What are pathologists, anyway? And, what do they do for me?
Pathologists are specially trained physicians who identify diseases by studying cells, tissues and body fluids such as blood and urine. To the untrained eye, it's as impossible as matching two snowflakes. But paring and comparing intricate patterns is what pathologists at Virtua Health do day in and day out.
Tools of the trade
Advancing medicine
Diagnosing cancer
Close cooperation with surgeons and radiologists
Tools of the trade
Equipped with high-power microscopes and other sophisticated tools, these specially trained physicians examine body tissue, blood and other fluids to determine the presence or absence of disease. What they see under the microscope are hundreds of thousands of small, large and bordered circles; red, white and translucent circles; squiggly and straight lines; oblong shapes, oblong shapes with dots.... And, all of this has an exact interpretation - one that is used to determine if a person has cardiac disease, cancer, anemia, arthritis, pneumonia, appendicitis, viral infection, cystic fibrosis, hemophilia, allergies ... and to help chart a course of treatment.
Referred to as doctors' doctors, pathologists bring the results of their studies to the physician who is treating the patient, and together they piece together a puzzle that forms a complete analysis of the patient's condition and identifies the best treatment. This ranges from determining the right antibiotic to treat strep throat to making a precise diagnosis of a cancer. This diagnosis guides the oncologist in selecting the best treatment, which may include surgery, chemotherapy, radiation therapy or other approach.
Advancing medicine
Over the past several years, the field of pathology has achieved significant milestones. "Pathologists now examine minute samples of separated cells found in tissues and fluids, which enables us to identify conditions earlier and prevent further damage," says
William Manion, MD, chief of pathology at Virtua Health. "We also practice preventive medicine through screenings such as Pap tests."
Diagnosing cancer
Modern technology, skill and experience allow pathologists to evaluate how cancer cells are formed, where they originated, their structure and how they interact with other cells. For example, breast cancer tissue is examined for the presence of hormone receptors such as estrogen and progesterone. A positive test result means that hormones may stimulate the cell growth, and that the cancer is more likely to respond to an anti-estrogen treatment. Other tests are performed to determine the growth rate or aggressiveness of the cancer and attempt to predict the likelihood of it spreading to other parts of the body.
"Special antibody stains are used to examine axilliary (under the arm) lymph node biopsies. These include samples of only those lymph nodes that guard the lymph node basin in breast cancer patients. This procedure lessens the impact of post-surgical side effects such as swelling and limitation of arm motion. The specimen's cells are so small that they may not even be seen by conventional microscopic examination, and they require special antibody stains to identify them," says Dr. Manion.
Some cancer cells, like prostate and melanoma, have unique "markers" or characteristics that aid in their precise identification. For example, pathologists look for the PSA antibody when studying prostate samples. "Others like mesothelioma (a malignancy caused by asbestos) don't have markers," says Dr. Manion. "To identify a mesothelioma, we run a panel of tests." This involves using a series of specific "antibodies" or substances to see if they attach to the cancer cells.
Close cooperation with surgeons and radiologists
Pathologists aren't confined to the lab. They collaborate with interventional radiologists during fine needle aspirations, a procedure in which a special needle is used to remove a small sample of tissue or fluid that is immediately examined by a pathologist. They also work closely with surgeons during operations by providing immediate diagnoses on biopsies. Specially processed tissues, called frozen sections, are removed and examined by the pathologist during surgery. This procedure, performed during surgery, guides the surgeon in treating the patient.
The study of pathology is as much an art as a science. While the pathologist relies on a combination of technology and clinical skill, experience counts for a lot. At Virtua Health, pathologists examine more than 30,000 specimens a year including thousands of cancer tissues. They have the latest equipment including multiheaded microscopes that allow the pathologist and the treating physician to examine specimens together. This close cooperation integrates the clinical diagnosis with the pathological one, which makes for the highest quality clinical care. There are currently 10 highly respected and experienced pathologists across Virtua. They work closely as a team, taking advantage of their individual expertise and combining their knowledge to bring each patient a reliable diagnosis.