He was going to check again the LVSI to ensure that it was not affected. If it was, then add to the hysterectomy, removal of pelvic lymph nodes and para aortic lymph node dissection. All using Da Vinci Robotic surgery.

    Ovaries are not removed.

    2nd Opinion: Recommended a conservative approach of wait and test again in 3 months. He wants to run the pathology tests on the tissue collected in the cone in the lab again. (different hospital)

    I also recently found some of the issues going on with the Da vinci Robotic procedure which are making me worry even more.

    So now it's decision time and I am as undecided as ever.

    Last edited by lyda721; 05-29-2013 at 11:48 AM.

     
    Old 05-30-2013, 08:56 AM   #3
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    Re: Cold Knife Cone excision lab results

    Sorry you're going through this! I assume both doctors are gynecology oncologists? With the huge overuse of hysterectomy and marketing tactics of daVinci, I personally would opt for a conservative approach. And even if I opted for hysterectomy, I wouldn't allow daVinci after everything I've read. But we all must make our own decisions after doing our own research and weighing all the pros and cons.

    Getting another pathologist's read on the tissue is a good idea. Just as doctors have various levels of knowledge and skills, so do pathologists. Depending on this other pathologist's results, you may even want to get a 3rd opinion. Don't rule out phone consultations with an out-of-town respected doctor/facility. I've even heard of people perusing medical journals and having phone consultations with author experts.

    Getting this 2nd opinion from a doctor affiliated with a different hospital was a good plan too. Doctors at the same hospital tend to treat similarly and may even "work together" which may not be in your favor. That was my experience. And the hospital is probably pushing doctors to use their robot since they have to recoup those costs.

    I had an unwarranted hysterectomy for a different problem and regret it. Although my ovaries were also removed, I think the loss of my uterus has done just as much (or more) damage than the loss of my ovaries. At least I can take hormones to ease the symptoms but there's really no fix for the loss of pelvic and anatomical integrity.

    So just be sure you do your research and fully understand your diagnosis, treatment options and their pros and cons so you can make a decision that's right for you and that you won't regret.

    Please let us know what you find out from the second pathology.

     
    Old 05-30-2013, 11:53 AM   #4
    lyda721
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    Re: Cold Knife Cone excision lab results

    Thanks STLouisgal for your feedback.

    Today I met with the doctor who performed the cone, and unfortunately after he checked again with the pathologist, he realized that even though the depth of the invasion was only 2 mm, the size of the tumor was over the 7 mm limit which now makes the cancer a stage IB1.

    He showed my husband and I pictures of the affected area, and clearly there was a lot of damaged tissue. So now only once choice remains. hysterectomy with lymph node removal (which was his original recommendation). Ovaries are repositioned so that in case there are cancer cells in the tissue that will be removed, radiotherapy can be used with as little damages as possible to the ovaries.

    We asked him about the robotic surgery, and he felt it was the best choice. He has done "hundreds" of robotic surgery, and felt very confident that this was the best way forward.

    I must say that my doctor has been great. He recommended that I get a 2nd opinion, spent 45 minutes to 1 hour each of the 3 times I met with him explaining everything in detail and he is very easy to talk to, so I've been lucky so far.

    The other choice would be a laparascopy hysterectomy which from what i found has similar results.

    Da Vinci marketing is pretty aggressive and I've read some of the cases and watched CNBC report on the company which are quite scary. On the other hand I also contacted 2 friends who had the robotic surgery and they are doing very well and their recovery time was fairly short. So since I am limited in choices at this point I think this is the best option for me.

    What I don't understand is why the 2nd opinion was so much off the established guidelines. I assume that he just did not have all the information needed to make an informed decision.

    The NCCN cervical cancer guidelines helped me immensely in clarifying what options I have based on my test results.

    Overall I consider myself quite lucky that the cancer is at an early stage, This all happened in one year !!!. Keeping my pap smear appointment this year, probably saved my life.

    The fact that I'm keeping my ovaries also is a relief.

    it looks like I should be ok after the hysterectomy. But I'll have to wait for the results of the hysterectomy biopsy. I'll post additional information in the upcoming weeks.

    Best to everyone

     
    Old 05-31-2013, 07:27 AM   #5
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    Re: Cold Knife Cone excision lab results

    Wow - I'm surprised that this developed in just a year. I'd read that cervical cancer is very slow to develop from dysplasia which is why they now say pap smears are only needed every 3 years (if you've had normal ones).

    I hope the surgery goes well and the biopsy is negative!

     
    Old 05-31-2013, 07:46 AM   #6
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    Re: Cold Knife Cone excision lab results

    my 2012 Pap was Ok, and I did not have one in 2011, all previous Paps were ok. So unless the results from 2012 were incorrect (which is a possibility) I went from nothing to IB1 in 12 months.

    My primary doctor also told me about the 3 year pap recommendation and how lucky I was not to have followed the guidelines in this case.

    Now instead of 3 years it will be every 3 months after surgery for the next 2 years and every 6 months for the following 3 years.

     
    Old 06-17-2013, 08:29 PM   #7
    lyda721
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    Hysterectomy - Da Vinci

    I had my DaVinci hysterectomy which included removal of the lymph nodes almost 2 weeks ago, ovaries were not removed.. The good news is that pathology was negative so no additional treatment is necessary and I just need to visit my doctor every 3 months for follow up.

    Recovery has been a bit difficult, had a urinary track infection (probably due to the catheter) and I've been really sore in my pelvic area as well as some lower back pain. This time unlike when I had the cold knife cone, I was prepared to avoid gases and constipation, so that was not an issue.

    I started walking the day after the surgery which was pretty amazing considering how I was feeling... the ride home with all the bumps on the road was difficult.

    For the first few days it was impossible to sleep laying down so I opted for the couch where I could keep with my upper body elevated.

    Fortunately pain medication has helped and although I see that many others were able to stay away from stronger medication after a few days, I cut down on mine but still need to take something strong to control the pain.

    Went for additional blood tests today to determine if the urinary infection is still present.

    I have been feeling a bit sad these last couple of days which I think is normal and I know it will get better.

    I am particular grateful that friends were able to help out with my 2 year old for a couple of days after the surgery while my husband helped me.

    Hoping to feel better by the time I have to go back to work in 2 weeks.

    I'll post another update by then.

     
    Old 06-19-2013, 05:24 AM   #8
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    Re: Cold Knife Cone excision lab results

    Glad to hear the surgery went well but sorry about the UTI. Those are pretty common after hysterectomy. Glad you've had help with your 2 year old especially since they advise no heavy lifting. Hope the UTI is gone and the rest of your recovery goes well!

     
    Old 07-09-2013, 04:10 PM   #9
    lyda721
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    Back to work - 4 weeks after Da Vinci Hysterectomy

    Recovery going well, still a bit sore but no real pain. I stopped taking pain killers about 3 weeks after hysterectomy.

    I started working from home last week and went back to the office yesterday.

    Other than feeling quite tired, recovery seems to be on the right track.

    It's been quite a crazy 3 months, glad I can move on with my life now.

    Overall I was very lucky, first to have the pap done this year and although the tumor was large in horizontal size, it was not very deep. All biopsies after hysterectomy were negative so i also avoided radio and chemo, and I was able to keep my ovaries.

    Da Vinci surgery seemed to work great and although I am not crazy about all the marketing and knew about some of the issues that made the news for this type of procedure, I am overall satisfied with the robotic surgery.

    I also had a great doctor who took the time to explain everything in detail and the support of friends and my husband.

    Best wishes for all.

     
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