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Pathologist's Role in Cancer Diagnosis

Knife to Microscope-The journey of tissue in Pathology Laboratory

What is Cancer?
  • Cancer/Carcinoma is an uncontrolled and abnormal growth of cells that forms a mass in the body affecting the normal functioning of the organ where it grows and spreads.

  • The abnormal mass can be benign (does not spread) or malignant (spreads to adjacent structures).

What can happen to this mass?
  • The abnormal mass can grow in size and may present as a lump.

  • It can affect normal functioning, causing symptoms of cancer like loss of weight, reduced appetite and tiredness.

  • It can grow and spread to other organs of the body which is called metastasis.

What is a Pathologist's role in cancer detection?
  • The surgeon/physician examines and orders a radiological examination like XRAY, USG and MRI to detect the mass.

  • Once the abnormal mass is detected, it is necessary to know which type of tumour it is and from where it is growing from.

  • So the surgeon takes out a small portion of the organ with a specialised instrument by a minor procedure and sends it to the pathologist.

  • The pathologist examines the tissue and makes a note of the appearance, colour and type of tissue received and mentions it on the report.

  • The small bit of tissue received from the surgeon is called biopsy.

  • Smaller bits from the tumour received by pathologists undergoes processing in various solutions in a machine and finally, a solid paraffin block is made containing the tissue of tumour embedded in wax like material. This is used to make slide of the tissue which is examined under the microscope.

  • The pathologist observes the biopsy under the microscope and prepares a report of all the details observed and gives a final impression of whether the mass is benign or malignant.

  • The report is conveyed to the treating surgeon or clinician who decides the further management of the patient.

Types of specimens a pathologist examines
  • Biopsy: (A small linear soft or bony tissue bit removed with a specialised instrument) for initial diagnosis of cancer

  • Surgical specimen: A part of whole of an organ (eg. Stomach) which the surgeon removes during an operation once the tumour is diagnosed by biopsy. Surgical removal of tumour may not be needed always.

Importance of Pathology (Biopsy or Surgical specimen Report)
  • Diagnosis of the tumour type

  • Determine the tumour size

  • Diagnosing whether the tumour is high grade or low grade.

  • Staging (describes the extent of spread, the structures and organs involved)

  • This helps to determine the treatment protocols, helps to determine how severe is the malignancy.

Thus, pathology is essential to direct the further course of management of a cancer patient and is an integral part of cancer care. In absence of pathology report, the surgeon and clinician would have to travel a blind path.


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