Barry M. Shmookler, MD
The first crucial step in cancer management is to assure that the pathology diagnosis (the biopsy) is correct and accurate. What is the basis for this statement?
A pathologist is the only physician who can make the actual diagnosis of cancer. He/she is a medical doctor with a specialty training in the examination and diagnosis of cells and tissues under the microscope that have been removed from the body by various types of biopsy procedures. Based on detailed characteristics of the cells, the tumor is diagnosed as either benign or malignant. Furthermore, the type (classification) and grade (aggressiveness) of the tumor must be accurately evaluated at this time. Based on these findings, the multidisciplinary team will determine the optimal therapy. An excellent article on your site by Dr. Peter Burger and Dr. Kenneth Cohen describes in detail the aspects of tumor examination. It is a common misunderstanding that a cancer diagnosis can be made on the basis of X-rays, blood tests and physical examination. While these studies may cause a great concern to your doctor that a cancerous (malignant) tumor is present, it is only when the pathologist studies a biopsy from this suspicious mass that a definite diagnosis of cancer can be made. This leads to another important guideline for newly diagnosed patients: except in rare emergency conditions, specific treatment should not be started until the diagnosis of cancer is absolutely confirmed by a pathologist.
The reality is that mistakes can be made in the diagnosis of cancer. Accuracy depends on the individual pathologist’s training, experience and judgment. In fact, a number of scientific articles have confirmed that errors occur in cancer diagnosis on an average of 2-4% of cases. Brain and spinal cord tumors are uncommon. Therefore, most pathologists, while maintaining competence in many areas, may be faced with diagnosing a neural tumor perhaps a few times a year. Once recent study revealed major neuropathology disagreements in 8.8% of cases. These errors can lead to incorrect and inappropriate treatments that may cause serious medical complications. If a patient or family member is aware of this possibility, there is an easy solution to catch most of these mistakes. It is important to obtain a second opinion from an expert neuropathologist. These individuals have spent many years developing expertise in this field of cancer diagnosis. Most are based in universities or major cancer centers and are available to do consultations on pathology microscopic slides.
The American Cancer Society and the American Society of Clinical Pathologists recommend a second opinion for cancer diagnosis. The modest effort and expense necessary to obtain a consultation can be rewarded by the comfort of knowing that an original diagnosis was indeed correct. On the other hand, an erroneous diagnosis can be detected so that inappropriate and potentially damaging treatments can be avoided.
Currently (2017), other methods are being employed to study brain tumors, via molecular/genetic approaches.
Barry M. Shmookler, M.D., recently retired
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