Objectives
  • To understand the pathological diagnosis and report, and be able to explain the information and its associated management implications to the patient

  • To be able to discuss the pathology report with the multidisciplinary team in a conference setting/tumour board

  • To be able to incorporate the information contained in the Cancer Checklist (Synoptic Summary) into the pathological stage (eg, Tumour Node Metastasis (TNM), Ann Arbor or other)

  • To be able to use the additional prognostic and predictive information contained in the Cancer Checklist to help formulate the best treatment plan for the patient

Awareness
  • Awareness that there is a difference between cytology specimen preparation and histology specimen preparation

  • Awareness of the different fixatives used in specimen preservation and transport

  • Awareness of histology specimen processing and the requirement for adequate fixation to ensure good-quality sections as well as reliable immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH) testing on the material if necessary

  • Awareness of the different preparations used in a bone marrow biopsy

  • Recognition of the indications for and limitations of frozen section diagnostics

  • Awareness that pathologists use gross and microscopic information to make assessments of certain elements in the report, such as size of the tumour and distance from the margins

  • Awareness of the value and indication of histomorphology, IHC, flow cytometry or FISH to confirm and make specific diagnoses

  • Recognition of limitations in pathological evaluation, including a small tissue sample, crush artefact or tumour of unknown primary

  • Awareness of pertinent history, clinical findings and radiographic findings needed to make adequate pathological diagnoses

  • Awareness that grading is predominantly based on differentiation and, in some tumours, mitotic activity

  • Awareness of the importance of direct communication with a pathologist in patient care

  • Awareness that invasive tumours are often composed of two components: the malignant tumour cells and the surrounding stroma (often desmoplastic)

  • Awareness that many pathology departments have associated biobanks, which enable the collection of surplus diagnostic tissue/fluids from consenting patients

  • Recognition that many patients are willing to provide their consent for biosample usage in ethically approved research studies

Knowledge
  • Knowledge and understanding of the nomenclature of neoplasia (eg, benign vs malignant, borderline, dysplasia, in situ vs invasive disease, carcinoma vs sarcoma etc) and knowledge of the local growth or metastatic potential of these different types of neoplasms

  • Knowledge of grading schemes in different types of tumours

  • Knowledge of the WHO classification of tumours

  • Knowledge of the TNM staging system, and other staging systems used in particular tumours (eg, Ann Arbor for lymphoid malignancies)

  • Knowledge of metastasis and the different mechanisms of spread (eg, haematogenous, lymphatic, perineural, perivascular and peritoneal)

  • Knowledge of the indications for requesting a biopsy of a new lesion, and selection of the best site to perform the biopsy

  • Knowledge of the different procedures and the types of specimens that are obtained

  • Knowledge of the role of genetic and epigenetic alterations in malignant tumour formation and dissemination

  • Knowledge of the role of infectious agents in the development of some cancers

  • Knowledge of predictive and prognostic factors—such as oestrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 (HER-2)—and how to interpret and use the results in forming a treatment plan

  • Knowledge about the use of IHC, and particular markers in establishing diagnoses

  • Knowledge about the applications of IHC on whole sections of tumours, on microdissected areas or on tissue microarrays (TMAs)

  • Knowledge about the limitations of interpretation of IHC

  • Knowledge of ethical, consenting and storage procedures involved in biobanking, and the various techniques offered in association with them

Skills
  • Ability to interpret the pathology report and explain it to the patient

  • Ability to discuss the pathology report with the pathologist and the other members of the multidisciplinary team

  • Ability to recognise a discrepancy or discordance in the pathological diagnosis with the clinical findings and to discuss with the pathologist

  • Ability to use the information in the pathology report to develop the best treatment plan for the patient

  • Ability to use the information within the pathology report to formulate research projects to help answer gaps in our understanding of cancer, and to propose improved therapeutic options