The Role of Surgical Pathology
August 04, 2022July 31, 2022
Yale Cancer Center
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- 00:00Funding for Yale Cancer Answers is
- 00:02provided by Smilow Cancer Hospital.
- 00:06Welcome to Yale Cancer Answers with
- 00:09your host Doctor Anees Chagpar.
- 00:11Yale Cancer Answers features the
- 00:12latest information on cancer care by
- 00:15welcoming oncologists and specialists
- 00:16who are on the forefront of the
- 00:18battle to fight cancer. This week,
- 00:20it's a conversation about the role
- 00:22of surgical pathology in certain
- 00:24cancers with Doctor Marie Robert.
- 00:26Doctor Robert is a professor
- 00:28of pathology and of medicine at
- 00:29the Yale School of Medicine,
- 00:31where Doctor Chagpar is a
- 00:33professor of surgical oncology.
- 00:36Marie, maybe we can start off by
- 00:38you telling us a little bit about
- 00:39yourself and what it is that you do.
- 00:42Sure, so I am a surgical pathologist
- 00:45and this is somebody who goes to
- 00:48medical school and does a residency
- 00:51in the specialty of pathology.
- 00:54And that specialty involves looking
- 00:58at diseases in the tissues in
- 01:02biopsy samples and and surgical
- 01:05resection samples from patients.
- 01:09And we look at that very
- 01:11deeply under both with our naked
- 01:13eye and under the microscope,
- 01:15and then inform the surgeon or the
- 01:20clinician oncologist
- 01:22who's taking care of the patient
- 01:23about what we're seeing and what
- 01:25their disease process might be?
- 01:27Yeah, you know I I often tell patients
- 01:30that there's only two people who
- 01:32can tell you anything for sure.
- 01:34God and the pathologist because we
- 01:36rely so heavily on the diagnosis
- 01:40that's rendered by pathologists.
- 01:42So you know, tell us a little bit
- 01:45more about what got you interested in
- 01:48pathology and what got you interested
- 01:50in GI and liver pathology in particular.
- 01:54So that is an easy question
- 01:55to answer and no secret.
- 01:57If you know my family at all,
- 01:59so I am the daughter of a French Canadian.
- 02:05Nurse and physician scientist.
- 02:08My father Andre Robert,
- 02:11who was a basic scientist studying
- 02:13gastrointestinal diseases so
- 02:15he had both the clinical side
- 02:18MD and the scientific training.
- 02:20And so I grew up visiting his lab
- 02:23and seeing and actually, you know,
- 02:25he would let me do a little help in the
- 02:28lab in in participating in his experiments.
- 02:31And so this is when I went to college and.
- 02:35Medical school, I thought that medicine
- 02:39was this the study of disease.
- 02:42And so when I it was,
- 02:44you know, not a far.
- 02:47Challenge for me to decide that
- 02:49pathology was where my heart really lay.
- 02:51And of course,
- 02:52the apple doesn't fall far from the tree
- 02:54and I was immediately drawn towards
- 02:56all things of the gastrointestinal tract,
- 02:58liver, and pancreas.
- 03:00So tell us a little bit more
- 03:04about kind of what you do.
- 03:07day-to-day. I mean, because one of
- 03:09the things that is frustrating.
- 03:11Anxiety provoking for patients is the wait.
- 03:16They have the biopsy done and
- 03:18then we say we need to wait and
- 03:21I always tell patients you know,
- 03:23never rush the pathologist because.
- 03:26You you don't necessarily want a fast answer.
- 03:30You want the right answer,
- 03:31because everything that we
- 03:33do rests on what you say.
- 03:36So can you give us a little bit more
- 03:39granularity in terms of what happens in
- 03:42terms of that black box while we wait?
- 03:46So delighted to talk about this
- 03:49because we are believe it or not,
- 03:51even though we are not meeting
- 03:53your patient first hand,
- 03:55we are constantly mindful of the fact
- 03:57that there is a wonderful human being on
- 04:00the other end of this specimen and we
- 04:03are working as fast as we can to provide.
- 04:06As you say the right answer.
- 04:08So what does this entail?
