Pathology, Pathologists and Cancer

If I have cancer, do I need a pathologist?

Yes, a pathologist is a specialist who identifies diseases by studying cells and tissues under a microscope. Pathology is a medical specialty focused on providing a definitive diagnosis of many different diseases, including cancer. Usually the services provided by a pathologist are on behalf of a referring physician. The referring physician is the doctor who directly treats the patient. The pathologist, whom most patients never meet, is something of a doctor's doctor.

What does the pathologist do?

He or she examines tissue under a microscope to see what kind of abnormalities are in the tissue sample. The pathologist writes a report detailing the diagnosis. The information in the report helps the treating physician decide on a course of action.

What is a biopsy?

The removal of cells or tissue for examination under a microscope. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

How big a piece is removed?

Very small, if it is a biopsy. However, the sample must be large enough to represent the abnormality.

How do they save the piece of tissue?

It is immediately frozen, then sealed in a block of wax. It is then taken to a laboratory where it is cut very, very thin by a special machine. The laboratory technicians use dye to stain the sample so the cells will show when examined in the microscope.

Are these samples labeled while still in the operating room?

Yes, immediately. The patient's sample is given a unique number that is recorded on the pathology report.

How can the pathologist handle this under the microscope if it is so tiny?

The laboratory technician places this very thin sample on a piece of glass and seals it under another thin piece of plastic. This is called a glass slide.

Is it easy to tell which cancer it is?

Usually most cases are straightforward. There are, however, instances when more study and special procedures, including immunohistochemistry and electron microscopy, are required to make a final diagnosis.

Does more than one pathologist read my slides?

Very often more than one pathologist reviews a case here at MD Anderson. We also have a weekly Tumor Boards where several , pathologists, oncologists, surgeons, psychiatrists -- really, all the specialists involved with the patients -- discuss the cases in great detail. Most subspecialties also have a weekly conference where the pathology is presented to treating physicians.

What do they do when they do not agree?

If pathologists do not agree, they meet to discuss all the aspects of the case and a consensus opinion is reached.

How long are these slides kept?

They are retained in the MD Anderson permanent file.

Can I, as a patient, take my slides to another doctor or hospital for a second opinion?

Yes, you may. You must also include a copy of the surgical pathology report.

What is a surgical pathology report?

The surgical pathology report identifies the tissue sample as belonging to a specific patient and details the diagnosis.

Do pathologists ever speak with the patient?

Yes, they do.

Can the diagnosis for cancer be made with a blood sample?

In some cases, for example, leukemia, the diagnosis is made from blood. There are a few cancers in which blood tests are helpful in diagnosis (prostate cancer). For the diagnosis of most cancers, however, a tissue sample is required.

What sort of training does a pathologist have?

A pathologist always has an M.D. degree and, in many cases, additional degrees, such as Ph.D. At the time of surgery the surgeon often waits for the diagnosis from the pathologist before deciding how much tumor to remove, if any, and what treatment is needed for that patient. The pathologist has a very life-saving position and is often never met by the patient.

How many different cancers are there? What are they called?

Cancer is a group of more than 100 different diseases that have some important things in common. Cancer cells are abnormal and divide without control or order. These cells can invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system. This process, called metastasis, is how cancer spreads from the original tumor to form new tumors in other parts of the body. Names of more common cancers include carcinoma, sarcoma, lymphoma and leukemia.

Can a pathologist locate abnormalities in my DNA?

There are some tests that help to locate DNA abnormalities. Much more work, however, needs to be done to further clarify what DNA abnormalities mean.

How is my case used in the research programs at MD Anderson Cancer Center?

There are many institutional research projects at MD Anderson Cancer Center that require the use of patient tissue samples. The patient, however, must consent to participation in such projects.