Cancer: A pathologist's journey from morphology to molecular

Abstract

The journey of cancer has taken significant positive steps towards better diagnosis and management. Pathologists have taken a leading role in this journey. Started with morphology which itself went through substantial developments in knowing the aetiology, pathogenesis, classification based upon the pattern, cellular details of the cancer. However, the histomorphologists met some road blocks in the form of ambiguities and some limitations that led to the expansion of pathologist's field to various other ancillary tests to enhance its values form diagnosis to therapeutics. This new journey facilitated the confidence of pathologist in the diagnosis, expanded their role in the clinical management through targeted therapy, monitoring of drugs, suggestions of prognosis. Various molecular diagnostic tests have been developed for the identification of tumor molecular profile for exploration of targeted therapy. The major problems in the management of cancer were resistance to chemotherapy, relapses and wide-spread side effects of chemotherapy. All these major problems to some extents are getting resolved with time as the molecular profiling is opening the gates. Many questions are being answered with the evolution in pathology. With the revolution of targeted therapy many difficult cancers are being treated with fewer side effects. In this review we will go through the journey from histomorphology, its advancement, digital pathology to the molecular pathology. These advancements interestingly haven't replaced the other, rather have enhanced others for the better management of cancer.

Keywords: Histomorphology; Immunohistochemistry; Molecular pathology; Next generation sequencing; Targeted therapy.