Pathology And Cancer

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The Department of Pathology 
The Department of Pathology is composed of the divisions of Anatomic Pathology and Clinical Pathology. The division of Anatomic Pathology comprises the sections of Surgical Pathology/Histology, Cytology and Autopsy. The Clinical Pathology division is more complex and constitutes what usually is known as "the clinical laboratory." It is composed of Chemistry, Hematology, Serology/Immunology, Microbiology, Blood Bank, Flow Cytometry and Phlebotomy.

The Pathologist
A pathologist is a medical specialist who provides consultation to physicians from other specialties such as Surgery, Obstetrics/Gynecology, Internal Medicine and Primary Care by evaluating tissues, cells and fluids received from procedures, surgeries and autopsies in order to obtain accurate patient pathologic diagnoses. In addition, each pathologist, under the supervision of the Medical Director, oversees one or more sections of the Clinical Laboratory to assure high quality and excellence in the provision of all these services. The Department of Pathology on Guthrie's Sayre Campus is composed five board-certified pathologists who are all highly skilled and experienced in the diagnosis and evaluation of cancer pathology. 

Role of Pathology in the Prevention and Diagnosis of Cancer 
The Department of Pathology plays an important role in the prevention and diagnosis of cancer. There are multiple examples where the pathologist plays a role in cancer prevention. The most commonly known is the evaluation of cervico-vaginal Pap smears in women in order to detect pre-malignant cells. Since 1947, when the Pap smear was introduced, the mortality for squamous cell carcinoma of the cervix has shown a remarkable decrease with a reduction of deaths from cervical cancer of approximately 70% to 80%. Before the introduction of the Pap smear, cervical cancer was the leading cause of cancer death in women. Today in the United States, it represents less than 2% of cancer deaths in women. This makes the Pap smear the most successful cancer-screening program in history.

A pathologist also evaluates biopsies from the prostate of male patients with abnormal prostatic-specific antigen (PSA) assays. With advances in technology making the obtainment of tissue through ultrasound-guided needle biopsies easier and more accurate, the number of these procedures has increased remarkably in recent years. This has allowed not only the early detection of cancer of the prostate, but also the identification of its pre-malignant precursors known as "high-grade prostatic intraepithelial neoplasia." Everytime the pathologist makes this last diagnosis, it raises a red flag for the urologist who will closely follow up with this patient in order to detect the presence of prostatic cancer at an early stage and consequently improve the prognosis, and sometimes obtain a complete cure of this cancer.

Another example in which the pathologist plays a role in cancer prevention is the microscopic examination of abnormal skin lesions and the evaluation of excisional or core biopsies of breast tissue in patients with abnormalities detected by mammogram or physical exam. The pathologist plays an important role in the diagnosis of other pre-malignant lesions such as those found in conjunction with Barrett's intestinal metaplasia, gastric dysplasia and colonic polyps.

However, the most traditional role of the pathologist involves providing diagnosis of malignancy through the examination of tissue or cells submitted to the laboratory. The specimen usually consists of one or more pieces of tissue obtained through biopsies or surgery, or of cells obtained through pulmonary brushing/washing, collection of sputum, voided or catheterized urine or fluid obtained from the peritoneal cavity (paracentesis), pleural cavity (thoracentesis) or spinal canal. 

In all these cases, the pathologist examines the tissue or cells under the microscope and renders a diagnosis of either benign or malignant neoplasm. Sometimes, the tissue examined is not a cancer but is a reactive or inflammatory process simulating a cancer, providing good news to the patient. However, when a diagnosis of malignant neoplasm is obtained and appropriate treatment must be planned, it is important to learn about the histological characteristics of the tumor (known as "grading" of the tumor), and determine how much the tumor has spread (metastasized) in the body (known as "staging"). In both cases, the pathologist plays an important role.

Breast cancer is but one of many forms of cancer routinely studied in the clinical laboratory. If breast cancer is diagnosed, the pathologist informs the clinician about the grade of the tumor. Regional axillary lymph nodes are examined to establish if the cancerous cells have spread into them. This information is extremely important because it will determine the "staging" of this tumor and consequently, the prognosis and treatment modalities. Additionally, the pathologist performs special immunohistochemical tests on the malignant breast tissue in order to establish if the cells express special molecular markers called estrogen and progesterone receptors. The results of these tests directly influence whether or not the clinician will treat the patient with a special drug called Tamoxifen. Another study performed in the clinical laboratory in patients diagnosed with breast cancer is the "ploidy study." This study determines the DNA content of the tumor cells, providing the clinician with an important
prognostic factor that influences the final outcome of patients with breast cancer. 

One relatively new technology that has completely changed the therapeutic approach to dealing with patients with leukemia and lymphoma is the cell-flow cytometric analysis (flow cytometry). The flow cytometer is a new instrument that through a laser beam, counts and sorts out characteristics of thousands of white blood cells obtained from lymph nodes, bone marrow aspirates or peripheral blood of patients with leukemia or lymphoma. This test determines if the patient's white cells are abnormal and in what category they belong. This allows the pathologist to classify leukemia and lymphoma in well-established categories, most of which have different
prognoses and therapeutic protocols. 

World-Class Guthrie Clinic Laboratories 
 All of these pathology services are provided in the Guthrie Clinic laboratories on Guthrie's Sayre campus, benefiting many individuals in the communities of the Northern Tier of Pennsylvania and Southern Tier of New York. We are fortunate to have such sophisticated technology and expertise available in our region. 

The treatment of cancer today is a multidisciplinary team effort, where the primary care physician, internist, surgeon, oncologist, radiologist, pathologist, radiotherapist, and nurses with cancer certification all play vital roles. Success in the treatment of cancer patients is the end result of this team effort.