- 04:10So take a biopsy.
- 04:12It is put in a fluid called.
- 04:17Formalin, usually that is allowed that
- 04:19sort of hardens the tissues so that we can
- 04:22then put them through an overnight process.
- 04:26And we actually.
- 04:27This may sound crazy.
- 04:28We actually take the small samples or large
- 04:32samples and put them into paraffin wax.
- 04:36Melted paraffin wax that then
- 04:38hardens in a small little box.
- 04:41If you will, we call it a tissue cassette.
- 04:44And believe it or not,
- 04:45old fashioned thing like paraffin wax
- 04:48is what holds the tissue in place.
- 04:50While we then apply a very sharp knife,
- 04:54it's called a microtome to the
- 04:57sample and we're actually taking
- 04:59small slices of the sample.
- 05:02We take that put it on a microscope slide.
- 05:06Remember from science class.
- 05:07And that microscope slide is then
- 05:10with the tissue section on it is
- 05:12stained with some very pretty colors.
- 05:15Purples and pinks really.
- 05:16Pathology is like looking at beautiful
- 05:19art under the microscope and these dyes.
- 05:22If you will are stains adhere to the
- 05:25cells and we during our residency
- 05:28have learned how to recognize cells
- 05:30with these dyes under the microscope
- 05:33so that whole process of just
- 05:35getting to the glass slide takes.
- 05:38At least one day so you know one day gone.
- 05:41Now depending on the type of sample it is,
- 05:46we can then grab it quickly,
- 05:48begin our process of looking
- 05:49under the microscope,
- 05:50and in some situations we are
- 05:52able to give an immediate answer
- 05:54doing nothing else to the sample.
- 05:56Just looking at the microscope for
- 05:59three or four minutes and we're
- 06:01able to assess everything and give
- 06:03a give the the surgeon, oncologist,
- 06:05whomever gastroenterologist,
- 06:06and then the.
- 06:08Patient the answer they need,
- 06:10but in especially in cancer there
- 06:13are often other steps we need to
- 06:16take to get the best possible answer
- 06:19with the greatest amount of detail.
- 06:22And nuance that will really help the
- 06:26person just treating the patient next
- 06:29to know exactly what therapy to apply.
- 06:32So these extra steps include things like
- 06:34we we use these terms called special stains,
- 06:38so if you think of a stain,
- 06:39think of like paint or or these
- 06:42colors I mentioned and there are a
- 06:45variety of very technical and highly,
- 06:48you know,
- 06:49honed technologies that we can
- 06:51apply to the tissue.
- 06:53This is getting more and
- 06:55more finessed every day.
- 06:56We can now even do molecular and
- 06:59genetic analysis and and put what we
- 07:03call biomarker stains and approaches
- 07:05so we can really get much further
- 07:09now to helping to guide the even
- 07:12the exact medication one might use.
- 07:15But this does take time,
- 07:17so sometimes there's a first answer.
- 07:19And then there's another more detailed
- 07:21answer that comes a day or a week later.
- 07:23Sometimes we have to hold up the whole
- 07:25thing for four or five days just to
- 07:27get the right answer from the start,
- 07:29so that's sort of a long answer to
- 07:31your question, but it is complete.
- 07:33Yeah, yeah, so I mean,
- 07:35so This is why I think it's good
- 07:38information for people who are listening
- 07:40and potential patients to kind of
- 07:42understand why it can take so long,
- 07:44because sometimes we expect these days
- 07:46to to get an answer instantaneously.
- 07:50And and that's just not
- 07:52practical or or feasible.
- 07:54So I want to dig a little bit more into some
- 07:56of the things that you mentioned, Marie.
- 07:59So one is that you know in
- 08:01medical school and in residency,
- 08:03you, as a pathologist got very
- 08:07good at recognizing patterns,
- 08:10understanding what looks benign
- 08:12under a microscope and what looks
- 08:16malignant under a microscope.
- 08:18But can you tell us a little bit more about
- 08:21the secrets that go into that pattern?
- 08:23Recognition?
- 08:24Because that's another piece that
- 08:27people don't really understand.
