The pathologist is sort of the hard drive of the hospital system.
We are providing this key information
that then everyone else can work off of to help the patient.
A pathologist comes into play
when the clinician has a question about the diagnosis.
What is the patient presenting me with?
So they need to take a tissue sample
or a blood sample or some other kind of sample
and we do our magic behind the scenes
and come up with the answer.
In a cancer patient,
first, just the initial diagnosis of cancer.
We'll let everybody on the team know this is what we're dealing with
and now we have to think about treatment,
which might be chemotherapy, radiation therapy and/or surgery.
So it starts with the pathology diagnosis and then everything else happens.
A pathology report contains
all the information that the clinician needs to decide
what is the next step for the patient.
In thinking about cancer,
it's useful to consider the two types of specimens we're dealing with.
One is the initial diagnostic biopsy
and in some patients that may be all that is ever needed
and we give a diagnosis that establishes that there is a tumor of some sort there
and that small specimen, we can then usually give a little bit more information
by doing some molecular testing or biomarker testing
that will already point towards
which therapies might work better than other therapies.
The second scenario is that one has a diagnosis of cancer
and now they've had a complete surgical resection to remove it entirely.
In that case, all the message is about
how far has it spread.
So the pathology report from a patient who's had a surgical resection
will contain something called a synoptic report
that includes what's called the surgical margins.
Was it completely excised?
Is it gone or is there something left behind?
Is there lymph vessel or blood vessel or even perineural,
the nerves,
Is there tumor around nerves?
So has it spread within this resection?
How many lymph nodes might be involved by the tumor?
That is always included If lymph nodes have been removed
and again, lymph nodes can be thought of as just a highway
of structures that are draining
normal waste fluids from every part of the body.
We also measure the tumor
so that we can arrive at both a grade and a stage,
something called the American Joint Cancer Committee or a AJCC stage
and patients will see that on every cancer report from a resection.
The questions you may have on your report, call your doctor,
your surgeon, your oncologist, whoever is taking care of you.
That's the place to start with your questions.
What we say as pathologists is that you don't want a quick answer.
You want the right answer.
And that means we have to be accurate
and, more importantly, complete.
To be complete these days, we need to apply the biomarkers and molecular markers and tumor profiling tests.
That is the whole reason patients come to Yale Smilow Cancer Center for care.
Because we do it all, we have the highest level of expertise.
We get all the information that you need
that your doctor needs to decide with you
what will be the next best step for your care.
Because it's the next best step in your care that will
hopefully give you the best possible outcome for your future.