Reading the Pathology Report

Cartia · New User Joined: 31 Jan 2006 Posts: 1

Greetings, I have been reading many of your posts since my Mom was diagnosed with Stage IIIB Adenocarcinoma on 12/12/05. We now have a copy of the Pathology Report and I wonder if anyone can help me clarify and confirm? I have working on it with the medical dictionary but have no background to put it all together.

Mom is a very youthful 78-year old, never smoker, never ill (not even an aspirin). We have enormous faith in our team at the NCI-Cancer Center yet I sometimes feel that they are very choosy with their words (perhaps to keep us from losing hope?).

Here is the "General Pathology Report"

Tissue Description: MR05-11673 A1 Right Supraclavicular lymph node (2.6 cm)

Diagnosis: Lymph node, right supraclavicular, excision: Grade 2 (of 4)
metastatic adenocarcinoma

Addendum: The tumor cells are positive for TTF-1 and cytokeratin 7, and negative for cytokeratin 20, supporting a lung primary.

Addendum: Immunohistochemical stain for EGFR shows 80% of tumor cells positive, with 3+ intensity. This tumor can be considered an EGFR-expressing carcinoma. Response to treatment does not appear to correlate with intensity of staining or number of cells positive.

Thanks to all of you who post. I'm glad that surviving is possible and that quality of life can be valued.

Thanks in advance for your help.

Cartia

rlee · Site Admin Joined: 15 Jan 2006 Posts: 245

Here's an abstract that should help provide some information on the biopsy. Available on Pubmed.

Sincerely,
RLee, MD

Any information provided is NOT intended to provide specific medical advice to users but rather to provide users with information to help them better understand their health condition and related care. All readers are strongly encouraged to consult with a qualified physician for answers to their personal medical questions.

Eur J Cancer Prev. 2001 Feb;10(1):77-82. Related Articles, Links

Use of cytokeratins 7 and 20 in determining the origin of metastatic carcinoma of unknown primary, with special emphasis on lung cancer.

Rubin BP, Skarin AT, Pisick E, Rizk M, Salgia R.

Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Metastatic carcinoma of unknown primary is a common problem, accounting for up to 10-15% of all solid tumours at presentation. Proper identification of the site of origin has prognostic and therapeutic significance. Prior immunohistochemical methods to identify the site of origin have been useful in a limited number of cases. Differential cytokeratin staining may be useful in this setting, particularly in identifying metastases from lung cancer. We have identified 144 cases of metastatic carcinoma of unknown primary to bone, lung or liver at Brigham and Women's Hospital between 1 January 1997 and 1 July 1998. Cytokeratin (CK) 7 and CK20 were used in 75 of these cases to narrow down the possible sites of the primary tumours. All of these cases were ambiguous as to the site of the primary tumour. Forty-five cases were CK7+/CK20-, 15 cases were CK7-/CK20-, 9 cases were CK7-/CK20+ and 6 cases were CK7+/CK20+. Three of the cases were selected for detailed presentation and discussion as well as a discussion of the pertinent literature. Overall, the CK7+/CK20- phenotype favours a lung primary, the CK7+/CK20+ phenotype strongly favours transitional cells (urothelial) carcinoma, the CK7-/CK20+ phenotype favours colorectal carcinoma, while the CK7-/CK20- profile is not helpful.

kris114 · New User Joined: 14 Mar 2006 Posts: 5

My mother had a similar pathology report and characteristics-- non-smoker, woman, over 75, Non-small cell cancer, adenocarcinoma, stage IIIB, and EGFR-expressing tumor. I did research and found that the drug Tarceva can be most effective for people who have these particular characteristics. Do a search on Tarceva (erlotinib is generic name) and ask your mother's doctors about this drug, especially the EGFR characteristics. Usually this drug is prescribed as a second line of cancer treatment, but researchers at Sloan-Kettering recently released a *study that confirms that the drug has much promise for the characteristics that you list on your mother's pathology report. I talked to my mother's oncologist about this. He immediately prescribed her the drug, and she just started taking it today. My mother had chemo last summer, and was hospitalized twice because of the severe side effects. Keep hopeful and keep asking questions. Take care, Kris

http://clincancerres.aacrjournals.org/cgi/content/abstract/12/3/839

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