Confusing biopsy results?

Hi everyone, this is my first post and i would like some opinions on my mums lung cancer.

About 3 months ago, a tumor was found in her lung, she had a pet scan and we were told that it was 'active' but only small, around 2cm big. The oncologist said then that his opinion was that it was non-small cell, and because it was so small the prognosis was very good. He predicted that they would be able to take it out and she would likely not need any further treatment.

Then she had a biopsy about 2 weeks ago, and the results for that stated that the tumor was 'acting like small cell cancer.' But the oncologist is saying that he is confused now because in 3 months the tumor only grew 1mm, and she has not lost any weight. Basically that her symptoms don't match the biopsy results.

So how often is a biopsy wrong? By the way, she is 55, has been a heavy smoker for 40 years, and her first and only symptom was coughing up a little blood which has stopped.

Thanks

By D1
Posted October 23, 2009 at 8:06 am
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Coughing blood is a serious symptom; I'm glad she didn't ignore it, and I hope she quit smoking.

You can have that same biopsy sample examined by another pathologist, preferably one at a cancer center. Perhaps, you will get a more definitive answer. I don't think you want to leave your Mom's care to this oncologist's "guesswork."

I think, and I am not a doctor, that you should have your Mom see a TOP thoracic surgeon at a cancer center, one who does VATS. Have this tumor removed, studied, and then make appropriate treatment decisions. Do NOT waste time.

By nanag
Posted October 23, 2009 at 9:16 am
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I totally agree with D1. I was diagnosed the week of the 24th of Sept. 2005, I was 55 at the time. was operated on Oct. 10 upper right lung removed. Stage 1B non small cell. I am so thankful for the quick time frame. Glad it is out of me and pray it not come back. I did not have vat from what I understand vat is a better procedure?
Point is D1 is right.
God Bless and pray all goes well.

By Marylou1
Posted October 23, 2009 at 10:39 am
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I do SO agree. Do not leave anything to an Oncologist's guess work. You need to have a correct biopsy done at a Cancer center and as D1 said, get a Top Thoracic Surgeon do the work. Cancer does not give you any room for guess work at all.

Also, I do hope she quits smoking since it can only cause great havoc during surgery, but also can hinder the full potential of any Chemo she would need.

Your mom is young. If she continues to smoke, chances are it WILL come back.

Love to all,
Marylou

By gpawelski
Posted October 23, 2009 at 12:03 pm
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Pathology is a very visual science. The pathologists look for patterns. It appeals to people who have a talent for recognizing patterns. Cancer grows in recognizable patterns that allow for their identification. Biological characteristics are exactly what pathology reports provide. A breast cancer has a certain growth pattern that differs from a carcinoma of the lung. Benign conditions also have patterns.

However, in between a diagnosis of benign cells and a malignancy are a dizzying array of possibilities, and sometimes more often than you'd expect, the pathology report is wrong. Researchers at Johns Hopkins have found that about 1.4% of the time, a pathologist mistakenly diagnoses cancer, gets the type of cancer wrong or misses a cancer altogether. Errors that can significantly change the type of treatment are even more common.

Even two different pathologists looking at the same cells can reach different conclusions about who has cancer and what type. Pathologists can readily distinguish between big invasive cancers and normal tissue, but they disagree about what to call cancer in a large gray area in between.

Usually, a pathologist will never make a diagnosis unless they are 200% sure of the diagnosis. Having said that, there are situations where a definitive diagnosis cannot be rendered. Sometimes it is because a biopsy sample that was taken by the surgeon is too small, or perhaps taken from an area that is not representative of the patient's lesion. Other times, the diagnostic process of key cells may be obscured by inflammation or the effects of treatment such as chemotherapy.

There are times when a pathologist must admit that they do not know. Considering that the rarest of diseases pass under the pathologists' microscope, this is not surprising.

There are occasions where the pathologist may turn to an immunohistochemical (IHC) diagnostic staining test performed on microscope slides, with intact cells and looks for proteins themselves. In a statistical analysis, the tentative diagnosis, the interpretation of stains and conclusions drawn from IHC are independent factors in reaching a diagnosis. An IHC is just furthering of the investigation of the tumor specimen when the original pathology is really unsure.

