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AUGUST 2018 | Published by RCPA

Issue #083

Pathology and cancer research

Pathology and cancer research

It is a little known fact that pathology affects each and every one of us. Pathology determines the cause, origin and nature of disease and, sometimes unknowingly, touches the lives of many during their lifetime, particularly those that have been affected by cancer.

Pathologists are specialist medical practitioners who study the cause of disease and the ways in which diseases affect our bodies by examining changes in the tissues and in blood and other body fluids. Some of these changes show the potential to develop a disease, while others show its presence, cause or severity or monitor its progress or the effects of treatment.

Pathologists are constantly working ‘behind the scenes’ to diagnose 100 percent of all cancers. They play a pivotal role in the diagnosis, treatment and management of cancer.

This year, Daffodil Day will take place across Australia on Friday, 24 August 2018 and in New Zealand on 31 August 2018, to raise funds for life-saving cancer research.

We spoke to Anatomical Pathologist, Associate Professor Chris Hemmings, Department of Anatomical Pathology, Canterbury Health Laboratories, to discuss the important role that pathologists play in diagnosing and managing all cancers, the importance of awareness days, such as Daffodil Day, and the role of pathology in cancer research.

“Essentially all cancer is diagnosed by a pathologist – be it blood cancers which are normally diagnosed by haematologists, or cancers of solid organs (including those in children) which are normally diagnosed by anatomical pathologists, which is what I am. I diagnose cancer every day in my job, but there’s more to it than that – we also assess cancers that have been removed through surgery to determine not only the particular type of cancer but how bad it is, how far it has spread and other factors that may influence treatment – such as genetic testing to determine susceptibility to particular drugs or other therapy.

“We also contribute to multidisciplinary cancer meetings, which is where all the doctors involved in cancer care (pathologists, radiologists, surgeons, oncologists) and other healthcare workers (cancer nurses, social workers, dietitians, etc.) get together to determine the best treatment for a particular patient. We can also advise on the best type of biopsy to make the diagnosis in the first place.”

Awareness days aim to immerse the public in important health information, promote efforts at prevention, and raise money for the cause. Daffodil Day is one of the best recognised awareness events with so many people knowing the significance of the yellow flower. Each year, supporters and volunteers come together in the community to sell daffodils and merchandise and to collect donations which help to fund vital research.

“Daffodil Day is a fantastic awareness day. What it does very well is raise general awareness of cancer in the community, educate people about both prevention (for example, not smoking, weight control and moderation of alcohol intake) and also the warning signs that should prompt them to see their doctor and of course raise important funds for cancer research too.

“In addition to Daffodil Day, which focuses on cancer broadly, there are also a number of other groups that focus on specific cancer types. These groups help to support patients and their families, and also organise fundraising efforts to support research. Of course, there’s a limited pool of research funding out there, so tailored grants can be a big help in supporting research into these less well known cancers. For example, the Unicorn Foundation is a great support for people with neuroendocrine (“carcinoid”) tumours, and several groups such as Rainbows For Kate do the same for sarcoma cancers. In my particular interest areas of rare cancers, these groups are particularly helpful in providing research funding for areas that are less well known in the public arena and tend not to attract the big dollars,” said A/Prof Hemmings.

“Pathology is fundamental to cancer research – in terms of understanding the biology of cancer, developing and tailoring new treatments, and also in supporting other forms of cancer research such as clinical trials. The first step in researching a cancer is to make sure that the diagnosis is actually correct, and that requires a pathologist. As well as conducting our own research, we often contribute to other research being performed by surgeons, oncologists, drug companies and so on. Pathologists also support the collection of tissues for research – such as The Canterbury Tissue Bank here in Christchurch.”

A/Prof Hemmings is a surgical pathologist with subspecialty interests in gut pathology and in rare cancers including sarcoma, GIST and neuroendocrine tumours. Her current primary research focus is aspects of radiation response in locally advanced rectal cancer.

“There are so many interesting projects going on, it’s hard to pick just a few to mention. My own area of research interest has been in looking at why different rectal cancer patients get a better or worse response to radiation treatment. I have found a particular marker that seems to predict for good or poor response, but now I need to go on and verify that finding in a second study, to prove that it wasn’t just a one-off for some reason.

“Other researchers here in Christchurch have recently identified a particular type of bacteria that, if present in the bowel, seems to predispose to the development of bowel cancer. If that finding holds true, it has huge implications for monitoring people at risk of one of our most common cancers. It’s a hugely exciting and rewarding area but it can also be frustrating because we want to just get on and find the answers, and you have to go down a lot of blind alleys before you get the results,” said A/Prof Hemmings.





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