Ask the Pathologist

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1. What characterizes cervical adenocarcinoma?
Edited: May 17, 2011
Most patients with cervical adenocarcinoma present with symptoms such as abnormal vaginal bleeding or discharge, or with pelvic pain. However, some patients do not have any symptoms but are diagnosed with cervical adenocarcinoma after an abnormal finding on a Pap test. Most cervical adenocarcinomas are characterized by an abnormal mass or growth on the cervix which can be seen during a colposcopy procedure (close examination of the cervix with a magnifying instrument). Some cervical adenocarcinomas may not be seen during a colposcopy, because they are smaller or occur higher in the endocervical canal where they are out of sight of the colposcopic examination; these may be detected when a pathologist performs a microscopic examination of cells or tissue removed in a Pap test or biopsy by the primary care physician.

2. What is cervical adenocarcinoma?
Edited: May 17, 2011
Adenocarcinoma is the second most common sub-type of cervical cancer, making up about 15 to 20 percent of all cervical cancers. Cervical adenocarcinoma arises within glands located in the endocervix. The most common sub-type of cervical cancer, called squamous cell carcinoma, arises from the surface lining of the ectocervix, usually at the area where the ectocervix connects to the endocervix. If not successfully treated at an early stage, cervical cancer is capable of invading through the wall of the uterus into adjacent areas and sometimes can spread through the bloodstream or the lymphatic system to parts of the body away from the uterus.

3. Who is most likely to have cervical adenocarcinoma?
Edited: May 17, 2011
Cervical adenocarcinoma is most common in women over 45, but it can occur over a wide age range, even during the teenage years. The cause of cervical adenocarcinoma is not completely known, but most are thought to be caused by human papillomavirus, which is a common sexually transmitted viral disease. However, only a very small percentage of women having the infection will ever develop cancer.

4. How do doctors determine what surgery or treatment will be necessary?
Edited: May 17, 2011
The pathologist consults with your primary care physician after reviewing the test results and determining the stage of your cancer. Together, using their combined experience and knowledge, they determine treatment options most appropriate for your condition.

5. What kinds of treatments are available for invasive ductal carcinoma?
Edited: May 17, 2011
Invasive ductal carcinoma is treated through one or more of the following: surgery, chemotherapy, hormonal therapy, and radiation therapy. It's important to learn as much as you can about these treatment options and to make the decision that's right for you.

Most women choose surgery. Advancements in surgical techniques have enabled about 70 percent of women to choose breast-conserving surgical treatments like lumpectomy rather than mastectomy, where the entire breast and often some or all lymph nodes near the breast are removed. Mastectomy reduces the chances the cancer will return. Lumpectomy is an option when the cancer is in a relatively small part of one breast. How far your tumor has grown and advanced will determine if breast-conserving treatments are possible. If your breast cannot be conserved, breast reconstruction surgery may be a possibility after you recover from your initial operation to remove the cancer.

Most women with invasive breast cancer will be offered chemotherapy and/or hormonal therapy. These treatments deliver drugs or hormones throughout the body and reduce the risk of the cancer spreading further or coming back. Radiation therapy is used to rid the body of any microscopic remnants of the cancer in the area where the original tumor was found and removed.

6. How does the pathologist make a diagnosis on a breast biopsy specimen?
Edited: May 17, 2011
The pathologist examines biopsy specimens, along with other tests if necessary. If mammography shows suspicious findings, a biopsy may be recommended. A biopsy is the most widely used method for making a firm diagnosis of breast cancer. During a biopsy procedure, a primary care doctor removes cells or tissues from the suspicious area for the pathologist to examine more closely in the laboratory. In some cases a biopsy may be performed with surgery. The surgeon removes all or part of the tumor for the pathologist to examine.

Laboratory testing enables the pathologist to determine the type of cancer and whether it is invasive. The pathologist examines the tissue sample under a microscope and assigns a histologic type and a histologic tumor grade. Grade 1 cancers tend to grow the slowest, while Grade 3 tumors spread more aggressively. The pathologist also notes the size of the tumor, how close the cancer is to the edge of the tissue removed by the surgeon, and whether the tumor invaded blood or lymphatic vessels. These factors help pathologists determine the likelihood of the cancer remaining in or returning to the affected area.

