Led by pathologists renowned for diagnostic excellence, the Department of Pathology at City of Hope combines state-of-the-art laboratories equipped with the latest diagnostic techniques and advanced instrumentation with superior investigative skills to accurately and rapidly identify even the rarest and most complex diseases.
Listen in as Sue Chang, M.D explains how City of Hope experts provide comprehensive services, from initial diagnosis to monitoring of prognostic indicators throughout the treatment process.
Selected Podcast
What is a Pathologist?
Featured Speaker:
Board-certified in anatomic pathology and clinical pathology, Dr. Chang is the recipient of many honors and awards including the selection to the Harvard College Dean’s list during four years of undergraduate work, research awards from UCLA, and the Association for Pathology Informatics Travel Award. She has published several articles in the peer-reviewed literature, and has been invited to present her work nationally. Dr. Chang’s professional interests include surgical pathology and cytology, as well as pathology informatics. In her free time, she enjoys collecting rare and vintage medical textbooks, reading biographies and historical fiction, traveling abroad, karaoke, personal finance/investment, and fantasy football.
Sue Chang, MD
Dr. Chang graduated cum laude from Harvard University in Cambridge, MA, then went on to receive her medical doctorate from New York Medical College in Valhalla, NY. Later, she completed an anatomical/clinical pathology residency at UCLA Health where she was honored as chief resident, and a resident informaticist. She furthered her training with a cytopathology fellowship at UCLA Health and a surgical pathology fellowship at Brigham and Women's Hospital in Boston, MA. During her academic and professional training, Dr. Chang exhibited leadership qualities as resident champion of UCLA’s CareConnect Initiative, resident delegate of the UCLA Graduate Medical Education Committee, steering committee member for the UCLA Institute for Molecular Medicine (IMED) Seminar Series and board member of the Medical Student Research Forum at New York Medical College.Board-certified in anatomic pathology and clinical pathology, Dr. Chang is the recipient of many honors and awards including the selection to the Harvard College Dean’s list during four years of undergraduate work, research awards from UCLA, and the Association for Pathology Informatics Travel Award. She has published several articles in the peer-reviewed literature, and has been invited to present her work nationally. Dr. Chang’s professional interests include surgical pathology and cytology, as well as pathology informatics. In her free time, she enjoys collecting rare and vintage medical textbooks, reading biographies and historical fiction, traveling abroad, karaoke, personal finance/investment, and fantasy football.
Transcription:
What is a Pathologist?
Melanie Cole (Host): Led by pathologists renowned for diagnostic excellence, the Department of Pathology at City of Hope combines state-of-the-art laboratories equipped with the latest diagnostic techniques and advanced instrumentation with superior investigative skills to accurately and rapidly identify even the rarest and most complex diseases. My guest today is Dr. Sue Chang. She's Assistant and the Clinical Professor in the Department of Pathology at City of Hope. Welcome to the show, Dr. Chang. People don't always know what a pathologist is. Tell us what you do.
Dr. Sue Chang (Guest): So, I think what we mostly think about is what we see on television, which is a forensic pathologist who performs autopsies, but, in reality, there's a lot more to that. There are two sides of pathology: there's the anatomic pathology and the clinical pathology side. The anatomic pathology side involves examining tissues under a microscope, usually for disease or infection causes and giving an answer as to what is happening within a patient's body. And, the clinical pathology side relates more with the laboratory testing and so has a lot to do with blood work, with microscopic, excuse me, microbiology cultures, and a lot of testing that gets done sort of in the background.
Melanie: So, do you work with doctors, or do you work with patients, or both?
Dr. Chang: Most of the time, we work with doctors. The cool girl phrase is that we're the “doctor's doctor”, so there's a lot of nuance and a lot of complexity to a lot of the medicine that we're practicing these days and most of the time, we consult with what we call “clinical physicians”, so your internal medicine doctors, your pediatricians, your oncologists, and we help guide them with decisions and what's really going on. Occasionally, pathologists will interface with patients, sometimes if we're taking biopsies, or we're checking to see if a specimen being obtained is adequate for diagnosis.
Melanie: And, then, how do you relay that information to the doctors? Is it via a report and then, does the patient see that or does the doctor work it up, re-work it up, and then give it to the patient so they can understand it?
Dr. Chang: Right. So, the report that we generate is given to the treating physician and then the treating physician passes it on to the patient, and that's probably the most common way that you see a pathologist's name, which is on paper. But, really, behind the scenes, there's a lot of phone calls, there's tumor board, there' face-to-face interaction with the treating physicians to make sure that what we're writing down on paper is clear and that the nuance of every case is described adequately.
Melanie: So, tell us a little bit about pathology at City of Hope. What are you doing that's really exciting there?