- 08:29I mean,
- 08:30how can you tell the difference between.
- 08:33You know a benign polyp,
- 08:36something that then is perhaps a
- 08:39carcinoma in situ, a precancer.
- 08:43And then something that is truly
- 08:46cancerous that for many people is a
- 08:49nuance that we don't really understand.
- 08:52How.
- 08:52How do you make that distinction?
- 08:56So thank you for these wonderful
- 09:00pathology type questions.
- 09:01The the answer is it all starts
- 09:05with knowing what is normal,
- 09:07what is normal tissue appearance?
- 09:10We use the term Histology,
- 09:12it doesn't matter,
- 09:13but it's just what are you expecting to see.
- 09:16That is normal.
- 09:17So in anything that you look at and
- 09:19in looking at, you know anything
- 09:21around your house or in your workplace.
- 09:23Your desk is something out of place.
- 09:25Were first to understand what is normal
- 09:29tissue, so you want to talk about,
- 09:30say, a colon polyp.
- 09:32We first have to learn,
- 09:34and this is actually, you know,
- 09:35at least a four year training
- 09:37process and residency,
- 09:38and then often today one or two years
- 09:41of specialty fellowship training,
- 09:44we learn very quickly what is normal in
- 09:46our first couple of years of residency,
- 09:48training and normal means,
- 09:49how in health are the this
- 09:52wonderful machine that is?
- 09:54Our body is organized at the cellular
- 09:57level so that you know you look at
- 10:00your skin and you see your skin.
- 10:02You might.
- 10:03The freckles or some blood vessels
- 10:06underneath under the microscope
- 10:08we learn what all those layers
- 10:10from the outside of the skin to
- 10:13underneath the skin down into even
- 10:15the muscles and the bone look like.
- 10:19So once we have that template,
- 10:22sort of that pattern if you will
- 10:24pattern recognition in our mind.
- 10:26Then we begin very slowly to build
- 10:29to learn abnormal and the one of
- 10:31the first things we start with is.
- 10:34Inflammation,
- 10:34you know you get a cut and you
- 10:37notice that there are bee sting and
- 10:39you notice swelling right away.
- 10:41Redness.
- 10:41Well,
- 10:42we learn what that looks like
- 10:44under the microscope with,
- 10:45you know,
- 10:46too much fluid and and inflammatory
- 10:48cells from the immune system
- 10:49being called to that area.
- 10:51The same is true when we
- 10:53start talking about cancer.
- 10:55There's often a process starting from
- 10:58an early, let's say, neoplastic,
- 11:01meaning that the cell is stopped.
- 11:04Just minding its own business and
- 11:06staying put where it should be
- 11:08to maintain the normal but is now
- 11:11dividing and growing and and we can
- 11:13see that under the microscope by
- 11:15changes and actually how the cell looks.
- 11:19Over overtime that growth.
- 11:23Can then.
- 11:25Disrupt the normal to the point
- 11:28that there is disruption of the
- 11:30the little little boxes of the the
- 11:33little alleys and lanes that that
- 11:35cells need to stay in and they invade.
- 11:38We talk about invasive cancer.
- 11:40It's because those cells actually
- 11:42go into a compartment that they have
- 11:45no business being like an epithelial
- 11:47cell which should be on the surface.
- 11:49So if you look at your skin,
- 11:50it's lined by a certain kind of cell.
- 11:52We call it an epithelial cell,
- 11:54just the lining.
- 11:55Now if it becomes a tumor,
- 11:58it can then go down into the soft tissues,
- 12:01even the muscle and bone,
- 12:03et cetera.
- 12:04And we can see this all under the microscope.
- 12:07So recognizing cancer or recognizing
- 12:10an abnormal process is recognizing
- 12:12that the normal has been disrupted.
- 12:16And so so you know, one of the
- 12:19questions that people often ask is.
- 12:22You know how important is it?
- 12:24Or is it important to get a second
- 12:27opinion with regards to your pathology?
- 12:29So very often you may have your
- 12:32biopsy done at one place if you go
- 12:35to another place to get treatment,
- 12:38they'll say, well, we need our
- 12:40pathologist to look at the slides.