And if this test is not helpful, the pathologist may turn to a consultant, a recognized expert in their field. The emergence of telepathology may also provide another source of immediate consultation for the pathologist. If a pathologist were able to send the microscopic images they are viewing to another expert, in real time, the benefits for the patient may be immense. With the growth of the internet, digital images can be emailed for future group discussions.

So, the first step in any cancer diagnosis is to tell your doctor you want a second opinion from a pathologist who specializes in your type of cancer. Insurance almost always covers the cost. Major cancer centers typically have several specialized pathologists.

By scared1
Posted October 23, 2009 at 12:32 pm
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Totally agree with above post. You have to remember doctors are only human and they too make mistakes. My father was dx with stage 4 "large cell" NSCLC last November. He decided on no treatment and was given less than 4 months to live. In a couple weeks he will not only have survived a year but improved and has no symptoms. He was offically kicked off hospice last week due to no disease progression...my point being even with a good diagnosis there is nothing for sure with this disease.

By HighlandGuy
Posted October 23, 2009 at 1:51 pm
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If what you are telling us is accurate in describing the actions and statements of your mother's doctors, they are simply incompetant of treating lung cancer.

You need to take her immediately to a medical center that specializes in diagnosing and treating many hundreds of people annually with lung cancer.

Lung Cancer is not like other medical conditions or for that matter, most cancers. It is extremely complex, to unforgiving and deadly to be treated by anyone, but teams of experts who specialize in it's diagnosis and treatment.

I know this is blunt, tough talk, but i am being frank and honest!

As a standard, I would not consider he being treated by a facility that treats less than 200 new lung cancer patients per year, if possible a lot more.

HighlandGuy

By debra1
Posted October 23, 2009 at 5:06 pm
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I agree with all the posts. Very important to get the right type of cancer. There is a HUGE difference in the way you treat Non Small Cell lung cancer and Small Cell Lung cancer. I would say find another opinion..

By Beenthere
Posted October 23, 2009 at 9:48 pm
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I would first suggest that if this doctor is not a pulmonary specialist that you get your Mother to see one. The first place to start with disease of the lung is not a thoracic surgeon or oncologist, but a pulmonary specialist.

I was diagnosed by biopsy in April of this year with small cell carcinoma of my right upper lobe of the lung and told after a PET SCAN that it had miraculously not spread anywhere. The answer by the doctors was to remove my right upper lobe. Two weeks after surgery my diagnosis was large cell carcinoma. BIG DIFFERENCE.

My pulmonary doctor never saw me after she scoped my bronchi. I am always told she is busy.... wonder why???

By howian1
Posted October 23, 2009 at 10:00 pm
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I would take a look at the biopsy report and if necessary, get a second pathology evaluation if the first is unclear. What does the Ct Scan say.

By Meplus3
Posted October 24, 2009 at 9:06 pm
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Firstly, thanks so much to everyone who took the time to answer!

My mum did quit smoking and I'm really proud of her for that, it would have been hard but she knows if she is to have any chance that was the first thing that had to happen.

Unfortunately we live far away from each other so I can't be there to ask the oncologist these questions and it's driving me crazy. But I am about to ring her and tell her she needs to get a second opinion on this. We have gone from her G.P. finding the tumor and that he said was almost definately cancer, then the oncologist firstly saying he did'nt think it was anything to worry about probably just scar tissue or something, to a PET scan confirming active cancer but everyone still being sure it was not serious because its not growing fast enough, and now finally to the needle biopsy saying it 'behaves like small cell cancer.'

I don't think they are moving this along fast enough but in Australia I don't really know how many options we have of going elsewhere when she is in the public health system. Unfortunately she does'nt have private health insurance. is there any Aussies here who know what other options we can look into to hurry this whole thing up? She lives close to Brisbane and is currently being seen through the P.A.

Thanks again everyone!

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