Chicago Health | Homepage
Sleuthing Out Cancer

Sleuthing Out Cancer

Above photo: Carey August, MD


Out of the spotlight, pathologists help detect disease

By Nancy Maes

When former President Jimmy Carter announced in August that a mass on his liver was a stage IV melanoma, along with four spots on his brain, the diagnosis seemed surprising since melanoma is usually associated with the skin.

Knowing the type of cancer—whether a mass is liver cancer originating in that organ or melanoma that spread from elsewhere in the body—is of critical importance for doctors, who can devise a treatment plan with drugs tailored to the type of cancer. The cellular detectives behind the discovery? Pathologists working in the laboratory.

“It’s not as though doctors opened Carter’s belly and looked in and saw a sign that said, ‘I’m a melanoma,’” says Carey August, MD, director of anatomic pathology at Advocate Illinois Masonic Medical Center, who was not involved with Carter’s cancer but read details in the press. “Pathologists had to figure that out, so in some ways, we are detectives.”

Pathologists first look at the tissue sample that has been removed from the patient. “We can tell by the look of the cells if they are malignant, because we know the characteristics of cells in every part of the body. We know if the features we see under the microscope indicate it is malignant because we’ve trained our eyes, just as art historians train their eyes to recognize a Chagall or a Rubens,” August says.

The pathologist then zeros in on specifics. “Cancer is a global term, and we need to know which type of cancer it is. Without pathologists, there would be no precise diagnosis,” says Thomas Krausz, MD, director of anatomic and surgical pathology at The University of Chicago Medicine, who was not involved in President Carter’s case. “After pathologists examine a representative tissue sample with the naked eye for cancer, they then preserve the tissue in a fixative solution, embed it in a paraffin block, cut off a very thin slice and stain it, most commonly with special dyes, so they can see the details of the individual cells under the microscope.”

Details of the meticulous work performed by pathologists is not well known because it is done away from the spotlight. “The difference between the surgeons and oncologists and the pathologists like myself is that we do not meet the patients but only the material that is removed from the patients,” Krausz says. “But in most hospitals in the U.S., the pathologist is one of the specialists on the multidisciplinary tumor board that meets every week to discuss the actual cases.”

Pathologists help solve the mystery of cancer so that the specialists can figure out the best way to treat the disease. While Carter had a family history of pancreatic cancer, his mass was neither pancreatic cancer nor liver cancer, August says. Instead, it was likely related to an undetected past skin melanoma.

“In Carter’s case, the pathologist might have recognized the features of melanoma under the microscope. Or he might not have known right away and used some additional staining techniques to narrow down the possibilities or confirm that it was a melanoma,” she says. “Sometimes the results are iffy, and we go back to the drawing board over and over again and do the detective work until we figure it out.”

Additional tests are often necessary, Krausz says, because the pathologist must identify the sub-type of the malignant melanoma as well as gene mutations. “It is very common in referral institutions to send tissue to the molecular pathology laboratory for genetic testing because within the subtypes of melanoma, you can have different gene mutations, which are important for the oncologist to know when deciding on one of the treatment possibilities,” Krausz says.

“The whole approach to melanoma treatment has changed in the past five years with the discoveries of molecular alterations and mechanisms of manipulating the immune system to encourage it to kill the melanoma cells,” Krausz says. “The concepts of personalized medicine and targeted therapy are very important in this era, so when we make a diagnosis, we try to be as specific as possible in each individual case.”

President Carter’s treatment includes radiation for the spots on his brain and a new drug called Keytruda (pembrolizumab) that boosts the immune system so that it can attack the cancer cells.

Typically, the paraffin block with the biopsy specimen and the slides are kept by the hospital for 10 years, August says. “As we have more and more information about new targets for treating patients, we may have new tests we can perform. If a patient has a recurrence of the cancer, there may be new tests we can perform that will facilitate the use of new medications. Or, if the patient has a secondary cancer, we can compare it to see if this is a metastasis or a new cancer.”

Now, and in the future, pathologists working behind the scenes will perform the essential work of sleuthing out the clues that reveal to the medical team the treatment option with the best potential for success. As the detectives of the medical world, they continue to solve many medical mysteries, aiding other physicians as well as patients.

Similar Articles

Speaking Up About Prostate Cancer

Speaking Up About Prostate Cancer

Above photo: Ken Griffey Sr. By Laura Drucker Ken Griffey Sr. had reason to be worried

Beyond Chemo

Beyond Chemo

Immunotherapy treatments rev up immune system to fight cancer By Katie Scarlett Brandt Six years ago Henry Kawell, then 72,

Getting Over It: Why You Should Get a Colonoscopy

Getting Over It: Why You Should Get a Colonoscopy

Facing the discomfort of a colonoscopy is a sure way to avoid the greater discomfort and

Simple steps to help prevent colon cancer

Simple steps to help prevent colon cancer

The Medicine Cabinet: Ask the Harvard Experts By Howard LeWine, M.D. Q: An older cousin was recently

Research shows clear benefits to colon cancer screening no later than age 50

Research shows clear benefits to colon cancer screening no later than age 50

Mayo Clinic Q&A DEAR MAYO CLINIC: Is a colonoscopy still recommended for everyone when they turn

Articles By Category

Family Health

In The Know

CH Lifestyle

January 2017
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
December 25, 2016 December 26, 2016 December 27, 2016 December 28, 2016 December 29, 2016 December 30, 2016 December 31, 2016
January 1, 2017 January 2, 2017 January 3, 2017 January 4, 2017 January 5, 2017 January 6, 2017 January 7, 2017
January 8, 2017 January 9, 2017 January 10, 2017 January 11, 2017 January 12, 2017 January 13, 2017 January 14, 2017
January 15, 2017 January 16, 2017 January 17, 2017 January 18, 2017 January 19, 2017 January 20, 2017 January 21, 2017
January 22, 2017 January 23, 2017 January 24, 2017 January 25, 2017 January 26, 2017 January 27, 2017 January 28, 2017
January 29, 2017 January 30, 2017 January 31, 2017 February 1, 2017 February 2, 2017 February 3, 2017 February 4, 2017

Categories

Recent Comments

Swing for the fences in the fight to Sideline Pancreatic Cancer

Swing for the fences in the fight to Sideline Pancreatic Cancer

Enjoy a great night of baseball at Peoples Natural

VIEW ARTICLE
Cost to give birth 1943 - Page 3 - Defending The Truth Political Forum

Cost to give birth 1943 - Page 3 - Defending The Truth Political Forum

A Hazy Shade of Healthcare: What does tort reform

VIEW ARTICLE

Archives