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Q. What does a biopsy report stating "ulcerated moderately differentiated adenocarcinoma in ascending colon" mean?

Answered by
Dr. Basuki Nath Bhagat
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 22, 2022 and last reviewed on: Nov 29, 2022

Hello doctor,

A recently conducted biopsy result of a 75-year-old woman states, "ulcerated moderately differentiated adenocarcinoma in ascending colon." The underlying condition is mild mitral valve thickening and anemia. What does it mean? I would like to know her cancer stage and whether it is curable. Her doctor recommended partial colectomy first. May I know which treatment is suitable for her? Currently, she takes Iron, Penicillin, Bisoprolol 2.5 mg, Salazine 500 mg, Aldactone 25 mg, and multivitamins. AFP is 7.3 ng/ml, and CEA is under 2.5. The blood sugar test before and after fasting is normal.

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Hello,

Welcome to icliniq.com.

I have read your query and biopsy report. After studying the report, I will reply.

Thank you.

Hello doctor,

Thank you.

#

Hello,

Welcome back to icliniq.com.

Colonoscopy revealed small session polyps in the transverse, descending, and sigmoid colon, which were removed by hot snaring polypectomy. Biopsy was done for ulcerative growth at the proximal ascending colon, which came in HPE (Holoprosencephaly) diagnosis as neoplastic glands with cellular and nuclear polymorphism present, mitosis present, and the tumor moderately differentiated. In the polyp, there are no malignant cells present.

Diagnosis based on the HPE report is moderately differentiated adenocarcinoma in the proximal ascending colon. It means there is cancer in the proximal part of ascending colon based on the HPE report. In such a scenario, cancer is located in the cecum and ascending colon, and the procedure of choice is right hemicolectomy. CBC (complete blood count) report is suggestive of very low Hb (hemoglobin), meaning she is very anemic. In the echocardiography report, there is mild mitral valve thickening which may be due to old-age calcification of the mitral valve. A right hemicolectomy would remove her tumor completely, and I hope there is no metastasis present. The surgery would require three units of PRBC (packed red blood cell) transfusion before surgery and cardiac clearance in view of mitral valve thickening, along with a routine workup.

All the best, and take care.

Hello doctor,

After surgery, would she be taken for chemotherapy? If it is possible, may I know what your continuous explanation related to the case is? Could you please guide us on which food is good or bad for her? How could we prepare for her not to be recurrent cancer?

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Hello,

Welcome back to icliniq.com.

Thanks for the follow-up. I will get back to you soon.

Hello doctor,

I am looking forward to your reply.

#

HHello,

Welcome back to icliniq.com.

Before the surgery is planned for her, CECT (contrast-enhanced computed tomography) whole abdomen and chest would be done to know any metastasis in the body. The most common location is the lung and liver. Your treating doctor can also recommend a PET (positron emission tomography) scan instead of a CT (computed tomography) scan to locate the metastasis in the body. If the tumor is confined to the proximal ascending colon in location, then right hemicolectomy would be the surgery of choice, and it would be curative surgery. After the surgery, the resected specimen would be sent for HPE for the location of cancer cells in the locoregional lymph nodes. The presence of cancer cells in the lymph nodes would change the staging of the tumor, and then only chemotherapy would be advised after the surgery. If there is no positive finding in the PET scan or negative HPE lymph node status, then chemotherapy would not be required. She can eat a normal daily diet. After surgery, your treating doctor would ask for a follow-up surveillance examination to know about any recurrence of the tumor.

I hope I am able to answer your query and you are able to understand my reply as I have tried to reply to you in simple, meaningful language.

Thanks.


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