It is critical that a newly diagnosed cancer patient be evaluated very carefully, pathologically, if the patient is to be served well. At City of Hope, our state-of-the-art pathology laboratories are 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 as Dr. Dennis Weisenburger, City of Hope's chair in the Department of Pathology, comes on City of Hope Radio to explain the role of a pathology in an accurate cancer diagnosis and how patients should seek a second opinion before beginning treatment to ensure the diagnosis is correct and that treatment options are the best available.
Selected Podcast
Pathology: Results Oriented at City of Hope
Featured Speaker:
Dennis Weisenburger, M.D.
An internationally recognized authority on hematologic malignancies, Dennis Weisenburger, M.D., is an outstanding physician-researcher, collaborator, and mentor. He has contributed significantly to the field of pathology and malignant hematology, and holds two patents for his work in lymphoma prognosis. In addition, he helped develop the Nebraska Lymphoma Study Group and served as chief pathologist for the collaborative clinical research network. He’s received international recognition related to his work on classification of Hodgkin and non-Hodgkin lymphoma. Transcription:
Pathology: Results Oriented at City of Hope
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 is Dr. Dennis Weisenberger. He’s an internationally recognized authority on hematologic malignancies and the professor and chair in the Department of Pathology at City of Hope. Welcome to the show, Dr. Weisenberger. So it’s critical that newly diagnosed patients be evaluated carefully pathologically if they’re to be served well. Tell us why this is so important.
Dr. Dennis Weisenberger (Guest): Well, it’s often pathologists who actually make the diagnosis and tell the surgeon or the oncologist whether it’s cancer or not, and specifically what kind of cancer it is. Of course, the type of treatment that the patient will receive often depends critically on these specific diagnoses. That’s why it’s so important to have an adequate biopsy, and to have a second opinion in cases particularly where there are some questions about the diagnosis.
At City of Hope, we routinely review the pathology on all patients who come here for treatment. We also see a lot of consultations from pathologists and other practitioners who send us cases for our opinion. We do also see cases at patient’s request that we review their slides for a second opinion. This is pretty common practice. It is actually part of our strategy for excellence at City of Hope that there is a second opinion on every patient who comes here. It actually does make a difference in how patients are treated at City of Hope.
Melanie: Dr. Weisenberger, tell us about second opinions, because people come to City of Hope for their second opinions and sometimes they learn good, sometimes they don’t. But what about second opinions, are doctors offended when a patient wants one? How do you go about seeking one?
Dr. Weisenberger: I think most doctors are not offended when the patient asks for a second opinion because it’s common practice, particularly in the field of oncology. I think patients should feel comfortable about asking their physicians to request the second opinion. Often the physician will know an expert to send the patient to, or to have the slides sent to an expert pathologist if it’s the pathology diagnosis that they want a second opinion on. So I think patients should feel comfortable requesting that from their clinician. Good clinicians respect the right of the patients to have a second opinion.
Melanie: What happens sometimes when a second opinion is sought at City of Hope? Is there a reversal of diagnosis? Can somebody find out something different than they originally found out?
Dr. Weisenberger: Yes. For routine pathology diagnoses, cancer diagnoses, probably we change the diagnosis in five to ten percent of the cases. In many of those cases, the change in diagnosis will result in a change of treatment. A more specific or a more effective treatment will be given. For my field, hematopathology, that is, diagnosis of lymphoma, leukemia, and blood disorders, it’s even higher. We change the diagnosis in probably up to fifteen percent of cases. In a recent study, we found that in thirteen percent, almost all of those cases, thirteen percent, it was a major change in diagnosis that resulted in a different therapy.
That’s why it’s policy at City of Hope to have these second reviews because we know that mistakes are often made in community, so when patients come here we want to make sure we treat them with the best treatment we have for their specific disease. It’s common practice here. It’s a mandated practice actually to have a second review of pathology slides.
Melanie: And even in some of the more common cancers that we hear so much about—skin cancer, prostrate, breast—sometimes the diagnosis error rate can vary up to forty percent. So tell us about City of Hope, when someone is coming to you for skin, breast, or prostate cancer for a second opinion, what are you seeing there?
