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The Question: I have recently been diagnosed with uterine cancer and have been told it is a “high grade.” I was referred to a surgical oncologist two weeks ago. She has scheduled my surgery and I had the pre–op visit. I know that I am in good hands and I thank God for the caring and wonderful personnel I have already met. At this point, I only have one question: I was told that the pathology report could take up to four weeks after the operation to stage the cancer? Is this correct?
The Answer: I am glad to hear a diagnosis is made, an operation booked and you are in the cancer care system. As you know, the early pathology work you already had done – a biopsy – led to a definitive diagnosis of uterine cancer. Now you are waiting for the second part of your pathology to take place, which will tell you, among other things, the size, grade and invasiveness of the tumour. Only after the pathology report can oncologists develop a treatment plan. The pathology and the treatment plan are usually provided after you have healed from surgery – three to four weeks after your operation.
“We make sure by the time the patient comes (for a post operative visit), this report will be available to the physician so an intelligent decision can be made about treatment,” said Mahmoud Khalifa, who is joint chief of anatomic pathology at Sunnybrook Health Sciences Centre and University Health Network.
At Sunnybrook, patients are booked to receive the results of their pathology report at the same time as their treatment plan – about three to four weeks after surgery. This is done deliberately: oncologists want to ensure that when patients learn the stage of their cancer, they also hear the plan to treat it. You can imagine how anxiety provoking it would be to only hear you have advanced cancer, but not to have a plan.
“What we don’t want is for a patient to come for follow up and the pathology is not available,” Dr. Khalifa said in an interview. “These patients know they have cancer. The only question is whether they are going to need further treatment.”
Now, as a cancer patient, you raise an interesting question about whether the pathology report could be provided sooner. In a public health care system, there is a fixed amount of funding and so administrators have to determine where best to spend it. Ultimately, it comes down to determining whether spending would change the treatment plan – or patient outcome.
“Patients really want to know whether they have cancer or not. There is an element of anxiety so we need to get this news out as soon as possible,” said Dr. Khalifa, whose department at Sunnybrook sees 70,000 cases a year, about three-quarters involving cancer diagnoses.
For example, a significant amount of funding is poured into pathology at the front end – typically making the initial diagnosis of cancer in the form of a biopsy result. In addition, anything that would change the treatment outcome is also fast-tracked. But in cases where earlier knowledge would not translate into different care or compromise an outcome, it is timed to take place when the adjuvant treatment – chemotherapy and radiation – would potentially start, if even needed, which is your case.
As you know, cancer has four stages, with the first one being the earliest and stage four being the most advanced, having metastasized or spread to other organs. With uterine cancer, there are early, obvious symptoms such as bleeding, which make earlier diagnosis more likely than say, ovarian cancer where the symptoms can benon-specific.
If the uterine tumor has deeply penetrated the uterine wall, patients may need radiation treatment. If the tumor has invaded the lymph nodes, patients may require chemotherapy, according to Dr. Khalifa, professor at University’s Department of Laboratory Medicine and Pathobiology. Sometimes patients require both forms of treatment.
So, in answer to your question, you will receive the results of your pathology plus your adjuvant treatment plan at your scheduled appointment after surgery. I wish you all the best.
Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre. Send questions to AskLisa@sunnybrook.ca.