- 12:42So is it that you know a
- 12:45pathologist is a pathologist,
- 12:47is a pathologist and this is a black
- 12:49and white answer and everybody is going
- 12:50to say the same thing, in which case.
- 12:53Why repeat it?
- 12:55Or is there some nuance there and
- 12:57and how important or not important
- 13:00is it to get a second opinion
- 13:02on your pathology slides?
- 13:05So another great question.
- 13:07I am a big fan of second opinions
- 13:10and I recommend that when folks
- 13:12are getting impactful diagnosis.
- 13:15Like a cancer diagnosis,
- 13:16that's going to change their life and
- 13:20start a train in motion of serious
- 13:23therapeutics and operations that a
- 13:25second opinion should always be obtained.
- 13:29And I'm not offended if someone would
- 13:31like to get a second opinion on a
- 13:35pathology diagnosis that I have made it.
- 13:37You know it many times as you sort of
- 13:41allude to probably 90% or more of the time.
- 13:44There will be no disagreement
- 13:47in an original diagnosis.
- 13:49But sometimes there is either a
- 13:51really a complete disagreement,
- 13:52very, very rarely,
- 13:53a complete disagreement between hey,
- 13:55you know, I actually,
- 13:56I'm not sure this is cancer.
- 13:57I know that.
- 13:58This was thought to be cancer,
- 14:01but actually I'm doing a little more
- 14:02extra work on it and I'm finding that
- 14:04maybe it might be just a precancer,
- 14:06or it may some nuance about that.
- 14:09In addition,
- 14:11in tertiary care centers tend
- 14:14to have specialized pathologists
- 14:17that are only doing one thing.
- 14:20So in my case I'm only doing
- 14:25gastrointestinal pathology,
- 14:26whereas in other centers there's
- 14:28a group of wonderful general.
- 14:30Pathologists who are looking at all all
- 14:34all specimens from all parts of the body,
- 14:36and they are all all outstanding
- 14:38and and this is a good system.
- 14:41But if it's a really impactful diagnosis,
- 14:44it's not a bad idea to have a
- 14:46very impactful diagnosis reviewed
- 14:47by someone who is a recognized
- 14:49specialist and they exist all over
- 14:51the country and all over the world,
- 14:54perfect, well, we're going to
- 14:55pick up the story learning more
- 14:58about surgical pathology right
- 14:59after we take a short break.
- 15:01For a medical minute,
- 15:02please stay tuned to learn more
- 15:04with my guest Doctor Marie Robert.
- 15:06Funding for Yale Cancer answers
- 15:08comes from Smilow Cancer Hospital,
- 15:10where you can view videos from their
- 15:12survivorship team by searching for the
- 15:15smilo survivorship playlist on YouTube.
- 15:19The American Cancer Society
- 15:21estimates that more than 65,000
- 15:23Americans will be diagnosed with
- 15:25head and neck cancer this year,
- 15:27making up about 4% of all cancers
- 15:30diagnosed when detected early.
- 15:32However, head and neck cancers are
- 15:34easily treated and highly curable.
- 15:37Clinical trials are currently
- 15:39underway at federally designated
- 15:41Comprehensive cancer centers such
- 15:42as Yale Cancer Center and Smilow
- 15:45Cancer Hospital to test innovative new
- 15:47treatments for head and neck cancers.
- 15:49Yale Cancer Center was recently awarded
- 15:52grants from the National Institutes
- 15:54of Health to fund the Yale Head and
- 15:57neck Cancer Specialized program of
- 15:59Research Excellence or SPORE to
- 16:02address critical barriers to treatment
- 16:04of head and neck squamous cell
- 16:06carcinoma due to resistance to immune
- 16:08DNA damaging and targeted therapy.
- 16:11More information is available at
- 16:14yalecancercenter.org you're listening
- 16:15to Connecticut Public Radio.
- 16:18Welcome back to Yale Cancer Answers.
- 16:20This is doctor Anees Chagpar and I'm joined
- 16:23tonight by my guest Doctor Marie Robert.
