• Blood banking and transfusions
• Chemical pathology
• Clinical informatics
• Cytopathology
• Dermatopathology
• Forensic pathology
• Haematology
• Molecular genetic pathology
• Neuropathology
• Paediatric pathology

Pathologists can be found in many health settings, including public and private hospitals and clinics, independent laboratories, and other medical and research facilities. The significant role that pathologists play in our healthcare system means that their work helps us every day – when you’re getting a skin biopsy checked, having a throat swab when you’re sick, or taking part in a national screening program for disease such as for cervical cancer or bowel cancer.

How pathology saves lives

Pathology plays a critical role in informing medical decisions and treatment plans every day. Timely results can save countless lives through the early detection of diseases and medical conditions, especially cancer. Cancer diagnoses are confirmed through pathology investigations, meaning that pathology is a vital tool for healthcare practitioners to provide appropriate care to their patients. In disease progression, pathology is also used to help monitor disease states and determine how to best manage various health conditions for a better quality of life.

Pathology’s contribution to the fight against cancer

All cases of cancer are diagnosed via pathology testing, including the diagnosis of cervical cancer, blood cancer and bowel cancer.

Australia has one of the best cervical cancer screening programs in the world, and consequently the lowest rate of cervical cancer globally. Cervical cancer symptoms often appear at the later stages of disease progression, which is why screening is so important. Estimates suggest that pathology screening methods for cervical cancer (combined with the HPV vaccination program) could reduce cervical cancer rates in Australia by as much as 20%.

Prostate cancer is also one of the most diagnosed cancers in Australian men, with pathology testing playing a vital role in the early detection of this disease via (prostate specific antigen) PSA testing.

Similarly, the National Bowel Cancer Screening program is essential in the early diagnosis of bowel cancer. The program uses a self-collected faecal sample that is sent to a laboratory to detect blood in faeces, which can be an early sign of bowel cancer, or another bowel issue. Anyone testing positive will be referred for further investigations. To diagnose bowel cancer a biopsy can be removed during an exploratory colonoscopy and be examined by a pathologist under a microscope, who determines whether cancerous cells are present in the patient’s sample.

Recognition of pathology

Pathology is also directly linked to chronic disease management, with the results of pathology tests used to diagnose and treat conditions such as diabetes, heart disease, heart attacks and cirrhosis of the liver. For example, in Australia, 30% of adults have non-alcoholic fatty liver disease and it is set to become one of our most prevalent chronic diseases in the near future. One aspect of pathology here is that a new blood test may provide a safer, relatively pain-free alternative to liver biopsy for some people living with chronic liver disease.

The post How Does a Pathologist Help Us? first appeared on Know Pathology Know Healthcare.

We asked Dr Mikkaela McCormack, an Anatomical Pathologist in one of Victoria’s busiest labs, what led her into Anatomical Pathology and why she loves her job.

What made you decide to become an Anatomical Pathologist?

I first developed an interest in forensic pathology in high school, fuelled by my need to know the ‘whys’ of everything, combined with a strong scientific curiosity, a compulsion to problem solve, and a desire to help people.

I studied medicine and law at university, and after completing my final year elective at the Victorian Institute of Forensic Medicine I set my sights on specialising in forensic pathology.

I’d heard the best grounding for becoming a great forensic pathologist was being a good anatomical pathologist, so I made this my goal.  As I trained in both however, I realised that what had really enamoured me with pathology was the opportunity to give answers to questions in an engaging and intellectually interesting way.  Anatomical pathology allowed me to do this in a more wide-ranging fashion and working with living patients meant I could potentially have a positive impact on their lives.

What does a typical day look like for you?

On any given day I will ‘see’ 30 to 80 patients – well, I will see their tissue specimens under my microscope! I analyse their slides and provide their referring doctors with written reports outlining my diagnosis.

Most can be given answers based on simple histology sections, but many will require additional testing of antibodies, special staining techniques or increasingly, genetic testing that I will also need to interpret.

This is interspersed with various other responsibilities including guiding trainees on dissecting and sampling specimens, discussing difficult cases with colleagues (good pathologists are collaborative pathologists), attending multidisciplinary cancer meetings on complex patients, speaking with general practitioners, medical specialists and occasionally patients regarding their results, and working with clinical and academic colleagues on research projects.

I am also involved in business strategy, innovation and marketing for our organisation, which further fuels my enthusiasm for the profession.

What makes your job satisfying?

My work provides me with an endless and wide-ranging supply of questions to answer and problems to solve, to help patients from all walks of life.

I often think of myself as a medical detective; I find and decipher the clues within patients’ specimens and I use my knowledge and experience to solve the mystery of what pathological process was occurring in that tissue.

My answers need to be of the highest standard and dependability as they will direct other medical specialists in how to manage and treat those patients; they can be the difference between life and death.  This motivates my practice as a pathologist, and the knowledge that what I do positively affects people’s lives in a meaningful way is what makes my work satisfying – even if most of them aren’t aware of my existence!

