- Joined
- Aug 15, 2003
- Messages
- 28,059
- Reaction score
- 438
Well, maybe that's taking it a bit far. I like this quote: "You have to just be born with it. . . . You can tell the best pathologists, even among students, right away. They detect things that other people don't see. It's a little bit of an art. It's difficult to explain."
From the Boston Globe 5/4/04
http://www.boston.com/news/globe/he...thology_playing_god_in_the_laboratory?pg=full
Pathology: playing God in the laboratory
By Raja Mishra, Globe Staff | May 4, 2004
Dr. Massimo Loda bore down on what resembled a technicolor map of Cape Cod, its signature upturned arm marbled with purple swirls and swishes, pink voids and hundreds of dark spots. But this was no casual exercise in map reading. He peered through his microscope, jotting down notes. There was a lot riding on his analysis.
Loda was examining a sliver of a local 54-year-old man's prostate gland. The Dana-Farber Cancer Institute pathologist was on the prowl for errant cells, a telltale sign -- to the properly trained eye -- of cancer. He could spot them a figurative mile away: Dark spots that seemed scattered, disorganized, as if in rebellion against the body.
Loda spoke with the accent of his native Italy, his salt-and-pepper hair closely cropped, his voice soft. "These have no organization," he said, directing a visitor's attention to a chaotic spattering of dark purple dots. "This makes no architectural sense. This is cancer. Definitely cancer."
No one has cancer until a pathologist says so.
Yet definitively diagnosing the disease is hardly a matter of a simple yes-no test or quick checkup. Cancers often hide deep within the body, growing in fits and starts. And beyond detecting cancer, pathologists must also determine how aggressive a particular cancer is -- whether simple surgery will help or if a patient has just months to live. They work with the detachment of medieval scholars but their decisions have life-or-death impact.
"If you're reasonably well-trained, 80 percent of the cases are simple. But then you get some difficult cases," said Loda, who often shows these hard cases around to colleagues hoping their eyes will discern something his eyes missed.
"Fortunately we don't get it wrong very often. But there are occasions where you make mistakes. You have to be humble in this job. You can't assume you know everything and you're not going to make mistakes."
A working pathologist can examine 200 to 300 tissue slides a day. Many simply look at computer screens filled with colorful blown-up images instead of microscopes. The tissue samples -- portions of some suspect gland or sections of a tumor -- resemble fantastical abstract paintings by an artist with a limited palette. All the swirls and striations and dots are in subtle gradations of pink and purple from the staining techniques. The stains are meant to highlight details, though even with this, pathologists need a sharp eye to differentiate between the subtle shades.
"The eye is extremely important," Loda said. "You can tell when a pathologist has a good eye. You need to have a visual type of memory."
"You have to just be born with it. . . . You can tell the best pathologists, even among students, right away. They detect things that other people don't see. It's a little bit of an art. It's difficult to explain."
Loda remembered, as a student, asking a prominent pathologist why he thought a particular tissue sample had cancer. "Because it looks like it," came the answer, Loda said with a laugh.
There is a certain "playing God" aspect to the pathologist's life: Their work can determine the course of a patient's treatment, or reveal how much time they likely have left. But Loda has never met any of the patients whose tissue he analyzed, saying, "It would be totally inappropriate." The patients, to an extent, become lost in the blur of slides and forms. In pathologists' jargon, examining a case is "signing out," referring to the paperwork that dominates their work.
About 12,000 board-certified pathologists practice in the United States, seeking direct physiological evidence of illness. Doctors typically diagnose patients based on symptoms. But disease resides within tissue, and patholgists find it and characterize it. They are better known for autopsies, which they often perform. Confirming diagnoses is much more central to their job.
Pathologists work to diagnose virtually every major form of disease. But their role in cancer medicine is particularly critical: Cancer is an ever-progressing affliction, requiring a deft diagnosis that will calibrate the best possible treatment.
