What is Pathology?
Pathology means, according to its word origin, ?the study of diseases?. Today pathology is one of the big special fields in medicine (e.g. besides surgery or internal medicine). A pathologist is a specialist for pathology and can work as an employed doctor in the department of a hospital or as a resident doctor in his own institute. Pathology should not be confused with the related special field of forensic science (?Quincy?). A forensic scientist helps to solve criminal offences; a pathologist, however, is extensively involved with the diagnostics of illnesses. Whereas in earlier times the pathologist spent a large part of his woking time doing autopsies (internal post mortems) , today he is mostly occupied with microscopic examinations. In contrast to general cliches, a pathologist has a decisive role in the diagnostics of the diseases of living persons.
Tissue and body fluids, which a doctor takes from a person (e.g. gall bladder, moles, tissue samples from the stomach or intestine during endoscopy), are not just discarded, but are sent to an institute of pathology (possible via the normal postage system). The material to be examined is thereby put into a special fixation solution to preserve it permanently and to prepare it optimally for further preparation. Depending on the size of the tissue sample, the pathologist must first make an expert assessment of the external appearance and choose and dissect out representative sections for the actual diagnostics.
In order to examine the tissue microscopically, thin sections have to be prepared and stained. These sections have a maximum thickness of 3/1000 mm! Due to these requirements, the procedures are complicated in the laboratory. Depending on the type of tissue, it takes between 4 and 16 hours until a section is ready for microscopic examination. With large surgical specimens (e.g. colon), multiple sections are prepared for every case and some of these stained with special stains (e.g. sections from the tumor, the excision margins, lymph nodes, etc.). The pathologist then examines the sections microscopically in enlargements between 25x and 100x and writes a report (statement of the type of tumor ( how aggressive, how large, how far it has grown ), about the excision margins (removed in healthy tissue or not), about metastases in the lymph nodes, about vessel infiltration). On the basis of such a report the doctor treating the patient can then assess the illness precisely and possibly conduct a further therapy (chemotherapy?, radiation therapy?, further surgery?, no further treatment?). The same also goes for inflammations (e.g. Which type of gastric mucosal inflammation? Must antibiotics be given? Is it a tumor or an unusual inflammation?)
A specialty is the fast section examination. A surgeon, gynaecologist or urologist takes a tissue sample during an operation. In order to correctly operate further, he sometimes needs a diagnosis at the time of the operation. In such a case the tissue is brought as quickly as possible to an institute of pathology. With the help of special procedures, it is then possible to prepare a stained frozen section and make a diagnosis within 10 minutes.
An important duty of the pathologist is the early diagnosis of cancer. For example, smears from the external cervix are made by the gyneacologist and diagnosed by the pathologist. Thus, cancer of the cervix can be discovered in the early stages, a therapy can be conducted and it can be healed. Pathologists still do autopsies. Knowledge gained by the autopsy is important for quality control and helps treating doctors with the diagnostics and therapy of similar or the same illnesses. A large proportion of the medical standards nowadays are based on the evaluation of autopsies. An autopsy (internal post mortem) does not delay the time of burial. An autopsied body can still be laid out and looked at by the family, because the autopsy is conducted expertly, according to exact rules and with the appropriate piety. The face, hands and feet are not touched. Although there are no laws in most states in Germany which forbid an autopsy, pathologists only do an autopsy if permission was given by the deceased during his lifetime or if the family agree to it.
Summing up:
Pathologists have a decisive role in the diagnostics of illnesses of living persons. A patient and ?his? pathologist do not see each other. A pathologist is a master in all areas of medicine, except medicinal therapy. He is an important contact for treating doctors in almost all special fields. Particularly in the diagnostics and therapy of tumor illnesses, nothing goes without the pathologist. The pathologist can be compared to an air traffic controller, who is also not seen by the passenger, but who does an indispensable job.
