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Know the Enemy: Pathology Leads the Way

Once a lung cancer is detected, it’s imperative to learn as much as possible about the type of cancer.

“In the long run, nothing can be acted on and treated until it’s biopsied and diagnosed by a pathologist. That’s required for treatments to be considered,” said Dr. Brian Ward, a pathologist at Owensboro Health and chair of the Cancer Committee at the Mitchell Memorial Cancer Center.

To gather the cells needed for testing, Dr. Ward and his fellow pathologists rely on the efforts of specialists, such as pulmonologists or surgeons. Harvesting those cells can be done with scopes or a technique called fine-needle aspiration, where a small, thin needle is used to extract samples for testing.

Lab technicians and pathologists have to be cautious with their testing. It’s important to have enough cells to do the lab testing. They also have to reserve enough material for genetic testing, which can provide invaluable information on possible treatments for the cancer in question. A U.S. penny is about 1.5 millimeters thick, and some of the tumors in question are even smaller.

“We may be looking at a millimeter or less of tissue,” Dr. Ward said. “Cancers are being caught earlier and with fine-needle aspiration and bronchoscopy, you’re just not getting a lot of material.”

Once tissue is gathered, then analysis can begin. This includes diagnosing the type of cancer and some of its main characteristics.

“The question becomes, ‘What’s going to be the best treatment option for this particular type of lung cancer?’ Based on what the pathologists say, certain types of genetic testing can be done and may offer specific types of targeted therapy,” Dr. Ward said.

Genetic testing then digs even deeper.

“There’s an explosion of information as far as the genetics of any given cancer. Just 30 or 40 years ago, sequencing DNA was a laborious process. Now we have next-generation sequencing, which allows very rapid analysis. That lets us search for genes that are targetable.”

Targeted therapies exploit the cancer’s weaknesses and Dr. Ward said the emphasis on understanding cancer genetics will continue to increase.

“The number of targetable genetic abnormalities is only going to grow,” Dr. Ward said. “We’re going to see more genetic profiling. That will hopefully give patients a therapy that will bring benefits.”

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