What is a Pathologist?

As a field, surgery owes much of its progress to the field of anesthesiology. If patients could not be safely placed unconscious, surgeons would have many fewer patients and those surgeries that did occur would be much different than they are today. Just as surgeons owe a great deal to anesthesiologists, they also are indebted to another type of physician, the pathologist. Pathology is a specialty of medicine that physicians can choose to specialize in once they have finished medical school. A pathologist takes samples of tissue or fluid and makes certain diagnoses based on how it looks under a microscope.

 

 

Perhaps the easiest way to describe the role of a pathologist is to describe their work in cancer surgery. Consider a patient that has been diagnosed with liver cancer. A tumor has grown in the liver and has formed a large ball of tumor cells deep within the liver. The surgeon makes an incision and progresses until the tumor is visualized. While it may look significantly different than the surrounding tissue, it may not. The surgeon is left with a difficult task. If she takes too little of the tumor, the cancer will recur, which could have serious consequences for the patient. If she takes too much tissue, liver function could be compromised leaving the patient very ill as well. What usually happens is that the surgeon cuts around the tissue taking out a border of healthy tissue right along with the tumor. This specimen is then sent to a pathologist for evaluation.

 

The pathologist will carefully cut the specimen into smaller chunks, freeze them until they are completely solid, then make very thin slices through the tumor and liver tissue. These thin slices may or may not be combined with special stains to make their features easier to see. The slices of tissue are viewed under a microscope and the pathologist makes a very specific diagnosis about the cancer. The pathology sample will allow her to determine how far the cancer has spread, what specific type of cell is the tumor made of and if the surgeon was able to remove all of the tumor. In some cases this pathology sample will allow the pathologist to recommend certain treatment options to the cancer doctor (also known as an oncologist).

 

In certain surgeries, the pathologist will be kept on standby during an important surgery. The surgeon will surgically remove a section and someone will rush the sample directly to the pathology laboratory. The pathologist will rapidly freeze and section (slice) the sample and call back the results to the surgeon while the patient is still under general anesthesia. The advantage of this rapid processing is to perform the entire surgery on one occasion rather than subjecting the patient to the stress and discomfort of multiple surgeries.

 

Many people never get to meet their pathologist, but she is the unsung hero in many surgeries. If you have had surgery, ask your physician if a pathology study was done in your case. If there was, it was most certainly overseen by a pathologist.