My wife had her surgery to remove a tumor (SC) from her gum. They took 3 teeth and 10 mm of bone. The pathology report came back saying there was no bone invasion and clean margins around the tumor. It was listed stage 1 - t1nx.

There was a presence of "cancerous lymphocytes" in the tumor. The doctor now recommends going back in and taking some tissue from the neck. He said they will then do radiation only if there is problems in the lymph nodes.

Can someone tell me what this means? I'm not sure if this is good or bad. The nurse seemed to think it was a really good pathology report. Where do these lymphocytes come from and what should we expect? Is this common> Indicative of a bigger problem? Easily fixed?

Thanks for any help.

Hello Dan-O!

Stage I t1nx is fantastic actually, the earlier the cancer is detected, the more options you have and usually far less invasive with less lasting side effects.

Lymphocytes are white blood cells and there are two types, B cells and T cells. Lymphocytes secrete products (lymphokines) that modulate the functional activities of many other types of cells and are often present at sites of chronic inflammation.

To give you advice, get a second opinion before taking any further steps. If I Google "cancerous lymphocyte" it gives me nothing but Leukemia links, which last time I checked can't be cured by getting tissue from the neck removed. This may be nothing and isn't meant to scare you, but it will show you that without all of the information we can't give any "indepth" advice and we are not Dr's (there are Dr's that monitor these forums however for OCF to ensure quality of information etc).

Best advice is to get the best Medical Advice available to you, which is a Comprehensive Cancer Center. Before people start taking tissue or radiation (not fun trust me) make sure you have a multidisciplinary team looking at your wife's records and scans. This will save potentially unnecessary procedures etc and give the best possibility of a good outcome and good quality of life.

Knowledge is power and the only thing we have when everything else is out of our control.

Keep your chin up! Look for answers!

Eric

Dan, Im sorry but Im unsure of what "cancerous lymphocytes in a tumor" means. This forum is made up of patients and caregivers so when something is in depth like this its best to ask for clarification from the physician. It sounds to me like the doctor is suggesting a neck dissection before ruling out radiation. There have been several threads on the pro's and con's of a neck dissection. Your wife seems to have been caught very early. My suggestion would be to have her seen at a cancer center where a whole team will evaluate her case.

NCI Cancer Centers

It is a neck dissection that they are talking about. We aren't at a CCC, but each decision and step is made after consultation with a "Tumor Board" that is a group of different physicians and specialists.

To clarify they said they checked the cells in the tumor during the pathology report. The nerve cells were negative for any cancer, but there were some lymphocyte cells that were positive for cancer. The doctor said the level was just on the borderline between "do nothing and monitor" and taking a second action. He preferred the neck dissection to radiation. He said radiation could be added later if the pathology report on that tissue indicated problems in the lymph node, but said our case is likely not to need the radiation. Before proceeding he is reviewing the recommendation/decision with the tumor board.

Thank you for the positive reactions, it looks like we are in pretty good shape (not counting having cancer of course) and it could be much worse.

Hi there yes... Lymphocytes may indicate lymphatic involvement, so a neck dissection would help possibly offset any spread. Good luck... An neck dissection isn't too bad.

We are not correctly answering the question here. Eric got this right. Lymphocytes are naturally occurring cells in the blood (white blood cells) , which are divided into 3 types, all part of your body's defense mechanisms. T, B and NK are the types, and they all have a function of defense. T and B create antibodies and fight infections, and NK cells go after viruses and cancer cells. Their name has clearly confused some because of the similarity to something we discuss all the time, which is lymph node involvement in head and neck cancers.

So the full question here really cannot be answered because the pathology comment is probably taken out of context. You would expect to find NK lymphocytes in a malignancy as a normal defense function. In a biopsy sample these would be found included with other cells that had characteristics of malignancy like and enlarged nuclei.

