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Diagnosing Cancer’s Chaos
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By Rob Mitchum When a pathologist peers into a microscope searching for telltale signs of a dangerous cancer in a tissue sample, the first clue is often an aesthetic one. “In the normal tissue, there is a beautiful order,” said Thomas Krausz, MD, FRCPath, director of anatomic and surgical pathology at the University of Chicago Medical Center. “In cancer, depending on how aggressive it is, there is chaos.” A cell can become a tumor through many routes, growing uncontrollably and invading surrounding areas with, as Krausz puts it, “no respect for its neighborhood.” And as the electron micrograph images on these pages show, cells that have become cancerous can take on shapes that are both fascinating and horrific: sprouting tendrils and vesicles that disrupt normal symmetry and reflect inner turmoil. For surgical pathologists charged with determining the diagnosis from a biopsy, the story is rarely so simple as the isolated, cultured cells pictured here. In some cases when a piece of potentially cancerous tissue is taken intraoperatively from a patient, pathologists have a mere 20 minutes to prepare the sample with freezing and stains, examine it with the naked eye and microscopes, and answer several critical questions: Is the tumor benign or malignant? How far has it spread? Has it invaded surrounding blood vessels? Those answers are crucial to a patient’s care, determining the course of treatment both immediately through the size of the area removed in surgery and long-term through the use of radiation or chemotherapeutic drugs.
Top right: A colored scanning electron micrograph of a breast cancer cell.
“At the end of the day, cancer is diagnosed by pathologists,” Krausz said. “Without a pathology diagnosis, there is no appropriate cancer treatment.” Newer techniques, like immunohistochemistry and molecular pathology that help categorize tumors by identifying aberrant genes and proteins, have changed pathology and have proven essential in the developing era of personalized medicine. But most decisions are still made with the microscope, a centuries-old technology that — combined with the experience of a pathologist who has viewed hundreds of thousands of slides — remains the most powerful tool in classifying cancer. For the trickiest cases, where a firm conclusion eludes the initial pathologist, the department’s extensive knowledge across different organ types and diseases is pooled. Daily meetings, in a room equipped with a special microscope through which 16 pathologists can simultaneously view a sample, help pathologists to collaborate, resolve these difficult cases and reach the proper diagnoses. “There’s no room for error; we have to be 100 percent accurate,” said Husain Sattar, MD, assistant professor of pathology. “We think multiple times before we sign and release our final diagnosis.” “There is only one diagnosis,” Krausz added. “The correct diagnosis.”
Special Cancer Issue: Attacking Cancer from Every Angle by Rob Mitchum Mapping the Genes that Help Cancer Drugs by Rob Mitchum and Susan Chandler Finding Answers through Clinical Trials by Rob Mitchum Advanced Approaches to Treating Breast Cancer by Cheryl L. Reed Getting a Clearer Picture of Breast Cancer by Cheryl L. Reed Life After Cancer is a New Focus for Research by Greg Borzo Saving a Cancer Patient’s Baby by Emily Stone
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Special Urban Health Initiative Pull-Out Section: Transforming Health on the South Side by Stephen Phillips On the Trail Less Traveled by Cheryl L. Reed
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Finding a Compatible Match for a Gift of Life Before an organ transplant is performed, both donor and recipient undergo months of meticulous tests to determine any incompatibilities. by Rob Mitchum
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A New Pediatric Comfort Team Makes Life Better for Kids Comer Children’s Hospital at the University of Chicago has formed a medical team that alleviates pain for kids. by Emily Stone
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The Man of Many Coats: Daniel Sulmasy, MD, PhD As a doctor, ethicist and Franciscan friar, he brings fresh perspectives to the Medical Center. by Susan Chandler
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International Adoption Clinic Assists in Promoting Health of Children Medical Center team works with prospective parents, particularly those who are adopting from other countries. by Katie Scarlett Brandt
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Nitric Oxide Therapy Proving Beneficial to Preemies’ Development For more than 10 years, Comer Children’s Hospital physicians have been studying the effects of a new therapy for treating premature babies. They have hundreds of living testaments to its success. by Kevin Davis
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Medical School Rocks This Future Doc John Paro thought he’d given up music when he entered the Pritzker School of Medicine, but medical school inspired a new album. by Cheryl L. Reed
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departments
Middle right: Close-up view of lung cancer. Bottom: A colored transmission electron micrograph of a carcinoma cell. Far right: A colored scanning electron micrograph of breast cancer cells.
Front cover: Radiation oncologists at the Medical Center use a linear accelerator to precisely target tumors within the body. Because of the precision of the machine, radiation oncologists can increasingly treat multiple metastatic tumors. Photo by Dan Dry
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Medicine off the Midway: Cancer Research Goes to Hollywood Harry Connick Jr., plays him in a Hollywood film, but Dennis Slamon, PhD ’74, MD ’75, doesn’t let his fame distract him. For Slamon, the real stars are the breast cancer patients who participated in clinical trials that led to the FDA approval of his drug Herceptin. by Don Reneau
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Perspectives: Four Medical Opinions on Continuing Health Care Reform Four different physicians associated with the University of Chicago Medical Center weigh in on what they hope and fear about the continuing health care reform.
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