- 16:25We're talking about the important role
- 16:27that pathology plays in cancer and
- 16:29right before the break we were talking
- 16:32about the role that pathology plays
- 16:34in actually making the diagnosis.
- 16:36Like you go for a biopsy and is
- 16:39this cancer or is this not cancer?
- 16:41That distinction is actually made by
- 16:44a pathologist whom you may never meet,
- 16:48but that your team really relies on.
- 16:50Now Marie, the other thing that
- 16:54pathologists often really provide
- 16:57is some of the genomic information.
- 17:00Whether that comes in the form
- 17:02of special stains like you were
- 17:04telling us about before the break,
- 17:06or whether it comes in.
- 17:08Actually you know doing things like
- 17:11sequencing and telling us about
- 17:13genetic and genomic mutations,
- 17:15can you talk a little bit more
- 17:17about how that's done and and the
- 17:19importance that that plays in various?
- 17:21Answers
- 17:22yes, delighted so I would say so.
- 17:25I've been practicing for,
- 17:27you know about 3 decades now and.
- 17:30Over the course of my career
- 17:33there has been really in the past.
- 17:3510 to 15 and I would say even in the past
- 17:39five an explosion of new technologies
- 17:43and new information that help,
- 17:45especially in cancer, help,
- 17:47oncologists and surgeons fine tune
- 17:50and find a very specific therapies
- 17:54for a specific patients tumor.
- 17:57How is this done?
- 17:59And it comes under the general
- 18:01heading of molecular pathology and.
- 18:06This means that so we talked
- 18:07about looking at the microscope,
- 18:09the light microscope and we
- 18:10can determine a lot from there.
- 18:12Now we're getting inside the cell
- 18:15and specifically the cell nucleus.
- 18:18For the most part.
- 18:19And so every cell I should say has
- 18:23a central brain called a nucleus,
- 18:25and then something called the cytoplasm,
- 18:27which is where all the working
- 18:29parts of the cell that do what
- 18:31they're supposed to do reside.
- 18:33But the nucleus is where the chromosomes are.
- 18:36The genetic material that are the,
- 18:40you know,
- 18:40the blueprint for what that cell
- 18:43should do all over the body.
- 18:45Tumors tend to occur when those
- 18:47genes or chromas or the chroma,
- 18:50the genes on the chromosomes.
- 18:53The chromosome is divided up
- 18:55into a gazillion genes,
- 18:56each one doing something and tumors
- 19:00happen when what we call mutations occur.
- 19:04Or deletions or other types
- 19:07of fusions and other damage.
- 19:10Overall damage to the genes and the
- 19:14genetic structure on the chromosomes.
- 19:17When this happens,
- 19:18when there's an alteration for the bad.
- 19:22Several things can happen.
- 19:23One is that a cell just recognizes that.
- 19:26Oh,
- 19:26you are no longer functioning normally
- 19:28and the body's going to sort of
- 19:30take you right out of Commission
- 19:31and you're you're off the assembly
- 19:33line and actually kills the cell.
- 19:35That's a good thing.
- 19:37Unfortunately, other times the cell,
- 19:40the mutations or genetic
- 19:42alterations give the cell power.
- 19:45To divide,
- 19:46make more cells with those same problems
- 19:50and that is the beginning of a tumor.
- 19:53We can now detect very smart
- 19:56scientists have created technologies
- 19:58that allow us to look even from
- 20:01the biopsy that you gave us the
- 20:03same piece of tissue that we made.
- 20:05The diagnosis of a tumor on.
- 20:08We can take the rest of that sample
- 20:11and apply something called next
- 20:13generation sequencing and other.
- 20:15Techniques. Why is this important?
- 20:18This is important because these days
- 20:21there are more and more specific therapies.
- 20:25How do you know when you say this doesn't
- 20:27apply to every patient and to every tumor?
- 20:29How do you know whether your tumor should
- 20:32have all of those fancy shmancy tests done,
- 20:36or whether simply looking at
- 20:39that pink and purple dyes under
- 20:42the microscope is sufficient?
- 20:44So maybe you had your biopsy done.
- 20:47At a given institution and you were told
- 20:50that this was a particular kind of cancer.
