Patient Experience

When you have a suspicion of cancer, you want to be sure that you are getting the correct diagnosis. A Pathologist is the doctor who will help verify if you have cancer and if so, what the stage is so that the rest of your care team can create a treatment plan for you.

It takes years of training and a specific skill set to become an expert pathologist. After medical school, doctors complete a minimum of four years in a pathology training program and generally pursue additional training in a subspecialty such as skin pathology (dermatopathology), cell pathology (cytopathology), surgical pathology or blood pathology (hematopathology), requiring an additional one or two years of training. Because accurate diagnosis depends on close scrutiny of samples, pathologists need strong visual orientation and memory.

In 90% of cases, Richard Cheney, MD, Chair of Pathology and Laboratory Medicine, says, the diagnosis is clear, because the cancer cells look very different from normal cells, or their growth pattern is different from that of normal structures. In the remaining cases, some cancers are more difficult to detect, requiring additional specialized testing for accurate diagnosis, and a very small percentage are nearly impossible to characterize.

Once cancer cells are found, pathologists use a variety of techniques to determine the specific type of cancer cell involved, how much cancer is present, whether it has spread to other parts of the body and how abnormal the cancer cells look. This enables them to determine the stage and grade of the cancer. “Precise diagnosis is what drives patient decisions and therapy. If the pathology is wrong, everything that follows will likely be incorrect as well,” says Cheney.

Staging and grading: classifications that guide treatment

Pathology tests help to determine stage and grade – two classifications that are essential to choosing the most effective cancer treatment and predicting how the disease will progress. The stage indicates the extent and location of the cancer. It takes into account the primary (original) tumor size, number of tumors and whether it has metastasized, or spread to the lymph nodes or distant parts of the body. Staging is based on the pathology report, physical exam and radiologic exams, such as x-rays, CT scans and MRIs.

Cancer grade describes how abnormal the cancer cells are compared to normal cells and how quickly they are dividing, which may indicate a more aggressive cancer.