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A Pathologist Makes Sense Out of Cancer’s Chaos

Pathologists looking through microscope
In a room equipped with a multi-headed microscope, up to 16 pathologists can simultaneously view patient samples.

During most hospital visits, there's a doctor behind the scenes who plays a major role in the patient's diagnosis and choice of treatment.

That doctor is the pathologist.

Working in the hospital’s laboratory, surgical pathologists use high-resolution microscopes to study cells and tissues and determine each patient’s diagnosis. They then report back to the patient’s surgeons or physicians on what they have discovered.

“In the normal tissue, there is a beautiful order,” said Thomas Krausz, MD, director of anatomic and surgical pathology at the University of Chicago Medical Center. “In cancer, depending on how aggressive it is, there is chaos.”

Thomas Krausz, MD Thomas Krausz, MD

Cancer cells grow uncontrollably and invade surrounding areas with “no respect for (the) neighborhood,” according to Krausz. And cells that have become cancerous can take on strange and unusual shapes that disrupt normal symmetry and reflect inner turmoil. Yet, the story is now rarely as simple as the appearance of tumor cells that the pathologist studies.

In some cases, when surgeons take a piece of potentially cancerous tissue from a patient, pathologists have only 20 minutes to examine it and answer several critical questions: Is the tumor benign or malignant? How far has it spread? Their answers are crucial to the patient’s care. They determine the course of treatment through surgery, radiation or chemo-therapeutic drugs.

“At the end of the day, cancer is diagnosed by pathologists,” Krausz said. “Without a pathology diagnosis, there is no appropriate cancer treatment.”

Cancer cell A colored scanning electron micrograph of breast cancer cells.

Pathologists often use new molecular techniques to help categorize tumors, identifying abnormal genes and proteins so small that even the most powerful microscopes cannot make them visible to the human eye. These techniques have changed pathology and have proven essential to the development of personalized medicine.

But the pathologist’s experience and expertise remains the most important tool. Though new technologies play an important complementary role, pathologists still make most decisions with the microscope, a centuries-old technology that--combined with the experience of a pathologist who has viewed hundreds of thousands of slides--is the most powerful tool in classifying cancer.

For the trickiest cases, when the first pathologist to look at a sample cannot make a firm diagnosis, the department gathers to pool their knowledge and obtain other pathologists’ opinions. At the Medical Center, they meet daily in a room equipped with a multi-headed microscope, and up to16 pathologists can simultaneously view patient samples. Their collaboration enables them to resolve these difficult cases and reach the proper diagnoses.

“Since there’s no room for error; we strive for 100 percent accuracy,” said Husain Sattar, MD, assistant professor of pathology. “We think multiple times before we sign and release our final diagnosis.”

Because, Krausz added, “There is only one diagnosis. The correct diagnosis.”

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