While most patients may never meet their pathologists, these physicians are critical members of the care teams at Memorial Sloan-Kettering. Working behind the scenes in the laboratory, pathologists examine cells and tissues to make an accurate diagnosis – the essential first step in identifying a treatment plan that will offer the best chance of success if cancer cells are present.
The pathologist determines the precise type and severity – or stage – of the cancer, and may also work with other members of the care team to recommend a treatment strategy that could include observation, surgery, chemotherapy, radiation therapy, or a combination of these approaches.
Memorial Sloan-Kettering’s Department of Pathology has 54 pathologists on staff and is growing, with five new pathologists to be added this year. The department reviews samples from more than 50,000 patients each year, generating some 100,000 pathology reports.
David S. Klimstra, Acting Chair of the Department of Pathology since 2011, has worked at Memorial Sloan-Kettering for 20 years. In a recent interview, Dr. Klimstra talked about the pathologist’s role on a patient’s care team.
How can an accurate pathology report improve a patient’s chance of receiving successful cancer treatment?
I would say that you can’t achieve any reasonable treatment success without having an accurate pathology report.
Our physicians can’t treat people without first diagnosing them with cancer. After the diagnosis, many different decisions hinge on proper classification of the tumor, staging, grading, and other genetic factors that are increasingly important for optimal treatment. Pathology guides almost every decision point in the cancer treatment process.
How have advances in molecular diagnostics and genetics enhanced the role of pathologists on a cancer treatment team?
Molecular diagnostics started as a technique to look for specific chromosomal changes as a way to further diagnose and classify cancers. But more and more we’re using our knowledge of genetics to detect abnormalities that confer sensitivity to certain drugs, which can help us determine which drug therapy will work best, and which tumor types may be resistant to certain therapies.
Pathologists have always helped direct whether therapy is needed. The difference is that now, not only can we say that a patient needs chemotherapy, but often we can also suggest a specific drug.
What is unique about the Department of Pathology of Memorial Sloan-Kettering?
As part of a world-class cancer center in which every physician and scientist is focused on cancer, and where most of our patients have a cancer diagnosis, we have the advantage of analyzing a high volume of material from many thousands of people each year.
Rare cancers that some pathologists see infrequently, our pathologists see on a daily basis. This extensive experience gives us an unusual understanding of the subtleties between different types of cancer, leading to an unsurpassed level of accuracy.
Our pathologists are also subspecialized. We have a group of pathologists dedicated almost exclusively to diseases of each organ – for example, the lung, breast, or the gastrointestinal system. This results in the highest level of clinical expertise available because each Memorial Sloan-Kettering pathologist is a true specialist in diagnosing a specific type of cancer, and understanding its nuances and variations.
How do Memorial Sloan-Kettering pathologists work together as a team to make a diagnosis?
We’re a very connected group, so we communicate extensively across subspecialties – from brain cancer to colorectal cancer and lymphoma. The whole department meets every day to discuss challenging cases, and our individual subspecialty teams meet frequently as well.
Because all of our disease-specific pathologists specialize in cancer, there are a lot of common areas of interest among different groups in the department, which results in the constant sharing of information that really helps patients. For example, if the lung group is using a new diagnostic test, they share this information, and we may realize that it’s also helpful in diagnosing prostate cancer. For patients and for us as physicians, that’s one of the great advantages of being at a place like Memorial Sloan-Kettering.