The Pathologist’s Crucial Role in Cancer Care

By Francesca Khani, MD

Some say that in medicine, healing begins with a diagnosis. Pathologists – physicians who work in a laboratory to examine samples of body tissue for diagnostic purposes – play a tremendously important role in determining a patient’s treatment plan, even though they usually do not directly interact with patients.

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Pathologists act behind the scenes, consulted by doctors in other specialties to render a diagnosis so that a patient’s disease can be managed appropriately. Armed with an accurate diagnosis, the treating physician can present the patient with the best therapeutic options.

There are many different types of pathologists, encompassing a wide range of laboratory medicine fields. Anatomic pathologists specialize in evaluating tissue or cell samples from patients and are responsible for diagnosing diseases. Samples range in size from collections of individual cells (such as a pap smear), to biopsies (removal of a small piece of tissue), to entire organs removed during surgery. These cells or tissue samples are traditionally evaluated under a microscope for the diagnosis of a variety of diseases, including cancer.

Pathology at Weill Cornell Medicine and NewYork-Presbyterian Hospital (WCM/NYP) is highly sub-specialized such that each pathologist has disease-specific expertise. In particular, we have multiple pathologists trained in and dedicated to evaluation of genitourinary (GU) malignancies, including prostate, bladder, kidney and testicular cancers.

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In patients suspected to have a GU cancer, pathologic evaluation is critical to initiate a treatment plan (e.g. surgery, chemotherapy, and/or radiation). Accurate assignment of a tumor grade (based on aggressiveness) and stage (based on the extent of the tumor) is essential to determining the patient’s prognosis and informing the most effective disease management plan. Some prostate or kidney cancers, for example, may be indolent (slow-growing) and can be safely monitored without treatment, instead of requiring immediate surgery or radiation treatment.

In some cases, the diagnosis is straightforward and can be determined easily from examining the first set of microscopic slides created from the tissue. In other cases, when the appearance of the tissue under the microscope may be more ambiguous and difficult to interpret, a team of pathologists will work together to reach a consensus on the diagnosis. Sometimes additional testing is necessary, such as the application of special stains that contain antibodies which reveal the presence or absence of certain proteins, aiding pathologists in determining the correct diagnosis. Other testing examines the genetic profile of the tissue. At WCM/NYP, we routinely perform a comprehensive genetic characterization of a patient’s tumor, which can inform next steps if actionable molecular targets are identified.

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GU pathologists at our institution implement a highly collaborative approach to patient care and are in close, constant communication with colleagues in urology, medical oncology, radiation oncology and beyond to discuss the nuances of individual patient cases. These discussions take place at regularly scheduled multidisciplinary meetings and as needed throughout our work. Open lines of communication among the various GU physician stakeholders truly helps to optimize care for people with these diseases.

The GU Oncology Program’s commitment to excellence runs deep – behind the scenes and beyond the exam room. Our pathologists’ hard work to secure the right diagnosis pays off in dividends when it puts patients on the fast track to receive the treatment most likely to act against their disease and produce the best health outcomes.

 

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