Loda, working with a Globe reporter at his side late last month, moved on to another case, an 82-year-old man already diagnosed with cancer of the prostate and bladder. The referring oncologist wanted to know: Is the cancer spreading? Loda had tissue samples from the man's lymph nodes as well as fatty regions surrounding the already-diseased organs. If the cancer has spread, these would be the areas where it would likely show up first.
Loda specializes in genito-urinary cancers like this, running a lab at Dana-Farber that studies how these cancers behave. These days, he only "signs out," that is, looks at patient cases, 13 weeks a year. But he has been through the daily grind of the typical pathologist for decades. Loda received his medical degree in 1980 from the University of Milan, followed by pathology training at New England Deaconess Hospital, and six years as staff pathologist at Beth Israel Deaconess Medical Center, before arriving at Dana-Farber in 1998.
The small glass slides before Loda are crisscrossed with thin pink lines, the end stage of a long process. Days earlier, the lab got the tissue samples from the patient's hospital in a Boston suburb. Dana-Farber doctors provide second opinions on cases from all over the state. The tissue was sliced into micro-thin slivers, then dehydrated, embedded with hot wax and stained before being placed on slides.
The slides are also treated with special antibodies that cling to healthy tissue, further helping to distinguish good from bad cells.
Loda examined the 82-year-old man's slides. The fatty tissue was an expanse of white and pink, with tiny squiggling riverlike structures snaking every which way. Quite clearly, there were massive ovals of dead tissue, the decrepit inner-core of tumors.
"This is a very advanced cancer," he said.
There was evidence of cancer in both the fatty tissue and the lymph nodes. Loda made back-of-the-envelope estimates of the ratio of healthy to cancerous tissue. Then he consulted a manual that translates his ratios and estimations into diagnoses. "Stage four," Loda said. "This man has stage-four cancer. He's got a pretty bad prognosis." He probably will have only months to live.
"He's 82, so you're not going to try to cure it but give him a decent quality of life," Loda said. "You don't want to poison him with drugs."
Loda filled out the forms indicating his analysis. The man's oncologist soon will have them in hand, break the news, then settle on a treatment option. In this case, Loda said, the man is likely to get medicine to ease his suffering as he moves closer to death.
It was Loda's work of several minutes one recent afternoon that set the course of the rest of the man's life.
"That's what we do."
From the Boston Globe 5/4/04
http://www.boston.com/news/globe/he...thology_playing_god_in_the_laboratory?pg=full
Pathology: playing God in the laboratory
By Raja Mishra, Globe Staff | May 4, 2004
Dr. Massimo Loda bore down on what resembled a technicolor map of Cape Cod, its signature upturned arm marbled with purple swirls and swishes, pink voids and hundreds of dark spots. But this was no casual exercise in map reading. He peered through his microscope, jotting down notes. There was a lot riding on his analysis.
Loda was examining a sliver of a local 54-year-old man's prostate gland. The Dana-Farber Cancer Institute pathologist was on the prowl for errant cells, a telltale sign -- to the properly trained eye -- of cancer. He could spot them a figurative mile away: Dark spots that seemed scattered, disorganized, as if in rebellion against the body.
Loda spoke with the accent of his native Italy, his salt-and-pepper hair closely cropped, his voice soft. "These have no organization," he said, directing a visitor's attention to a chaotic spattering of dark purple dots. "This makes no architectural sense. This is cancer. Definitely cancer."
No one has cancer until a pathologist says so.
Yet definitively diagnosing the disease is hardly a matter of a simple yes-no test or quick checkup. Cancers often hide deep within the body, growing in fits and starts. And beyond detecting cancer, pathologists must also determine how aggressive a particular cancer is -- whether simple surgery will help or if a patient has just months to live. They work with the detachment of medieval scholars but their decisions have life-or-death impact.
"If you're reasonably well-trained, 80 percent of the cases are simple. But then you get some difficult cases," said Loda, who often shows these hard cases around to colleagues hoping their eyes will discern something his eyes missed.
"Fortunately we don't get it wrong very often. But there are occasions where you make mistakes. You have to be humble in this job. You can't assume you know everything and you're not going to make mistakes."
