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ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer. In today's podcast, we'll discuss the role of pathologists in cancer care. This podcast will be led by Dr. Carey August and Dr. Chanjuan Shi. Dr. August is the Director of Anatomic Pathology at the Advocate Illinois Masonic Medical Center, and Dr. Shi is an associate professor in the Department of Pathology, Microbiology and Immunology at the Vanderbilt University Medical Center. ASCO would like to thank Dr. August and Dr. Shi for discussing this topic.

Dr. Shi: Hi, my name is Chanjuan Shi. I am a pathologist at Vanderbilt University Medical Center.

Dr. August: My name is Carrie August. I'm a pathologist and Director of Anatomic Pathology at Advocate Illinois Masonic Medical Center in Chicago.

Dr. Shi: Dr. August, can you briefly describe the role of a pathologist in the care of a person with cancer?

Dr. August: A pathologist has an extensive role in the care of a patient with cancer. To start with, we are the people who initially make the diagnosis on whatever cellular or tissue sample is taken from a patient. Beyond that, we are the people who complete an extensive report, your big pathology report, when a cancer patient undergoes a resection for their disease. The information we put in that report is critical to staging, prognosis, and treatment. We participate on multidisciplinary tumor board teams to help guide the treatment plan for each individual patient. Pathologists also ensure that everything is done exactly right. In our labs, we are under the governance of the College of American Pathologists, which has a rigorous program of inspection of the labs to make sure that everything's done correctly. We are the people who develop tests for specific molecular and genetic findings, and who implement those tests, and help advise other members of the cancer care team on which tests to use. So we have an extensive role, all the way through a patient's care. Dr. Shi, do you have anything else that I missed that you want to add?

Dr. Shi: I think that you gave a very, very comprehensive description about what pathologists do in this area so I don't have anything to add.

Dr. August: So I have a question for you. We know there are many different branches of pathology, surgical pathology, clinical pathology, molecular pathology. Can you explain how they differ and how all of them contribute to making a diagnosis and a treatment plan for a cancer patient?

Dr. Shi: Sure. Pathology can be divided into two major areas, anatomic pathology and clinical pathology. Surgical pathology is the main part of anatomic pathology. Surgical pathologists use a microscope, make a cancer diagnosis by examination of stained slides of tissue. Surgical pathology is itself further divided into several separate specialties. For example, lung pathologists specialize in diagnosis of lung cancer. And the gastrointestinal pathologists specialize in the gut, liver, and pancreas cancer. Clinical pathology has many areas too, which include clinical chemistry, blood bank, and the molecular pathology, et cetera. Clinical pathology also plays an important role in curing cancer patients. For example, doctors monitor a cancer by measuring some cancer related molecules in blood, which is done by clinical chemistry. Molecule pathology uses molecule technologists to analyze gene mutations in cancer tissue, while surgical pathology provides a comprehensive and a final diagnosis of cancer. Clinical chemistry helps to monitor cancer recurrence after a cancer is removed, and/or treated by chemotherapy. As we know that some cancers cannot be cured by surgery and chemotherapy, many cancers cannot be treated with new targeted therapy. The treatment specially targeting cancer cells based on their genetic changes. Molecule pathology looks at genetic changes in cancer cells, and it tells your doctor whether your cancer can be treated with certain new targeted therapies. That is my definition and classification of pathology. Dr. August, do you have anything to add?

Dr. August: I think it's important for patients to know that one of the roles of the pathologist is to help integrate all the information from all of these different subdisciplines of pathology to help make the best plan for a cancer patient. But Dr. Shi, you covered them all beautifully. Thank you.

Dr. Shi: Thank you. So, but I have another question for you. Pathology plays an important role in cancer care, yet many patients may never meet their pathologist. Under what circumstances might a patient need to speak or meet with their pathologist?

Dr. August: So we are some of the hidden people on the cancer care team, but one time that you may actually see us is if, for example, you undergo aspiration of a lesion, perhaps in interventional radiology or just maybe a palpable lesion. And a pathologist may either actually do the procedure himself or herself, or a pathologist may be on site while another doctor performs the procedure in order to help guide that doctor to make sure the best possible sample is obtained. And the pathologist does this to make sure that a patient only has to undergo a procedure once and doesn't have to be inconvenienced with multiple procedures. That's a very specific time that you might see your pathologist. However, what patients should know is that pathologists can and are willing to talk to patients any time needed. Sometimes there's something that perhaps a patient wants more information about, and they want to talk to the person - the mysterious person - who wrote this big pathology report. You should feel free to contact your pathologist and ask to speak to them because your pathologist will be happy to discuss with you, even show you what your slides look like under the microscope. Dr. Shi, did I miss anything?

Dr. Shi: No, you don't miss anything at all and I totally agree. We are all very happy to talk to you and explain the pathology report with you if you have any questions.

Dr. August: Now, I have one more question for you. What else do you think patients should know about the work that pathologists do?

Dr. Shi: I just want our patients to know that many pathologists are also doing medical research. They continue to look for better treatments and many research projects require the use of patient tissue and blood samples. So as the opportunities arise, I strongly encourage patients to donate tissue or blood and to participate in cancer research projects. So that's a thing I really want to emphasize to our patients. Dr. August, do you have anything to add?

Dr. August: Well, I have something different to add. I think patients should know that pathologists are specifically trained. Most pathologists have training in a subspecialty area beyond their residency, and that, as I said before, part of the role of pathologists is to ensure that we treat every sample from every patient as though it came from one of us or somebody we care about. We are diligent in making sure that every specimen is handled properly so that every patient can feel safe with the results they get from the work we do. And this is a big part of what we do to make sure that everything is done just right.

Dr. Shi: I agree.

ASCO: Thank you, Dr. August and Dr. Shi. Dr. August and Dr. Shi talk more about the role of pathologists and cancer care on the cancer.net blog. Visit www.cancer.net/blog to learn more. Cancer.net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net podcast.

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