Dr. Chang: Our department is expanding and it's very dynamic. What we are doing currently are three different really aspects of it, which, the first is that we review a lot of the cases that come from the outside. A lot of our patients have seen many other doctors and they come here for either definitive care or for a second opinion and, at the same time that they're seeing a new oncologist, or a new surgeon, we're also reviewing their pathology slides from outside hospitals. Another thing that we do is that when the patients come here for surgery, we're examining the actual tissue that gets resected from them during the time of surgery and this is also extremely important, especially since so many patients receive neoadjuvant therapy, or treatment before they even go to surgery. So, it's a way for us to examine whether or not that treatment is working; whether or not we should stay the course; or we should shift to something else, what its effect is on the tumor. And then, the third thing is that it's very exciting here that we're leading the charge with molecular testing. So, a lot of our knowledge from the past has been what it looks like, but now we're able to see what kind of mutations are within the tumor and what the tumor is capable of doing or about to do.
Melanie: Do you sometimes, if someone is coming in for a second opinion, and as you stated, you get the information from another hospital, then do you sometimes want to take your own tests as opposed to just checking those? How does a second opinion even work?
Dr. Chang: So, the second opinion can come in two different ways. Either a treating physician at City of Hope would like to double-check or a different pathologist is asking for help on their own cases and the patient may or may not even come to City of Hope. And, that's more of a pathologist consultation. Sometimes we do undertake more testing, especially if the diagnosis is in question. I would say the majority of the time, though, the pathologists that I've worked with from other hospitals have been extremely diligent and very smart, and for the most part, we agree on our diagnoses unless there's that 10% of cases, maybe 5-10% of cases, where the diagnosis is very difficult and it requires a lot of study, even consultations on our own, showing our case to lots of other pathologists to make sure that we have all considered all of the possibilities out there.
Melanie: People hate waiting for test results. It's one of the worst things about being a patient. What do you tell them when they ask you why do some tests take longer than others?
Dr. Chang: Yes. I definitely understand that, especially if you're waiting to hear if a biopsy is benign or malignant, the level of anxiety in that every minute can feel like a lifetime. Part of it is that we have to take this fresh tissue, what we call fresh tissue, which has just been taken out of the patient and we have to preserve it so that we can run tests on it and preserve it for future testing. There's a number of different ways that we can convert this tissue into what we call “permanent” or “fixed tissue” and those processes take some time and if we rush it, it actually ends up hurting our testing in the future. So, a lot of times, the waiting is the hardest part. For us as well.
Melanie: It certainly is. And, where do you see the field of pathology going in the future? What's on the horizon?
Dr. Chang: My hope is that in the future, we'll have targeted therapy and that the type of tumor that a patient has isn't just based on what we can see and what we think it looks like, but rather a molecular signature or a DNA change and that there's a drug that can treat that specific, targeted change and so things like chemotherapy can become less toxic to other parts of the body that are sort of in the way, or are collateral damage to the therapy we do that's really intended for the tumor.
Melanie: So, in just the last few minutes, Dr. Chang, just wrap it up for us about the pathology department at City of Hope and why you really want listeners to come there for their first or second opinion.
Dr. Chang: I think that you have here a collection of physicians who are up-to-date with the current practices of pathology, who are extremely dedicated to the clinical care of our patients, and though you don't really see us in the background, we're trying very hard to make sure that everything that comes through the door is looked at with a critical eye. Especially because the field is changing so fast, it's really important for all of us to be on the same page with regards to what we can do, what we can do in the future, and possible avenues that perhaps have not been pursued yet.
Melanie: Thank you so much for being with us today. You've really cleared up a lot of good information. You're listening to City of Hope Radio, and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole, thanks so much for listening.
What is a Pathologist?
Melanie Cole (Host): Led by pathologists renowned for diagnostic excellence, the Department of Pathology at City of Hope combines state-of-the-art laboratories equipped with the latest diagnostic techniques and advanced instrumentation with superior investigative skills to accurately and rapidly identify even the rarest and most complex diseases. My guest today is Dr. Sue Chang. She's Assistant and the Clinical Professor in the Department of Pathology at City of Hope. Welcome to the show, Dr. Chang. People don't always know what a pathologist is. Tell us what you do.
Dr. Sue Chang (Guest): So, I think what we mostly think about is what we see on television, which is a forensic pathologist who performs autopsies, but, in reality, there's a lot more to that. There are two sides of pathology: there's the anatomic pathology and the clinical pathology side. The anatomic pathology side involves examining tissues under a microscope, usually for disease or infection causes and giving an answer as to what is happening within a patient's body. And, the clinical pathology side relates more with the laboratory testing and so has a lot to do with blood work, with microscopic, excuse me, microbiology cultures, and a lot of testing that gets done sort of in the background.
Melanie: So, do you work with doctors, or do you work with patients, or both?
