"Histologic examination revealed pieces of soft tissue covered by normal and atypical stratified squamous epithelium with overlying material. Atypical cells exhibiting nuclear hyperchromasia, increased mitotic activity and cellular pieomorphism directly invaded the underlying fibrous tissues. Neoplastic cells formed tumor islands and sheets. Focally infiltrating between skeletal muscle bundles. Perineural invasion was noted. Some inflammatory cells were present."

I have a lesion on the bottom of my left of my tongue. No pain.

Can anyone decipher this? My chest xray was clear.

My team at Yale thinks I am ok to wait two weeks for surgery...

The only way to truly interpret this is to have your MO or H&N surgeon explain it to you or you would have to look up every word in a medical encyclopedia, then all of the associated words and still not get it right.

But, for what it's worth, IMO, it sounds like a typical early stage tongue cancer pathology report. The 2 most important terms in a path report are: Differentiation -which means has the cancer remained in one tissue type ("well differentiated") or is in the bone, muscle, lymph and other soft tissue ("poorly differentiated"), in other words it's degree of invasiness? Secondly "Focally infiltrating" is related to differention. Ideally you only want one tissue type involved.

Without knowing the degree of differentiation, it is difficult to interpret your report (and we are not doctors or pathologists anyway). We might sound like it at times, but we are patients and/or caregivers just like you.

Gail,
I cannot deciper it but compare it to mine which was moderately well differentiated. I had invasion of skeletal muscle focally, but not anything about fibrous tissues or perineural invasion. Mine was only 1 mm deep, and less than 1 cm at the widest point. Some of that other stuff is the same, and I apparently had more inflammation than you. The second pathology dept that had a go at it (using slides as I had the lesion removed 5 days after it was found) called it "superficially invasive SCC", meaning it did not penetrate the basement membrane. As you see I had a lymph node involved, so tricky stuff. I made one more switch after that, slightly diff. pathology report (still moderately well diff) and those were the folks I stayed with.
Anne

[quote=Gary]...But, for what it's worth, IMO, it sounds like a typical early stage tongue cancer pathology report. The 2 most important terms in a path report are: Differentiation -which means has the cancer remained in one tissue type ("well differentiated") or is in the bone, muscle, lymph and other soft tissue ("poorly differentiated"), in other words it's degree of invasiness? Secondly "Focally infiltrating" is related to differention. Ideally you only want one tissue type involved.... [/quote]

Somewhat different; pertaining to cancer cell differentiation, I was told a "well differentiated cancer cell" is very similar to a normal cell, but a "poorly differentiated cancer cell" has devolved into a somewhat primitive cellular structure that reproduces frequently and haphazardly in an out of control manner.

I was also told that radiation is considerably more effective on the poorly differentiated cancer cells because they have lost the ability to effective repair the DNA damage it does.

Yes, and chemo is more effective against it as well. BTW, any metastasis can have a different histology/aggressive state than the primary. And if any bits of poorly diff cancer that are left standing after burning & poisoning (rad & chemo) they may become well diff., or at least that is what I picked up from the discussion I had about it.

Anne

Gail,
Actually I think you are asking us: can this wait 2 weeks? Probably none of us are qualified to answer that. I can tell you lots of places would make you wait 2 weeks and say it would not matter.

After my primary was excised, and the lymph node surfaced (almost immediately, it seemed), I went to the nearest we had to a ccc; they are applying for NCI status. I had been there before the lymph node, so I already had an "in". They could not do the surgery on the lymph node and a neck dissection for about 4 weeks, and told me it would not matter. They said all their patients had cancer & could not bump anyone in favor of me--I had not asked for that either! So utilizing that time, I got a second opinion, took more than a week to get my first appointment after I got all my records & applications done, and they got me in before that 4 weeks surgery date, although only 4 days, but it meant that I would see one of my sons that way. So the surgery transpired there only a week after I was first seen. They seemed to think it did matter, but maybe I was lucky. So bottom line was I did not get in much earlier at MD Anderson, but it felt like I did!

So you probably at this point could not get in earlier for the surgery too many places, by the time you jumped through hoops. If you trust your doctors, I would think you would have to go with them.
You did not say if you had a lymph node involved. I would think they would discuss having treatment after surgery, or are they also doing a neck dissection when they remove the primary?

Best of luck and hope this helps!
Anne

Sorry - not asking someone for their diagnosis/interpretation. I have already spoken to my doctor at Yale and my pre-op is scheduled for Friday.

Just letting you know what report this "newbie" got and how I tried to google every single word to try and figure out what was going on while I was waiting.

Thought I would run it by you guys.

Sorry for the confusion and/or waste of your time. I did not mean that and should have clarified myself.

Gail,
No problem! I was just trying to help out. And I am embarrassed I got into it deeper than you meant. I did the same thing with my path & asked the doctors as well. It was all new to me.
Best,
Anne

Sorry, everyone, especially Anne.

Just freaking myself out and wanted some help from those of you who have been through this.

One woman, who had similar biopsy, told me she had a trach, feeding tube, jaw split, and spent almost 2 weeks in hospital, and I was bracing for the worst, hoping for the best, since my doctor told me they caught it early and it would, probably be "routine". Obviously nothing here is routine.