A working pathologist can examine 200 to 300 tissue slides a day. Many simply look at computer screens filled with colorful blown-up images instead of microscopes. The tissue samples -- portions of some suspect gland or sections of a tumor -- resemble fantastical abstract paintings by an artist with a limited palette. All the swirls and striations and dots are in subtle gradations of pink and purple from the staining techniques. The stains are meant to highlight details, though even with this, pathologists need a sharp eye to differentiate between the subtle shades.
"The eye is extremely important," Loda said. "You can tell when a pathologist has a good eye. You need to have a visual type of memory."
"You have to just be born with it. . . . You can tell the best pathologists, even among students, right away. They detect things that other people don't see. It's a little bit of an art. It's difficult to explain."
Loda remembered, as a student, asking a prominent pathologist why he thought a particular tissue sample had cancer. "Because it looks like it," came the answer, Loda said with a laugh.
There is a certain "playing God" aspect to the pathologist's life: Their work can determine the course of a patient's treatment, or reveal how much time they likely have left. But Loda has never met any of the patients whose tissue he analyzed, saying, "It would be totally inappropriate." The patients, to an extent, become lost in the blur of slides and forms. In pathologists' jargon, examining a case is "signing out," referring to the paperwork that dominates their work.
About 12,000 board-certified pathologists practice in the United States, seeking direct physiological evidence of illness. Doctors typically diagnose patients based on symptoms. But disease resides within tissue, and patholgists find it and characterize it. They are better known for autopsies, which they often perform. Confirming diagnoses is much more central to their job.
Pathologists work to diagnose virtually every major form of disease. But their role in cancer medicine is particularly critical: Cancer is an ever-progressing affliction, requiring a deft diagnosis that will calibrate the best possible treatment.
Loda, working with a Globe reporter at his side late last month, moved on to another case, an 82-year-old man already diagnosed with cancer of the prostate and bladder. The referring oncologist wanted to know: Is the cancer spreading? Loda had tissue samples from the man's lymph nodes as well as fatty regions surrounding the already-diseased organs. If the cancer has spread, these would be the areas where it would likely show up first.
Loda specializes in genito-urinary cancers like this, running a lab at Dana-Farber that studies how these cancers behave. These days, he only "signs out," that is, looks at patient cases, 13 weeks a year. But he has been through the daily grind of the typical pathologist for decades. Loda received his medical degree in 1980 from the University of Milan, followed by pathology training at New England Deaconess Hospital, and six years as staff pathologist at Beth Israel Deaconess Medical Center, before arriving at Dana-Farber in 1998.
The small glass slides before Loda are crisscrossed with thin pink lines, the end stage of a long process. Days earlier, the lab got the tissue samples from the patient's hospital in a Boston suburb. Dana-Farber doctors provide second opinions on cases from all over the state. The tissue was sliced into micro-thin slivers, then dehydrated, embedded with hot wax and stained before being placed on slides.
The slides are also treated with special antibodies that cling to healthy tissue, further helping to distinguish good from bad cells.
Loda examined the 82-year-old man's slides. The fatty tissue was an expanse of white and pink, with tiny squiggling riverlike structures snaking every which way. Quite clearly, there were massive ovals of dead tissue, the decrepit inner-core of tumors.
"This is a very advanced cancer," he said.
There was evidence of cancer in both the fatty tissue and the lymph nodes. Loda made back-of-the-envelope estimates of the ratio of healthy to cancerous tissue. Then he consulted a manual that translates his ratios and estimations into diagnoses. "Stage four," Loda said. "This man has stage-four cancer. He's got a pretty bad prognosis." He probably will have only months to live.
"He's 82, so you're not going to try to cure it but give him a decent quality of life," Loda said. "You don't want to poison him with drugs."
Loda filled out the forms indicating his analysis. The man's oncologist soon will have them in hand, break the news, then settle on a treatment option. In this case, Loda said, the man is likely to get medicine to ease his suffering as he moves closer to death.
It was Loda's work of several minutes one recent afternoon that set the course of the rest of the man's life.
"That's what we do."