- 20:53Should patients know which particular types
- 20:58of cancer should get advanced kind of
- 21:02diagnostics done that might help their care.
- 21:06How do people figure that out?
- 21:08How do you know which cancers and
- 21:11which patients need to have more
- 21:13studies done and which ones don't?
- 21:15So that is a terrific question.
- 21:18I think that every patient and I hope every
- 21:21patient listening who has a some sort of.
- 21:24Tumor or cancer diagnosis and is
- 21:27beginning down that path of getting
- 21:30treated should ask the question.
- 21:33Does my sample? Will my sample?
- 21:36Will this tumor benefit from genetic testing,
- 21:39molecular testing or whatever
- 21:41phrase you want to use?
- 21:43And it is the oncologist who knows best,
- 21:46so if you're not talking to an oncologist,
- 21:48talk to an oncologist.
- 21:50The oncologist will know best that,
- 21:53Oh yes, this tumor,
- 21:55if it has this mutation,
- 21:57we have these three drugs that
- 21:58we might want to try, and this is
- 22:01certainly true in many tumors of the.
- 22:03Of the gastrointestinal tract,
- 22:05liver and pancreas.
- 22:06And the oncologist will also know well today.
- 22:10As things stand,
- 22:11we don't have anything that we're
- 22:13giving based on genetic analysis,
- 22:16and so they may say at this
- 22:18moment in time we know what to do.
- 22:20This is.
- 22:21This is exactly what we should do,
- 22:22and we don't need further information.
- 22:25I will also share that at many
- 22:28academic centers there is a philosophy
- 22:30that really we want to sequence.
- 22:33Every tumor and we want to start
- 22:35moving towards a world where every
- 22:38diagnosis of malignancy, cancer,
- 22:40type of tumor will automatically
- 22:43have a gene you know.
- 22:46Sequencing of the genetics of that tumor,
- 22:50and this is for two reasons.
- 22:51One is that.
- 22:53We want to continue learning about
- 22:55tumors because we we we are continuing
- 22:58to develop medicines based on the
- 23:01information we're finding and the second
- 23:03reason is that sometimes a tumor of 1 type.
- 23:07May have a mutation that we
- 23:09weren't expecting and hey,
- 23:10you know there's a drug out here.
- 23:12We usually use this drug to
- 23:14treat to treat another tumor.
- 23:16Usually not this tumor,
- 23:17but now that you tell us this tumor
- 23:20surprisingly has this mutation.
- 23:21Well,
- 23:22you know,
- 23:22now we've got another thing to
- 23:23put in the toolkit.
- 23:26And so one of the questions
- 23:28that people may be asking as
- 23:30they're thinking about this is,
- 23:32you know. Oftentimes,
- 23:33when patients think about genetics,
- 23:36they think about their family history
- 23:38and whether they need to have a
- 23:41blood test or a saliva test to
- 23:43look for genetic mutations that may
- 23:45predispose them to certain cancers.
- 23:47So, for example, you know the one
- 23:49that is most often talked about,
- 23:51at least in my sphere is BRC A1 and two,
- 23:55which will increase your risk
- 23:57of breast and ovarian cancer.
- 23:59How is that different from the
- 24:02work that you're talking about?
- 24:05Where you're looking at the
- 24:07genetics of the cancer itself?
- 24:10Yeah, that is super and these things
- 24:14go actually hand in hand so the
- 24:17the the thing we just discussed
- 24:20was any particular tumor that one
- 24:23might have and that is something
- 24:26that an oncologist and discussion
- 24:28with their patient may may initiate.
- 24:32But in addition, the patient their
- 24:34physician oncologist and sometimes
- 24:36the pathologist will discover that
- 24:38there's something about the patient
- 24:41as they walk in the door with
- 24:43their first diagnosis of cancer.
- 24:44That, or even they don't have it yet.
- 24:47But there's a family history should be
- 24:50at something in them should be analyzed
- 24:54for a specific genetic disorder.
- 24:57Like bracca as you discuss or like in
- 24:59the GI tract, familial polyposis syndrome,
- 25:02or something called Lynch syndrome,
- 25:05which are colon cancer syndromes and
- 25:08endometrial and other cancer syndromes.
