- Premalignant & Benign Varieties
- Surgical Margin
- Personalized Prognostication
- Low Cost
- Premalignant & Benign Varieties
- Surgical Margin
- Fast and Fully Automated ’Image to Report’ Pipeline
I have had a breast biopsy taken. My doctor thinks it might be cancer. What kind of treatment options will be open to me?
Biopsies are performed on solid tissue in any part of the body. In breast tissue, for example, the aim is to identify whether cancer or precancerous lesions are present. If cancer is identified, the histopathologist will determine whether it is invasive, and identify its subtype and grade (i.e. how abnormal this appears under the microscope, which offers are measure of how aggressively it is likely to behave). Features, such as spread to the bloodstream and the presence of small calcium deposits are also reported (the latter allow correlation with mammography findings to ensure that the lesion has been appropriately sampled by the surgeon). If an invasive cancer is identified, immunohistochemistry is performed to establish the status of hormone and growth factor receptors on the cancer cells; these findings will guide the clinical care team’s choice of the most effective drug-based treatment after surgery. The entire process takes a number of days to complete and commands a significant time commitment by histopathologists.
What is cytology? How long will it take for me to get my results?
Cytology is the extraction of small numbers of cells from a suspicious area/body fluid using a needle or a brush. This can be in any part of the body (e.g. cervix, lung, thyroid, breast). The cells are placed in a liquid preservative, spread on a slide, stained and assessed by a histopathologist. If cancer is identified, doctors need to define what kind it is. This may require using additional tests, such as so-called immunohistochemistry. In response to these findings, further tests may again be requested, such as genetic testing as in lung cancer. This is important to determine the best treatment. The whole process takes a number of days.
I had a melanoma removed. Now I am going back for surgery. What is going to happen?
The surgical excision of a malignant melanoma is the first line of treatment. However, doctors also need to determine whether the cancer has spread to the lymph nodes (these drain fluid from around the site of the cancer and cancer cells often remain trapped in them as they start to spread throughout the body). These are therefore also removed. These are sliced manually and multiple levels of each slice are then examined by a histopathologist under the microscope to rule out the presence of cancer within each slice. Immunohistochemistry, which highlights the presence of cancer cells, is also performed to aid the histopathologist in his/her visual assessment. A simple case with several lymph nodes therefore rapidly becomes a repetitive, labor-intensive and time-consuming exercise with significant associated immunohistochemistry costs.
My mother has been diagnosed with a cancer of unknown primary. What does this mean for her and her treatment?
The term ‘metastatic’ is used to describe cancers that have spread elsewhere in the body (e.g. lung, liver, bones). If patients have had more than one cancer in the past, histopathologists determine which one the metastatic disease arose from by comparing it with the original cancers and, where needed, confirming this by immunohistochemistry. Occasionally, however, there are so-called ‘cancers of unknown primary’ (CUPs). These metastatic cancers occur in instances where the primary cancer (the cancer that first formed) cannot be found (e.g. because very small, eradicated by the immune system or unknowingly removed during surgery for another condition). CUPs carry very high mortality rates, because the disease is advanced and no targeted therapy can be implemented until the specific cancer type is identified.
My mother has just been diagnosed with ovarian cancer. Her doctors say her outlook is poor, but I have read that some newly available chemotherapy drugs could benefit her more. Is there a way of finding out if this is the case?
The choice of optimal cancer treatment remains one of the great challenges in oncology. Almost a fifth of ovarian cancer cases are associated with mutations in genes called BRCA1 or BRCA2. These women particularly benefit from targeted (so-called ‘PARP inhibitor’) therapy, which greatly improves survival rates. Sometimes, even if the patient undergoes testing for mutations in these genes, doctors are not always successful in choosing the best therapy. This is often due to tumor-specific characteristics, which are not obvious to histopathology doctors.
I have been given a diagnosis of uterine cancer and I am distraught. Doctors say that people like me have a 50% chance of being alive in 3 years’ time. What does that mean for me though?
The outcome of cancer treatment can vary greatly, especially with uterine cancer. Doctors usually arrive at a prognosis dependent upon how far the cancer has spread or how aggressive it appears under the microscope. However, they are unable to offer a reliable, tailored prognosis for each patient that takes age, general health and medication in consideration.
I have been diagnosed with lung cancer. I am worried by having to wait so long for my diagnosis and treatment. Is there any way to speed this up?
Cancer diagnoses, such as in lung cancer, can be followed by tumor genetic testing. This enables doctors to tailor treatment more effectively for their patients. However, these tests are costly and time consuming and are not always reliable since the genetic material (DNA) extracted from the tumor is not consistently suitable for testing.
I have had a skin cancer removed by my surgeon. What will the histopathology doctor do with it?
Cancers, where possible, are surgically removed. The specimen (called a ‘resection’ or an ‘excision’) is sent to a histopathologist who will perform a number of tasks: (i) confirm the diagnosis of the prior biopsy (if performed), (ii) stage the cancer (i.e. determine how far it has spread, which guides subsequent therapy), and (iii) assess that the surgeon has fully removed it. This is a critical and time-consuming task for histopathologists that can take upwards of a week to complete.
I donate money to a medical charity that aims to improve access to specialist healthcare in developing countries. Is there any hope for patients in those countries to benefit from significant improvements in diagnostics?
There is a growing shortfall in the number of histopathologists, particularly in developing countries, where healthcare is either difficult to access, prohibitively expensive to low-income patients or in short supply altogether.