The Pathology Report; Abdominal MRI

It’s Monday, 18 days after The News.

I woke at 8:00 this morning when my alarm went off. And I felt a bit groggy. This is good news. My body is fighting the anti-vampire schedule regimen the medical profession is so fond of.

The Pathology Report

The pathology report for the colonoscopy finally showed up in PAMF’s online system. The gastroenterologist had previously said that the report might not be available for a week or two since additional tests were being conducted. There weren’t any surprises as the gastroenterologist who did the colonoscopy did a great job of conveying what she had found both while I was in recovery and in subsequent calls, and the tumor has of course been the star of the show in the consultations and tests.

But seeing the actual report was interesting. Even if it is full of jargon that took half an hour to decipher. Here’s the main part on the mass the gastroenterologist observed:

“The histologic sections of the ‘rectal mass’ biopsies shows superficial fragments of adenocarcinoma with irregular, infiltrating glands with high N/C ratios, hyperchromasia, loss of polarity and brisk mitotic activity within a desmoplastic stroma.

There are a number of sites on the web that can help you understand a pathology report. I found this one from cancer.org, focusing on colon cancer, particularly useful. Basically from what I can make out the pathology confirms it is an adenocarcinoma, and that it is a “true” cancer (“infiltrating” means its a true cancer, but don’t read too much into it. It doesn’t mean the tumor is necessarily large or has extended its tendrils into neighboring organs). The report also indicated no lymph-vascular invasion, which is a good thing – something indicated by the ultrasound and CT scan as well. The report describes the adenocarcinoma as “well to moderately differentiated”, which is again good (poorly differentiated cells tend to grow and spread more quickly.)

Aside from the rectal mass (the tumor), a single polyp was found and removed during the colonoscopy. The pathology report identifies it as a tubular adenoma, which is a common type of polyp with a 4-5% chance of becoming cancerous. The report indicates its size as “0. cm in the greatest dimension” which would be wonderful (since it would suggest it was non-existent), but I assume is a typo 🙄.

Oh the following was amusing and may explain the “0. cm” 🙂

This report was created with voice recognition software. Some typographical errors may occur despite editing.

Pathologists use voice reco software? I worked on reco systems back in the early ’90s. Back then we could barely get it to handle someone saying their credit card number of a landline. Things have certainly come a long way since then. But I still find it weird to use voice dictation or to talk to my Apple Watch. I guess pathologists are on the more progressive side.

Abdominal MRI

I had the first MRI – abdominal with and without contrast – this afternoon. I’d never had an MRI and admit I was a little nervous going in. Mostly because I was worried that the dental implant or the post holding one of my crowns would come flying out of my mouth (if I were lucky through my brain resulting in a very quick and painless death. Or with my recent luck leaving me like Phineas Gage.) The logical part of my brain was chastising the concerned part that this was an irrational fear. MRIs aren’t exactly new and surely any dental work would account for that. I hate it when one part of my brain gets into an argument with another part.

As it turns out, the logical part of my brain was right. The MRI was uneventful. If anything it was a bit relaxing. Prior to going into the room the technician used a metal detector wand similar to those used in airports to make sure there wasn’t anything metallic in or on me. She paused a bit at my mask’s ear straps – apparently a lot of those are made of metal, though mine apparently weren’t. I told her there was a nose strip as well and she said it didn’t register on the detector, but I decided to swap my mask for one of their MRI-approved surgical masks. Better safe than sorry.

Hooked me up to an IV, strapped me to the table, put headphones on to mute the loudness of the MRI, and told me the machine would tell me when to hold my breath and when to breathe. There would be a rhythmic breathing portion as well. Then off I went into the machine. I can see how people who are claustrophobic might not fare too well. I just closed my eyes. Between the whooshing of the air conditioning, buzzing of the MRI, and the voice telling me to hold/breathe it crossed my mind this could be a scene from 2001: A Space Odyssey. “HAL, open the MRI door please.” “I’m sorry Dave, I can’t do that. Now hold your breath for 20 seconds….and breathe.” Every so often the technician would ask if I was doing ok, and tell me the sequence that was coming up. Oh, I also had a squeeze bulb in my left hand that I could use Just In Case I needed to stop the procedure. I suppose people with claustrophobia might use that a lot.

It was over before I knew it, which was unfortunate since I was starting to feel quite relaxed. The breathing instructions were almost meditative. Interrupted with the loud buzzing of the MRI. They should really work on that. Some VR glasses would be nice too 🙂.

Shortly after I got home I got a call from the gastroenterologist who performed the colonoscopy. She was just checking in to see how I was doing. She said the oncologist would be the focal point going forward but I could always call on her if I had any questions or concerns. I really appreciate the thoughtfulness of the PAMF team.

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