- 25:11So in these scenarios,
- 25:13there may or may not be a cancer
- 25:16diagnosis yet in the patient,
- 25:19but they may on their annual visit
- 25:21to their you know physician,
- 25:22discover that, Oh yeah, well,
- 25:24you know my mom,
- 25:25dad and three uncles had colon cancer.
- 25:28Before the age of 50,
- 25:29that person that will be a series
- 25:31of things set in motion like early
- 25:34screening in the 1st place with
- 25:36a colonoscopy and possibly some
- 25:38blood tests in it with a genetic
- 25:40counselor that might go on where
- 25:42a pathologist might be.
- 25:43The first one to initiate something
- 25:45is that when we get a sample.
- 25:48From someone of of the right age group,
- 25:50or maybe a young person,
- 25:51or that they have for example on colonoscopy,
- 25:55have you know 10 or more types of
- 25:58polyps that are all precancerous polyps?
- 26:01We will raise our hands and say,
- 26:03hey, here's your diagnosis,
- 26:04and oh, by the way,
- 26:06please sign this patient up for
- 26:08some for genetic screening,
- 26:09because they they have too many
- 26:11polyps at age 50 that you know
- 26:13that's the we want to make sure
- 26:15it doesn't mean something more.
- 26:18Right and but, but there's a clear
- 26:20difference in terms of, you know,
- 26:23in the one instance when we're
- 26:25talking about molecular diagnostics,
- 26:27we're really talking about
- 26:28doing these tests to look for
- 26:31mutations in the cancer itself,
- 26:33whereas when we're looking at
- 26:36predispositions and genetic screening,
- 26:39for example, we're really talking about
- 26:42cells that are baseline that are in
- 26:45your blood or in your saliva that.
- 26:48All of your cells carry versus in.
- 26:50The tumor itself.
- 26:51Is that right?
- 26:52That's absolutely right,
- 26:53and it's such a good, nuanced point.
- 26:56And and so this again,
- 26:59it's all good tools that physicians at
- 27:04all levels of interacting with folks.
- 27:06So in the in the you know, annual physical
- 27:10exam at that level by family history,
- 27:14personal and family history, the physician.
- 27:18Can can begin the process and say, yeah,
- 27:20we probably want to check into this.
- 27:23And at the same time finding finding
- 27:25early lesions that the pathology level,
- 27:28in addition to finding a truly already
- 27:31invasive cancer as they walk in the door.
- 27:34Someone walks in the door at
- 27:36age 45 with colon cancer.
- 27:38They already have it.
- 27:39We're going to work on that.
- 27:40They're going to get testing of the
- 27:42tumor itself to see what might work,
- 27:44but because they're young,
- 27:45this will, with all the clinicians,
- 27:47will say, Oh yes.
- 27:48And by the way, we want to screen
- 27:50your family members now too.
- 27:52We want to just make sure this is.
- 27:54Not just an isolated thing.
- 27:56Right,
- 27:57so Marie, in our last kind of 30
- 28:00seconds here, where do you think
- 28:02the field of pathology is going?
- 28:04Should we be expecting more of these
- 28:06kinds of genetic and genomic tests?
- 28:09Yes, I think it's going to go further
- 28:13and further and deeper in this
- 28:15direction with hopefully much more
- 28:17useful information down the line.
- 28:19I believe we are also poised to enter
- 28:22the digital era and with artificial
- 28:24intelligence to apply to samples.
- 28:27To improve even further,
- 28:29our ability to glean treatable information.
- 28:34Doctor Marie Robert is a professor
- 28:36of pathology and of medicine
- 28:37at the Yale School of Medicine.
- 28:39If you have questions,
- 28:41the address is canceranswers@yale.edu
- 28:43and past editions of the program
- 28:46are available in audio and written
- 28:48form at yalecancercenter.org.
- 28:49We hope you'll join us next week to
- 28:52learn more about the fight against
- 28:54cancer here on Connecticut Public
- 28:55radio. Funding for Yale Cancer Answers
- 28:57is provided by Smilow Cancer Hospital.