Our specialty is in a constant state of fast-paced change, as we learn more about diseases thanks to scientific and technological advances. This requires constant learning and improving across multiple medical specialist areas. I also get to work collaboratively with other specialties, research institutions and industries to drive research, innovation, scientific discovery and the delivery of up to date and accessible medicine.

This is all incredibly exciting and makes it very easy to remain engaged in my career!

What are the most common conditions and samples that you deal with?

The nature of anatomical pathology means I work across multiple body systems, so on any given day I may diagnose a range of benign and neoplastic diseases within almost any organ, including breast, skin, lung, liver, bone, lymph node, gastrointestinal system or gynaecological system.

It is also important however, to foster a greater level of expertise within a smaller number of sub-speciality areas.  I am our laboratory’s main breast pathologist; I am involved in the daily diagnosis and management of benign and malignant breast disease and I also participate in multi-institutional breast cancer research.  My other areas of interest are in skin (neoplastic, inflammatory skin conditions and alopecia), urology (most commonly prostate specimens), and gastrointestinal and thyroid pathology.

What is the most unusual diagnosis you have made since working in pathology?

As a trainee, I examined a set of lungs from a young transplant patient suffering from a rare condition called lymphangioleiomyomatosis (LAM lung disease), which causes muscle cells in the lungs to multiply abnormally. This results in the formation of many large cysts, which can rupture and cause serious complications. The lungs also contained several small nodules, and when I examined them they showed features of a second disease, angiomyolipoma (AML).

These two diseases are classically found in patients with a genetic condition called tuberous sclerosis, but AML almost always occurs in the kidney. At that time the phenomenon of these small tumours also occurring in the lungs had not even been described in the literature.

What is your most memorable moment working in pathology?

Undertaking my first autopsy would have to be the moment in my career that holds the most meaning for me.  It is in some ways the most intimate and intrusive procedure we perform in medicine, and I felt the gravity and respect that comes with that. Whilst I don’t perform autopsies these days, I think that was the moment I first understood what it truly meant to be a pathologist.

What advice would you give to students or young people considering pathology careers?

Pathology is a slightly mysterious area of medicine, including for medical students and other doctors. The only way to know if you’d be interested in a career in pathology is to spend time within real pathology laboratories – meet the pathologists, scientists and support staff, ask them for honest answers to hundreds of questions about working in the laboratory. Observe, experience and get involved in the tasks that are part of the job. Then ask yourself if you could do those things for at least the next 5-10 years!

The post “I often think of myself as a medical detective” – Dr Mikkaela McCormack on her role as an Anatomical Pathologist first appeared on Know Pathology Know Healthcare.

All of the coloured tubes you see in a collection centre have different chemical additives which affect the blood in many ways. Collectors need to know which tubes to collect for all tests, as well as any special conditions. These can include keeping the sample at body temperature after collection, freezing it or even whether the patient needs to have fasted prior to the blood draw.

Double checking patient details is vital to ensure samples aren’t mixed up and to avoid recollections, hence you’ll often be asked to check or verbally repeat your personal details.

Speed is also essential given how many people can attend a collection centre at any one time. Collectors outside of hospitals often work to courier schedules, so processing the samples to get them to the lab quickly is vital.

And on top of all of this, first aid may need to be given when people are afraid of needles or are very unwell.

Beyond collectors is a vast network of other staff, without whom laboratories could not function. From couriers delivering samples to laboratories through to reception staff phoning critical results to doctors, the delivery of fast and accurate results relies on an army of skilled and dedicated professionals.

The post Collectors first appeared on Know Pathology Know Healthcare.

Many of the practical skills and scientific knowledge used by Medical Scientists is the same as research scientists searching for cures to conditions. The difference is that Medical Scientists apply that know-how to providing results that can help someone here and now.

In large pathology laboratories, Medical Scientists may specialise in certain areas such just as specialist doctors do. In small or rural labs, they may become multi-skilled and perform a wide range of tests.

Some tests are done on sophisticated machinery and the scientists must know not only the theory behind how the machines work, but how to maintain and fix them and how to assess results to ensure that the machine is functioning as expected. Other tests are performed manually and may involve scientists mixing chemicals in tubes or peering down microscopes at cells.

Because their work is needed to provide urgent results, Medical Scientists will often work in shifts around the clock or participate in ‘on-call’ rosters which can see them rushing into work at all hours of the night or holidays to complete life-saving work.

The post Medical Scientists first appeared on Know Pathology Know Healthcare.

Specialities cover conditions such as infections, allergies & immunity, cancers or chronic diseases. They often advise referring doctors, explaining complex or inconclusive test results and recommend further tests where needed.

Pathologists often work in laboratories but sometimes see patients directly as part of their work. Many also contribute to medical research – some great examples of this include research into immunisation, organ transplant, genetics and blood transfusion.

A Pathologist will be involved in every single diagnosis of cancer that is made. Their report provides details needed to understand the type of cancer and how best to treat it.

The post Pathologists first appeared on Know Pathology Know Healthcare.