Again, didn't mean to alarm or waste anyone's time. Just wanted someone to help me understand...

Thanks again, Anne. You shouldn't be embarrassed. I am truly thankful to you..

Gail,
no problem - freaking out comes with the disease (I passed out when I got my Dx) and please never think that you are wasting our time.

Gail, we are here to help in any way we can my dear. We are a support community , if you can't freak out here where people "get" what you're freaking out about, then where can you?

I just posted about being bummed about having to take a pain pill for pain and debating anger management and the Apostle Paul with Gary...just goes to show we can talk about most anything around here

Gail: Ditto what Eric said... try as they may, our spouses/caregivers, friends, relatives and even our medical staff don't "get" what we feel so this is the place where we all come to vent, question and sometimes just to ramble. You can say/ask anything (except for the No Nos on Brian's list). You should never be embarrassed to post a concern/question/statement. I'm so glad I found this site and all of these veteran survivors. They've helped me a lot and I'm sure will continue to do so. p.s. I had to wait 2 weeks post- diagnosis to have my surgery because it was during the holidays and all the docs were going on vacation.

Jesus - people having to wait for surgery for cancer because the doctors are going on holiday? I just don't understand any of this.

My dentist, who had been doing a root canal on me for 3 weeks told me when I first came in with an earache and tongue swelling told me "no problem, you have a small slit on your tongue but no worries - your tongue got cut from your broken tooth - it will go away as soon as I do the root canal and put the crown on". 2 more visits - "well it's not any better, but it will heal soon. The tongue is quick to heal". Finally, on my last visit, when I insisted he look at my tongue closely he practically dropped his tools and sent me to an oral surgeon. If I didn't insist, I would still think nothing was wrong. And he would not have checked. The only time he checked anything was to make sure I made arrangements to pay the $2,700 for a root canal. (No dental insurance). Yes - I paid in advance. My bad.

I am sorry, I don't know about the no no's on Brian's list so I am just going to speak my mind.

My employers and my friends are thinking I am going to just have something removed from my mouth next Thursday, rest for the weekend, and be back on to work on Monday.

No one gets that I have cancer. Cancer. I might never recover. My 20 year old son cries himself to sleep at night. My high school sweetheart husband of 26 years can't function at his job because of this. I cannot even dream of planning our Bermuda vacation because of this. Sounds petty but we have waited 25 years to to this. We had no "official" honeymoon so this was our year to do it.

Sorry to vent.

It's OK Gail. We've all had our turn venting and this is the right place to do just that.

It brings me back to my initial Dx. After I came too, after fainting, I got mad as hell, only to find out later that I also have HCV. I thought that if I didn't die, life was certainly over as I knew it. But it wasn't in the cards and life is very sweet today - in many ways superior to my pre-cancer life.

You'll get there too - it's just one big pothole for a while.

About the docs vacation - another perspective, maybe it'll be better if he is rested up and fresh. My H&N surgeon told me once that the initial screening interval was every 6 weeks because it couldn't grow that fast enough to make a difference in the outcome. Although the waiting is the hardest part.

IMHO the time between the initial DX and the start of Tx is the most difficult. Try not to let your "magic, magnifying mind" run with this (we all have it believe me). Breath deep and take it one day at a time.

Hey, Gail,
I just now read your apology to me--none needed! I think everyone on this board has had their fair share of coping problems, how could you not? I try not to do so much "thinking" now, just get through today, or "now", this hour, etc. I have been given that advice & I think it is good. I do fail at it sometimes, though. Glad you are sharing your questions and concerns.
Best thoughts for you,
Anne

Thank you all again. Pre-op with CT scan on Friday. Will let you know.

G

Hey Gail. I can add to what they all said to you... perineural invasion... it means the tumor is deep enough that it hit the nerve. Why is this important... because apparently to the research I did, cancer cells have a tendency to move along the path of least resistence. In this case it is easier for it to move along the nerve paths.
I too had perineural invasion. What this meant was post op, it put me in a gray area with regards to radiation and chemo therapy. It was one of the things they looked for. The second thing was spread to the lymph nodes. I did have one node involved... it`s all gone now along with 39 others. But they are still giving me chemo and radiation. Partially because the second marker they look for is ECE of the lymph node (extra capular extension) a little of the cancer outside the capsule of the node. I was told I was still in a gray area, however I expressed to them I wanted this treated aggressively - so they agreed and recommended it.

Best of luck in your surgery... PS I didn`t have my jaw split. My dr. made me sign off on it, he said he would only split my jaw if he couldn`t get all of the tissue with good margins without doing it. He told me later he lost 10 lbs in the OR because of that, but his smallest margin was 6mm... so I am duly grateful. One less thing to recover from.

Take care and hopefully things go well.

Sorry - I wasn't referring to you with the jaw split. It was another site, which I refuse to go on anymore because it scared the heck out of me. Sorry if you thought I meant you.

No, no, I didn't - I was just telling you what transpired. Not to worry.. I'm not vain really but it would have been a bigger recovery had they split it. Thankfully they didn't - though I was given no guarantees at the time. Also - I know this sounds totally silly but I'd planned a trip shortly after sugery with the family, so trying to recover from a split jaw would have definitely changed that. As it was we got our week away.