Dr. Weisenberger: Well, sometimes the outside diagnosis is right, but maybe the estimation of how aggressive the malignancy will be. So, in prostate cancer, for example, we do something called grading, where we say it is “high-grade,” meaning it’s going to be very aggressive clinically, or “low grade,” meaning it’s not going to be very aggressive clinically. So pathologists look at the slides and they grade the tumor, and sometimes there’s a lot of variation in how pathologists do that. Even with a common cancer, like prostate cancer, often the grade that we will give the cancer is different and that will result in different therapy. The same thing is true of breast cancer. For breast cancer, we do a lot of specialized testing for estrogen receptors and other kinds of receptors.
What we have found is that often our testing differs from the testing at the outside hospital, and so we routinely will repeat some of the tests to be sure that the outside findings are correct, and sometimes they aren’t. Again, that will really dramatically affect how the patient is treated here. So we’re very careful to evaluate the diagnosis, the grading, repeat some of the tests in order to make sure we have the best information for our doctors to treat the patient.
Melanie: Now if a cancer is really hard to diagnose, a rare type, or if the patient wishes to be considered for a clinical trial, is there any difference in the way that you go about pathological reports?
Dr. Weisenberger: No. We pretty much treat all the patients the same. For clinical trials, sometimes we do additional tests which are part of our research program, but we pretty much treat all of the patients the same, whether they’re part of a trial or not. Also, I should probably add that usually most insurance companies and HMOs will cover a second opinion because they do realize the value of the second opinion. Nowadays, some of the treatments are so expensive it could cost up to $80,000 or $100,000 a year for certain kinds of new treatments. So it’s important to make sure you have the right diagnosis because some of the therapies are so expensive and sometimes you can avoid giving the expensive therapy depending on the diagnosis.
The other thing we do sometimes is that sometimes the patient comes with a diagnosis of cancer and when we look at the slides we realize they don’t have cancer. Of course that’s very important for the patient. Those kinds of things happen. That’s another reason to get a second opinion.
Melanie: So in just the last couple of minutes, Dr. Weisenberger, tell people why they should come to City of Hope for their pathology consultation services or their second opinions.
Dr. Weisenberger: Well, in our department, we have expertise in all the various fields of pathology. We have a lot of special expertise in hematopathology. We have the latest equipment, diagnostic testing, molecular testing, to both diagnose and confirm diagnosis and also for prognosis. We’ve got tests that sometimes will speak to the prognosis of the patient. Then we’ve got excellent clinicians in medical oncology, in hematology, in leukemia, lymphoma, in myeloma, breast cancer, prostate cancer. We’ve got excellent clinicians who have a wealth of experience in taking care of patients. We have teams.
The nice thing about City of Hope is it’s a hospital dedicated to cancer, so we are really focused, not just on treating patients but also in doing basic research and clinical research to try to find new treatments. We have new clinical trials. We have new drugs. We have therapies that are not available at other hospitals in the region, and so there are a lot of good reasons to pick the City of Hope for a second opinion.
Melanie: Thank you so much for such great information. Dr. Dennis Weisenberger. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Pathology: Results Oriented at City of Hope
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 is Dr. Dennis Weisenberger. He’s an internationally recognized authority on hematologic malignancies and the professor and chair in the Department of Pathology at City of Hope. Welcome to the show, Dr. Weisenberger. So it’s critical that newly diagnosed patients be evaluated carefully pathologically if they’re to be served well. Tell us why this is so important.
Dr. Dennis Weisenberger (Guest): Well, it’s often pathologists who actually make the diagnosis and tell the surgeon or the oncologist whether it’s cancer or not, and specifically what kind of cancer it is. Of course, the type of treatment that the patient will receive often depends critically on these specific diagnoses. That’s why it’s so important to have an adequate biopsy, and to have a second opinion in cases particularly where there are some questions about the diagnosis.
At City of Hope, we routinely review the pathology on all patients who come here for treatment. We also see a lot of consultations from pathologists and other practitioners who send us cases for our opinion. We do also see cases at patient’s request that we review their slides for a second opinion. This is pretty common practice. It is actually part of our strategy for excellence at City of Hope that there is a second opinion on every patient who comes here. It actually does make a difference in how patients are treated at City of Hope.
Melanie: Dr. Weisenberger, tell us about second opinions, because people come to City of Hope for their second opinions and sometimes they learn good, sometimes they don’t. But what about second opinions, are doctors offended when a patient wants one? How do you go about seeking one?
Dr. Weisenberger: I think most doctors are not offended when the patient asks for a second opinion because it’s common practice, particularly in the field of oncology. I think patients should feel comfortable about asking their physicians to request the second opinion. Often the physician will know an expert to send the patient to, or to have the slides sent to an expert pathologist if it’s the pathology diagnosis that they want a second opinion on. So I think patients should feel comfortable requesting that from their clinician. Good clinicians respect the right of the patients to have a second opinion.
