Cancer Treatment

Surgery

Most types of cancer are found later and have formed large tumours.  Surgeons probably cure more patients of cancer than any other doctor and can often deal with localised tumours very effectively.  The goal of surgery is to remove the entire tumour.  The specimen is carefully examined by pathologists to find out whether this has been achieved.

Once cancers spread more widely treatment is more difficult.  Surgery can reduce the amount of cancer present, radiotherapy can deal with localised cancer tissue that is left behind, and chemotherapy given at the same time (adjuvant therapy) can reduce the risk of recurrence.

Chemotherapy

When cancer spreads to other tissues and is difficult to treat, chemotherapy is the only option for most such tumours.  The anti-cancer drugs used are improving all the time, but many have nasty side effects.  They work by targeting the differences between cancer cells and normal cells in the body.  As our understanding of these differences grow, new anti-cancer drugs are being produced with greater specificity and fewer side effects.  Some are proving to be spectacularly successful in the clinic and there are great hopes for a revolution in cancer treatment within the next few years.  However these drugs will not benefit everyone due to the wide variety of changes present in individual patients' cancers.  We need to select treatment carefully for each patient, and that is where the new Cancer Laboratory will give patients the best possible chance of successful treatment.

What do Pathologists do?

Hospital pathologists work in laboratories and are responsible for screening diagnosis and monitoring of diseases, including cancer.  Pathology includes histopathology, microbiology, haematology, immunology and biochemistry.  The Cancer Laboratory will be sited within histopathology - the specialty that deals with diagnosis from tissue samples sent by surgeons, but will interact closely with the other laboratories in the pathology department.

Around 80% of the work of histopathologists relates to cancer - usually to exclude the diagnosis.  In many cases, the final diagnosis is confirmed by the histopathologist using methods that have not changed all that much in more than a century!  We still use formalin to preserve tissue, and then embed specimens in it so that thin sections can be cut and stained with coloured dyes.  The patterns of cells within the tissue allow the histopathologist to work out whether the tissue is normal, inflamed, infected or cancerous.  We can also define the extent of the tumour - important information if surgical removal is an option, or further treatment such as radiotherapy is being considered.

Over the last 15 years or so, histopathology has begun to change with increasing automation of tissue processing and the introduction of sophisticated molecular methods that allow us to examine the function of cells as well as their size and shape.  

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