From an article by
Dr. Tarek Bishara
Pee Dee Pathology Associates

When a patient is faced with a cancer diagnosis, they look to the physician delivering this news for answers about their cancer treatment. These answers are often based on the information the surgeon or oncologist receives from the team working behind the scenes — those who determine the precise type and stage of the cancer – the pathologists.

THE DIAGNOSIS
“Pathologists are physicians concerned with the study of the nature, origin, progress and cause of diseases,” said McLeod Pathologist Dr. Tarek Bishara. “We are primarily involved in the diagnostic side of cancer care. The most effective cancer care starts with an accurate diagnosis. It answers the patient’s basic question: ‘do I have cancer?’ Our job is to answer that question.”

Pathologists diagnose cancer by examining a biopsy or surgical tissue under the microscope.

Information about the patient is also important for the pathologist to review before making a diagnosis.

“We have basic demographic information and some idea of what the physician is thinking clinically,” states Dr. Bishara. “Some diagnoses are more difficult, and we need to know the context of the clinical situation with which we are dealing. Reviewing the patient’s medical history and imaging may allow us to interpret the biopsy findings more effectively.

“Once we determine that cancer is present, there are certain additional pieces of information the oncologists and surgeons need to help them get a more complete picture of the patient’s cancer. Every patient’s cancer is a bit different, even if it’s from the same body site. One patient’s breast cancer is not exactly the same as another person’s,” explains Dr. Bishara.

Pathologists provide physicians with information on the behavior of the tumor:

• Has it spread beyond its site of origin?
• Is it likely to behave aggressively?
• Has it invaded into blood vessels yet?

WHEN SURGERY’S REQUIRED
If the patient requires surgery to treat the cancer, the pathologist’s role is to inform the surgeon of the extent of the tumor and how much it has spread. Pathologists can also provide a surgeon with confirmation and/or assessment of cancer during surgery.

“If a surgeon is in the operating room and needs an answer immediately, the surgical team sends us a portion of tissue,” says Dr. Bishara. “Within 15 to 20 minutes, we can give the surgeon an answer, enabling them to determine how to proceed with surgery.”

GETTING IT RIGHT
“The physicians count on us to be right,” explains Dr. Bishara. “The surgeon is operating on the patient, or the oncologist is giving treatment, based on what we are telling them. There must be a high level of trust between us. I believe they appreciate and understand the nature of our role and what it means to their patients.”

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