Pathologists: The Most Important Doctors You Never Meet
From left to right: Josephine Harter, MD, Paul Weisman, MD, Aparna Mahajan, MD and Christopher Flynn, MD, PhD.
In almost all suspected cancer cases, a biopsy is performed and the sample is sent to the pathology lab. Pathologists first analyze the tissue under a microscope and establish whether the cells are benign or cancerous.
“To identify cancer, we look at the cell morphology: what the cells look like and how they arrange with the other cells around them,” said Josephine Harter, MD, a pathologist with the Carbone Cancer Center who specializes in breast and gynecological pathology. “That part is critical, if not very sophisticated – people have been doing essentially the same thing for over 100 years.”
More recently, pathologists have been able to rely on advanced techniques to help physicians determine best treatment options moving forward.
“We can perform molecular studies to determine characteristics of the cells, or immunohistochemical stains to determine which proteins the cells are expressing,” Harter said. “In breast cancers, for example, we label for common hormone receptors, and the results determine whether or not anti-hormone therapy will be useful for those patients.”
Pathologists also determine if the cancer is original to the site from which it was biopsied or if it is a metastasis from another site, further helping to drive treatment plans.
“If I am looking at a breast tumor biopsy and see lymphoma, not carcinoma like we typically see in the breast, then that woman needs to have a complete redirection of her care; she doesn’t need to see a surgeon, she needs to see a hematologist for her cancer,” Harter said.