Dr. Priyadarshini Guha
Often, people ask me about my profession, wondering if I’m an oncologist or a pathologist, and whether I see patients directly. Oncopathology, in simple terms, is a specialized branch of medicine focused on diagnosing cancer by analyzing patient samples, including tissue biopsies and body fluids. Before any treatment is administered, it’s crucial to understand every detail of the disease, as this information influences the treatment type, approach, and outcome, ultimately affecting the patient’s quality of life after treatment.
Oncopathologists are physicians who perform this diagnostic work and more. They not only confirm the presence or absence of cancer in a sample but also determine the cancer type, grade, and stage. They run additional tests to analyze the tumor’s chromosomal, genetic, and molecular characteristics, which are vital for predicting the prognosis and deciding on the appropriate therapy. With the rise of precision oncology and personalized medicine, cancer treatment has moved away from the “one size fits all” approach. Oncopathologists now identify tumor mutations that can be targeted with specific drugs, leading to more effective treatments with fewer side effects compared to traditional broad-spectrum chemotherapy. We are also witnessing a surge in immuno-oncology, where immunotherapy delivers remarkable outcomes by enhancing the patient’s immune system to combat certain types of cancer.
Companion diagnostics, a subfield of pathology, evaluates the effectiveness of immunotherapy by using molecule-specific tests. Here too, it is the oncopathologist’s report that determines whether immunotherapy should be prescribed. Today, cancer treatment is carried out through a multidisciplinary tumor board approach, where various specialists, including oncopathologists, radiologists, nuclear medicine experts, and oncologists, collaborate to decide the best management plan. In many cases, these specialists interact directly with patients and their families during such discussions.
The collaboration and communication between an oncopathologist and the treating clinician are crucial, forming the foundation of cancer management. The responsibility is immense because a single report can dictate a treatment course that might cost a patient their life savings, and in many cases, it’s a matter of life and death. While the clinician is at the forefront of patient care, the management hinges on the diagnosis, including the tumor’s molecular profile, provided by the oncopathologist—where even a minor error can have catastrophic consequences. The stakes are high, which is why they often say, “An oncologist is only as good as their pathologist.”
We also encounter situations where patients seek second opinions, leading to more direct interactions between oncopathologists and patients compared to the past. Multiple diagnoses from different institutions can complicate matters for the treating clinician, who must decide which report to trust. This highlights the importance of thorough, meticulous work by the pathologist, which fosters the clinician’s trust and increases referrals over time.
To succeed, oncopathologists must always be open to communication and feedback. If a clinician raises concerns about a diagnosis, it’s essential to re-evaluate the case with proper clinical and radiological context to ensure the correct diagnosis and treatment.
Diagnosing one of the most elusive and deadly diseases known to humanity is far from easy. Often, in a global reference lab like ours, samples have already gone through multiple diagnoses, and the responsibility to provide the final, definitive answer falls on us. These situations can be highly challenging, but with the right approach, skill, and determination, we usually find the correct path. In many ways, we are the Sherlock Holmes of the oncology world, donning lab coats and using our microscopes to uncover the critical details that help our clinician colleagues diffuse the threat early on.
In conclusion, oncopathology today is an exciting and rapidly evolving field, drawing more interest from graduates and leading to significant research and innovation in medicine. It also comes with a profound responsibility—to care for patients battling one of the most terrifying diseases known to mankind. Despite the challenges, I love my job. It’s rewarding, impactful, and humbling to have the opportunity to make such a significant difference in people’s lives.
Dr. Priyadarshini Guha, Oncopathologist and Director, APEX PATHLABS – Lucknow
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