Dr. Chang: Most of the time, we work with doctors. The cool girl phrase is that we're the “doctor's doctor”, so there's a lot of nuance and a lot of complexity to a lot of the medicine that we're practicing these days and most of the time, we consult with what we call “clinical physicians”, so your internal medicine doctors, your pediatricians, your oncologists, and we help guide them with decisions and what's really going on. Occasionally, pathologists will interface with patients, sometimes if we're taking biopsies, or we're checking to see if a specimen being obtained is adequate for diagnosis.
Melanie: And, then, how do you relay that information to the doctors? Is it via a report and then, does the patient see that or does the doctor work it up, re-work it up, and then give it to the patient so they can understand it?
Dr. Chang: Right. So, the report that we generate is given to the treating physician and then the treating physician passes it on to the patient, and that's probably the most common way that you see a pathologist's name, which is on paper. But, really, behind the scenes, there's a lot of phone calls, there's tumor board, there' face-to-face interaction with the treating physicians to make sure that what we're writing down on paper is clear and that the nuance of every case is described adequately.
Melanie: So, tell us a little bit about pathology at City of Hope. What are you doing that's really exciting there?
Dr. Chang: Our department is expanding and it's very dynamic. What we are doing currently are three different really aspects of it, which, the first is that we review a lot of the cases that come from the outside. A lot of our patients have seen many other doctors and they come here for either definitive care or for a second opinion and, at the same time that they're seeing a new oncologist, or a new surgeon, we're also reviewing their pathology slides from outside hospitals. Another thing that we do is that when the patients come here for surgery, we're examining the actual tissue that gets resected from them during the time of surgery and this is also extremely important, especially since so many patients receive neoadjuvant therapy, or treatment before they even go to surgery. So, it's a way for us to examine whether or not that treatment is working; whether or not we should stay the course; or we should shift to something else, what its effect is on the tumor. And then, the third thing is that it's very exciting here that we're leading the charge with molecular testing. So, a lot of our knowledge from the past has been what it looks like, but now we're able to see what kind of mutations are within the tumor and what the tumor is capable of doing or about to do.
Melanie: Do you sometimes, if someone is coming in for a second opinion, and as you stated, you get the information from another hospital, then do you sometimes want to take your own tests as opposed to just checking those? How does a second opinion even work?
Dr. Chang: So, the second opinion can come in two different ways. Either a treating physician at City of Hope would like to double-check or a different pathologist is asking for help on their own cases and the patient may or may not even come to City of Hope. And, that's more of a pathologist consultation. Sometimes we do undertake more testing, especially if the diagnosis is in question. I would say the majority of the time, though, the pathologists that I've worked with from other hospitals have been extremely diligent and very smart, and for the most part, we agree on our diagnoses unless there's that 10% of cases, maybe 5-10% of cases, where the diagnosis is very difficult and it requires a lot of study, even consultations on our own, showing our case to lots of other pathologists to make sure that we have all considered all of the possibilities out there.
Melanie: People hate waiting for test results. It's one of the worst things about being a patient. What do you tell them when they ask you why do some tests take longer than others?
Dr. Chang: Yes. I definitely understand that, especially if you're waiting to hear if a biopsy is benign or malignant, the level of anxiety in that every minute can feel like a lifetime. Part of it is that we have to take this fresh tissue, what we call fresh tissue, which has just been taken out of the patient and we have to preserve it so that we can run tests on it and preserve it for future testing. There's a number of different ways that we can convert this tissue into what we call “permanent” or “fixed tissue” and those processes take some time and if we rush it, it actually ends up hurting our testing in the future. So, a lot of times, the waiting is the hardest part. For us as well.
Melanie: It certainly is. And, where do you see the field of pathology going in the future? What's on the horizon?
Dr. Chang: My hope is that in the future, we'll have targeted therapy and that the type of tumor that a patient has isn't just based on what we can see and what we think it looks like, but rather a molecular signature or a DNA change and that there's a drug that can treat that specific, targeted change and so things like chemotherapy can become less toxic to other parts of the body that are sort of in the way, or are collateral damage to the therapy we do that's really intended for the tumor.
Melanie: So, in just the last few minutes, Dr. Chang, just wrap it up for us about the pathology department at City of Hope and why you really want listeners to come there for their first or second opinion.
Dr. Chang: I think that you have here a collection of physicians who are up-to-date with the current practices of pathology, who are extremely dedicated to the clinical care of our patients, and though you don't really see us in the background, we're trying very hard to make sure that everything that comes through the door is looked at with a critical eye. Especially because the field is changing so fast, it's really important for all of us to be on the same page with regards to what we can do, what we can do in the future, and possible avenues that perhaps have not been pursued yet.
Melanie: Thank you so much for being with us today. You've really cleared up a lot of good information. You're listening to City of Hope Radio, and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole, thanks so much for listening.