7. What else does the pathologist look for on a breast biopsy specimen?
Edited: May 17, 2011
The biopsy sample is also tested for the presence of estrogen (ER)and progesterone receptors (PgR) using a method called immunohistochemistry, or IHC. Women with cancers containing these receptors are more likely to respond positively to hormonal therapy such as tamoxifen. If breast cancer cells have estrogen receptors, the cancer is called ER-positive breast cancer. If breast cancer cells have progesterone receptors, the cancer is called PgR-positive breast cancer. About 75 percent to 80 percent of breast cancers are ER-and/or PR-positive, especially those which are of low grade.

The College of American Pathologists (CAP) and the American Society of Clinical Oncology (ASCO) have issued a joint guideline aimed at improving the accuracy of IHC testing for the expression of ER and PgR in breast cancer. One of the areas addressed in the guideline the handling of breast tissue specimens.

Pathologists also may check for a protein called HER2. There is also a guideline developed by the CAP and ASCO in 2007, that details how this test should be done so that it will be accurate and reproducible. Laboratories doing testing for HER2 The College of American Pathologists (CAP) and the American Society of Clinical Oncology (ASCO) have issued a joint guideline aimed at improving the accuracy of IHC testing for the expression of ER and PgR in breast cancer. One of the areas addressed in the guideline the handling of breast tissue specimens should be following these guideline recommendations. The recommendations are very similar to the new ER and PgR recommendations. Cancers with too much of HER2 are very likely to respond to targeted therapy with trastuzumab or lapatinib. Due to continual advances in research, other tests may be used as well.

After reviewing the results of the laboratory tests, your clinician may recommend additional tests to determine to what extent malignant cells may have spread to other parts of the body. Depending on your situation, these tests may include a chest x-ray; a bone scan; and imaging tests, including computed tomography (CT), magnetic resonance imaging (MRI), or PET (positron emission tomography). All these tests can detect signs that the cancer may have spread to other parts of the body.

With all necessary tests completed, the pathologist determines the cancer's stage. Stage 1 IDC tumors are confined to the breast, and Stage 4 IDC tumors have spread beyond areas near the breast. Stages 2 and 3 describe conditions in between these two extremes.

8. Who is most likely to have invasive ductal carcinoma?
Edited: May 17, 2011
Women have a greater likelihood of having breast cancer after they reach age 45. As a woman ages, breast cancer risk does not decline, with about 50 percent of IDC cases occurring after age 65. About 20 percent of women with breast cancer have a family history of the disease. Other factors increasing the risk of breast cancer include having no children or the first child after age 30, early menstruation, and consuming more than three alcoholic drinks a day.

9. What characterizes invasive ductal carcinoma?
Edited: May 17, 2011
Invasive ductal carcinoma is characterized by a hard lump with irregular borders. The IDC lump will feel harder, firmer, and more anchored than a benign breast lump. The skin over the affected area or the nipple may be retracted (pulled in). On a mammogram, IDC usually looks like a mass with spikes radiating from the edges; sometimes it appears as a smooth-edged lump or as calcifications in the tumor area.

10. What is HPV and its role in cervical cancer? Am I at risk?
Edited: May 17, 2011
The human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). Studies have noted that women with high-risk HPV infections are at a greater risk of developing cervical cancer and its precursor conditions in the future. According to the National Cancer Institute, approximately 11,000 women in the United States are diagnosed with cervical cancer each year and about 4,000 die of the disease. Cervical cancer is highly treatable in most cases if detected early.

Local physicians can order the Cervista HPV HR test from InCyte Pathology that screens for the presence of high-risk types of the human papillomavirus, which are strongly associated with the development of cervical cancer. The Cervista HPV HR test is intended for reflex use with ASC-US (inconclusive) Pap results and for co-testing with the Pap test in women ages 30 and over.

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