But all this is kind of academic here since we are only getting parts of the pathology report. The important points would be that the sample taken had clean margins, meaning they got all of it. But since there was no mention of scans, which might show cervical lymph node involvement, (which I would want to see with and without contrast before making additional decisions) the next sample would be taken from sentinel nodes if none were enlarged and obvious, and done with a fine needle biopsy initially, or a single node excision, before someone leaped off into a full neck dissection to remove what was after that second pathology report, clearly identified as a neck metastasis.

This was luckily a very early find. Early USUALLY equates to better long term outcomes.

May I suggest the nurse might have considered it a good report because
a)there were clear margins which means they are confident they got all of the tumour;
b)there is no bone involvement which means tumour has not gone to a place that can be difficult to manage, and
c)the tumour is T1 which means it is early stage which gives your wife a reasonably good prognosis (certainly better than any other stage and better than some of the other sites of the oral cavity too).

As you say it looks like you are in pretty good shape (relatively speaking)

Thanks again for the replies. I feel like such a freshman here. I didn't understand what the doctor told us, and I don't full understand all the replies. One thing that stands out is Brian's reply sound almost identical to what the doctor said so I take some comfort in the positive view of the situation. Not being conversant enough to report the info accurately, I just uploaded the pathology report, maybe this helps. Thanks again.

http://i40.photobucket.com/albums/e239/danbanks808/pathology.jpg

OK Dan-O!

this is actually a really good path report! It's OK not to understand these things, I wish I never had to read mine and then look it all up to understand it. But it is what it is and we do what we have to.

I think the term you are referring to is this "lymphovascular space invasion" which kind of reminds me of an old video game I used to rock, but I digress. LVSI & LVI (lymphovascular involvement) are fancy terms for activity in the lymph system, so therefore yes, a neck dissection would be the proper course of action.

It is important to understand these things and it's all very confusing (it's my suspicion that the Dr's confuse themselves sometimes, but probably just the ones that went to State schools...hahaha) as lymphocytes and LVSI are going to be very different courses of treatment. Thanks for posting the Path report, where I'm not a Dr, I play one on the internet sometimes for laughs (sorry to all the misdiagnosed out there! my bad!). This is exactly the reason why I do recommend making sure to get the best advice available to you, it's just prudence.

Keep your chin up Dan and keep plugging in my friend, we are here to help! Sorry if my humor offends, I'm a hick from N. Idaho and don't always have what you'd call "social graces".

Eric

Whenever someone asks about "what next" following clean margins in surgical removal of oral cancer I always wince, and tell them to be careful. Notice my own oral cancer was extremely small, 1 mm in depth, classified as superficially invasive initially. Even the repeat path report at MD Anderson, where I ended up, called it cancer in situ at the least, so obviously a somewhat shallow lesion that somehow got out of control. I have my own view of what happened, not necessary to go into here.

You don't mention scans, and if that has not been done that will surely be done before anything invasive, even FNB (fine needle biopsy). In my case the FNB showed abnormal cells, completely replacing anything that was normally in a lymph node. When I had neck dissection surgery at MDA, the surgeon removed two lymph nodes (the bad one and another) and sent them to pathology before they took 28 more. Luckily only the one was metastatic, but as you will note I got the works because my cancer, moderately differentiated as is your wife's, was aggressive and had penetrated the lymph node capsule, called "ECE". Actually I found that ECE particularly when confined to one lymph node is not as frightening as what it first seemed. Bad enough, but studies show when doctors are aggressive in treating it, patients can do well.

Hopefully your wife won't have my issues, but it is best to find out now what, if anything, is in the lymph nodes. If there is nothing there, you and the doctors can closely watch it.

Truly wishing you all the best,
Anne

OK, thanks for all the info, I think I have a way better understanding of what is going on.

Now off to research "neck dissection" and see how much that can scare me.

And if you have more ???'s, don't hesitate to ask. We've been there done that.
Anne

You don't have to look far. The OCF main site has a description of the different types of ND's
http://oralcancerfoundation.org/facts/neck_dissections.htm