Melanie: What happens sometimes when a second opinion is sought at City of Hope? Is there a reversal of diagnosis? Can somebody find out something different than they originally found out?
Dr. Weisenberger: Yes. For routine pathology diagnoses, cancer diagnoses, probably we change the diagnosis in five to ten percent of the cases. In many of those cases, the change in diagnosis will result in a change of treatment. A more specific or a more effective treatment will be given. For my field, hematopathology, that is, diagnosis of lymphoma, leukemia, and blood disorders, it’s even higher. We change the diagnosis in probably up to fifteen percent of cases. In a recent study, we found that in thirteen percent, almost all of those cases, thirteen percent, it was a major change in diagnosis that resulted in a different therapy.
That’s why it’s policy at City of Hope to have these second reviews because we know that mistakes are often made in community, so when patients come here we want to make sure we treat them with the best treatment we have for their specific disease. It’s common practice here. It’s a mandated practice actually to have a second review of pathology slides.
Melanie: And even in some of the more common cancers that we hear so much about—skin cancer, prostrate, breast—sometimes the diagnosis error rate can vary up to forty percent. So tell us about City of Hope, when someone is coming to you for skin, breast, or prostate cancer for a second opinion, what are you seeing there?
Dr. Weisenberger: Well, sometimes the outside diagnosis is right, but maybe the estimation of how aggressive the malignancy will be. So, in prostate cancer, for example, we do something called grading, where we say it is “high-grade,” meaning it’s going to be very aggressive clinically, or “low grade,” meaning it’s not going to be very aggressive clinically. So pathologists look at the slides and they grade the tumor, and sometimes there’s a lot of variation in how pathologists do that. Even with a common cancer, like prostate cancer, often the grade that we will give the cancer is different and that will result in different therapy. The same thing is true of breast cancer. For breast cancer, we do a lot of specialized testing for estrogen receptors and other kinds of receptors.
What we have found is that often our testing differs from the testing at the outside hospital, and so we routinely will repeat some of the tests to be sure that the outside findings are correct, and sometimes they aren’t. Again, that will really dramatically affect how the patient is treated here. So we’re very careful to evaluate the diagnosis, the grading, repeat some of the tests in order to make sure we have the best information for our doctors to treat the patient.
Melanie: Now if a cancer is really hard to diagnose, a rare type, or if the patient wishes to be considered for a clinical trial, is there any difference in the way that you go about pathological reports?
Dr. Weisenberger: No. We pretty much treat all the patients the same. For clinical trials, sometimes we do additional tests which are part of our research program, but we pretty much treat all of the patients the same, whether they’re part of a trial or not. Also, I should probably add that usually most insurance companies and HMOs will cover a second opinion because they do realize the value of the second opinion. Nowadays, some of the treatments are so expensive it could cost up to $80,000 or $100,000 a year for certain kinds of new treatments. So it’s important to make sure you have the right diagnosis because some of the therapies are so expensive and sometimes you can avoid giving the expensive therapy depending on the diagnosis.
The other thing we do sometimes is that sometimes the patient comes with a diagnosis of cancer and when we look at the slides we realize they don’t have cancer. Of course that’s very important for the patient. Those kinds of things happen. That’s another reason to get a second opinion.
Melanie: So in just the last couple of minutes, Dr. Weisenberger, tell people why they should come to City of Hope for their pathology consultation services or their second opinions.
Dr. Weisenberger: Well, in our department, we have expertise in all the various fields of pathology. We have a lot of special expertise in hematopathology. We have the latest equipment, diagnostic testing, molecular testing, to both diagnose and confirm diagnosis and also for prognosis. We’ve got tests that sometimes will speak to the prognosis of the patient. Then we’ve got excellent clinicians in medical oncology, in hematology, in leukemia, lymphoma, in myeloma, breast cancer, prostate cancer. We’ve got excellent clinicians who have a wealth of experience in taking care of patients. We have teams.
The nice thing about City of Hope is it’s a hospital dedicated to cancer, so we are really focused, not just on treating patients but also in doing basic research and clinical research to try to find new treatments. We have new clinical trials. We have new drugs. We have therapies that are not available at other hospitals in the region, and so there are a lot of good reasons to pick the City of Hope for a second opinion.
Melanie: Thank you so much for such great information. Dr. Dennis Weisenberger. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.