Pathological examination is very important in personalized cancer treatments!

Stating that pathological examination has a very important role in personalized cancer treatments, Ankara University Department of Medical Pathology Faculty Member Prof. Dr. Serpil Dizbay Sak stated that both the medical world and the public do not have enough information about pathology and that this specialty branch is sometimes neglected. Medical Academy Ankara Representative Hatice PALA KAYASpeaking to Prof. Dr. Sak noted that one of the most important elements in the treatment of cancer is pathology, and that pathological examination plays a critical role in personalized treatments and innovative treatments that are increasingly popular.

Stating that it was discussed at the 28th National Pathology Congress, which was held in cooperation with the Federation of Pathology Societies and the Ankara Pathology Association, the lack of adequate recognition of the pathology discipline by the society was discussed. Dr. Serpil Dizbay Sak said, “We even encounter questions such as whether pathologists are doctors or not. This is actually a problem not only for pathology, but also for all physicians who do not have direct contact with the patient and work in laboratories.

Pathology has begun to generate much more detailed information than previously thought.

Saying “There have been extraordinary detailed developments even in my professional life”, Former President of the Federation of Pathology Societies Prof. Dr. Serpil Dizbay Sak emphasized that when it comes to cancer, pathologists not only diagnose whether it is cancer, but also the type of cancer, its genetic structure, and even what defense mechanisms the cancerous cell has, and gave the following information:

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“This information is decisive in the decision of which treatment to apply. Much more complex analyzes are performed than determining whether the tumor is benign or malignant. The tumor is classified as benign or malignant. Because there are almost thousands of types of benign and malignant tumors, and there are many pathologies other than tumors.

For example; If you give us a cancerous lung, we can do a lot more about that lung cancer than just tell you it’s cancer. We can say the type of lung cancer, its prevalence in the organ, whether it will benefit from some treatments or not. Same for breast cancer and stomach cancer etc. is also in question. I wish pathology was something that simple. When we look, there is a tumor; If we could say a-benign tumor, b-malignant tumor and separate it and leave it. Then there would be no need for so many equipment and books.”

Critical role for targeted, personalized treatments in pathology

Stating that the developments in pathology play the main role in personalized treatments, which have increased in weight recently, Prof. Dr. Serpil Dizbay Sak emphasized that these developments, which are one of the most promising processes in cancer treatment, are directly related to the developments in pathology. prof. Dr. Sak noted: “We detect genetic changes in tumors. Why do we detect these genetic changes? Basically, there are some treatments for genetic changes. These are called targeted therapies, they are called personalized treatments, they are called smart drugs.

All of these actually mean the same thing. For example; I’m a lung pathologist, I’m typing a lung cancer first, what type of cancer. If it is a type of cancer we call lung adenocarcinoma, a significant portion of these cancers now have targeted therapies other than standard chemotherapy. These targeted therapies are not just one type. It is necessary to determine what is the characteristic of cancer, in which genes mutations and changes can make this cancer continue to be cancer. In other words, each of the cancers has some weapons that make it cancer and make it more active.

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We determine what these weapons are, in our investigations, we say that; for example, this cancer is an EGFR mutant cancer. What does this mean? It means you can give the patient with the EGFR mutant some treatments that target the EGFR mutation. When this happens, you are doing the job of determining which drug to treat a disease with. When you detect the mutation there, you also determine which drug you can give and which drug the patient can benefit from.”

Pathologists can contribute to early diagnosis

Stating that various analyzes can be made to determine the cancer tendency in someone who does not have cancer yet, Prof. Dr. Serpil Dizbay Sak pointed out that some cancers can develop on precursor lesions and said, “There are some pathologies that we call dysplasia. These are the pathologies we call dysplasia, pathologies that do not threaten the patient’s life at that time, but can develop cancer if left in place.

We report these when we detect them, and those patients can enter the control process at more frequent intervals. If the area where the dysplasia is located is an area suitable for removal, removal of this area can ensure that the patient does not develop a cancer from this area from now on. Since we can recognize such early lesions, we can also provide information about them.”

Noting that when people think of pathology, cancer immediately comes to mind, Prof. Dr. Sak noted that although most of their work is related to cancer, they make detailed diagnoses of many diseases by looking at the incoming biopsies.

Pathology uses technology intensively, smart diagnostic software is developing

Stating that technological developments affect pathology very closely, Prof. Dr. Serpil Dizbay Sak emphasized that the examinations, which were done by looking at microscopes in the past, could be done on a computer screen or even on tablets, by transferring the image to the computer, after the development of imaging technologies. Stating that this provides the opportunity to examine high-resolution photographs in a much more detailed way, it also provides the opportunity to compare other archived images by constantly examining them, Prof. Dr. Sak reported that this way, the diagnoses reached much better points.

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Stating that software called artificial intelligence or smart software has started to come into play, Prof. Dr. Sak said, “When I can teach a program the difference of these tumors from normal breast tissue by uploading a thousand, two thousand, five thousand breast cancer images to a computer program, the computer program becomes able to distinguish between cancerous and non-cancer images after a while. There are studies on this. In other words, there are systems that the computer can learn to distinguish between cancer and non-cancer, but none of these systems have yet reached the level of the human brain,” he said.


Lung cancer was a men’s disease, but it’s also on the rise in women due to smoking

Stating that he has been working intensively on breast and lung cancer, Prof. Dr. Serpil Dizbay Sak said that although lung cancer is known as a male disease, its incidence is increasing in women due to smoking. Stating that there is a very close relationship between the formation of lung cancer and smoking, Prof. Dr. Sak continued his words as follows:

“When you separate this relationship from sex, that is, when smoking reaches the same amount in the female population as in men, the rate of lung cancer in women will also increase. Therefore, it is actually true that women smoke more after entering social life, and as a result, their cancer rate is higher. There is also the issue of the exposure of spouses and fathers of women who have never smoked to cigarettes used by their fathers. Because, unfortunately, women are more sensitive to carcinogens in cigarettes, and therefore the harm they will suffer from smoking is more than men.

The number of pathologists is sufficient, but there is a lack of equipped laboratories.

Stating that there are more than 1500 specialist pathologists and around 200 pathology assistants in Turkey, and with the newly trained pathologists, this number seems sufficient for now. Dr. Sak said that there is a lack of equipment and technology in the organization and some laboratories across the country.

Pathologists must have devices, systems, etc. Reminding that he has to work with high-tech tools, Prof. Dr. Sak said, “There is no shortage of pathologists, but there are well-equipped laboratories where pathologists can work comfortably. When we look at 90 percent of tumors, you can divide them into benign and malignant, but there is a gray category of 10 percent in between. Some of those grays are light gray, some are dark gray but gray.

When making a diagnosis, not everything is so clear. We pathologists, for example, are perhaps the people who refer to each other’s knowledge the most among all our colleagues. It is a very difficult thing to decide, especially in those gray categories. That’s why when you drop a pathologist with a microscope anywhere in the country, it may be a part of the case that it functions on its own, but in some cases it is a very difficult thing. In other words, he needs to work with a good laboratory from the ground up, a technical and administrative team that can work in the laboratory, and other pathologists that he can consult.

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