When a large malignant appearing GI mass is encountered on endoscopy but biopsies show dysplasia or carcinoma in situ, would you recommend additional biopsies or proceed with treatment for invasive cancer?
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4 Answers
Mednet Member
Radiation Oncology · Brigham and Women's Hospital
This is an issue that comes up fairly regularly. The simple answer is that we should not treat (with radiation or chemotherapy) without a cancer diagnosis, but life is rarely that simple and every rule has exceptions. Certainly, whenever possible, a repeat biopsy should be done, or, as @Dr. First La...
Mednet Member
Radiation Oncology · Varian Medical Systems/Allegheny health network
Generally we favor repeat bx but sometimes ask the pathologist to review path with clinical information. This may lead to a change interpretation to possible invasion. Also if imaging shows locally advanced disease then we have proceeded with treatment after discussion with patient.
Mednet Member
Radiation Oncology · Memorial Sloan-Kettering Cancer Center
These are all good points. I also like to present these cases in conference and reach a multidisciplinary consensus about the risk/benefit ratio and suspicion before treating without confirmed invasive cancer.
Mednet Member
Radiation Oncology · Washington University School of Medicine
Agree with all of the above. It's very unlikely that either a review of the initial pathology or a repeat biopsy will be non-diagnostic, but occasionally our hand is forced. All of this discussion is predicated on the assumption that management of the mass with surgery alone (which wouldn't require ...