Interview with Dr Priakshi Chowdhury (Pathologist)

Dr Priakshi Baruah Chowdhury (Pathologist) is an experienced General Physician known for offering excellent patient care. She obtained her MBBS degree and MD in Pathology from Assam Medical College, Dibrugarh. And had obtained highest marks in professional exams in the subjects Biochemistry, Microbiology, Preventive Medicine, Forensic Medicine and ENT. She has 16 years of work experience, along with added expertise in Transfusion Medicine. Dr Chowdhury also has a teaching experience of 11 years and is currently a Professor of Department of Pathology. When it comes to awards and recognitions, she has been awarded the MN Bhattacharya Gold Medal Award and is also a Recipient of Pfizer Medical Award.

When it comes to cancer treatment, the importance of early detection cannot be stressed enough. Would you like to share your comments on that and tell us how a complete and accurate pathological report could be crucial in the patient's Cancer Treatment plan?

Early detection of cancer is essential, and that is possible only when people are aware and conscious of cancer symptoms, and regularly go for their check-ups. In a routine body check-up, you get to know so many things that you may have ignored or didn't have a complaint about until then. Routine health check-up is like a stitch in time, which will save nine. Just like we care for our belongings, we should take care of our body as routine check-ups can lead to early diagnosis.

There are tests like the Papanicolaou test (or Pap test), which screens for potential Cervical Cancer. After the age of 30, every lady should go for her pap test; it can save so many lives. Early detection can save you from not only the financial burden of cancer but also from the agony that a patient and his/her family may go through. Sometimes, all that might be visible would be a simple symptom that we will ignore, which may later become complicated. It might be just an irregular bowel habit, an ulcer in your mouth, chronic constipation, irregular bleeding, or chronic vaginal discharge. Self-examination is also very important. Every woman should go for a breast examination regularly. Routine health check-ups can detect all these and can save a person's life.

What are the challenges that you face as a pathologist? Also, could you walk us through the state- of- the- art equipment and safety measures that you take while analyzing thousands of samples?

Our biggest challenge as a pathologist is that we don't get to see the patient most of the time and we have to analyze and diagnose the patient based on the blood or tissue sample that we receive. Therefore, every little thing is necessary. At the end of the day, if the patient does not give the proper history, the facts are hidden from us, and then there will be a difference in reports, which may wrongly affect the Cancer Treatment.

Suppose a patient gives a fasting sample, but he may have just had a cup of tea and would have given the sample to save himself of the agony of coming back another day. He may be thinking what change a cup of tea will bring to the fasting report, but it does bring about a change in the results, and thus the patients must be honest with their samples and history. The treatment of the patient will be based on the results that we give, and therefore maximum cooperation is imperative. Especially in the case of biopsy, the clinical history, mode of presentation, details, pre-operative diagnosis, everything matters, so it's a holistic concept to conclude. One mistake can change the whole scenario and can make life difficult for everyone involved, even for the patient, the doctor, and the diagnostician.

Further on this

So, it's always better for your safety to give the sample with the preparation and cooperate with the laboratory person and give them whatever details they need honestly. I also feel the patients should be familiar with the person signing their report. Personally, I make it a custom to meet all my patients and answer all the queries they have. The patients also should be honest in their answers for the doctors to arrive at the right Cancer Treatment decision. Pathology has undergone a lot of upgradation. We have very high-class instruments these days, that are fully automatic.

So, as a pathologist, I always make it a point to do some quality control tests. We are using not only internal quality control tests but also external tests. This is essential; I take a third-party control from other companies to do it my labs. I also do an external quality assurance program with CMC Vellore. There are so many ways you can judge your work. We do the sample check at every level to ensure that the correct samples are processed, and accurate reports are dispatched.

Is Biopsy the only method to diagnose cancer? How are they divided into benign and malignant, and how does this help the doctor?

No, these days we have more accessible and better modalities like Fine Needle Aspiration Cytology (FNAC), which is a technique that can be done very quickly and in a very effective method. In FNAC, we make a cellular diagnosis of any tumour. Initially, it was done just for palpable tumours, but now we can access even internal organs that are not visible through the naked eye using imaging techniques.

So, with the FNAC, a provisional diagnosis is made, which is very important for the clinicians and the treating surgeons. We can at least give them the information as to whether we are dealing with a benign tumour or a malignant tumour, and accordingly, the Cancer Treatment protocols will follow. So, the entire decision can be taken based on the FNAC report, which is quickly done, and the reports will be ready on the same day itself. The FNAC is usually confirmed by Biopsy. The FNAC immensely helps when the cancer is in resource compromised places like lung, where surgical Biopsy is not practical. This helps to get the diagnosis done quickly.

Further on this

When we do a grossing, which is nothing but a grossed naked eye examination of the tissue that has been sent for the biopsy, we get clues as to whether it is a benign tumour or not. There are parameters like the size of the tumour, the margin, the capsule and these are the things which tell you whether it's cancer or not.

There are procedures like frozen sections wherein, when the patient's operation is in progress, while the patient is under anaesthesia or undoing OT, the surgeon sends a small selection of the tissue to the frozen section in the laboratory. From that very moment, the pathologist can do a frozen section study. And in a brief period, they can inform the surgeon whether they are dealing with a cancerous lesion or not. So accordingly, the Surgery is planned, and the decision is changed on the table according to the result.

Is it wise to go for the routine check-ups if a person's family has a history of cancer?

Yes, because there are so many cancers that run in the families. In fact, we have some genes which can make a person prone to some types of cancer. So, if a person has a family history of cancer, they should definitely go for routine check-ups.

If you had to explain to a layperson what a pathological report would contain, how would you deal with it?

Pathology is a very vast subject with so many aspects. We have to deal with everything starting from the head till toe. A pathologist should know the eyes as well that he/she knows the uterus. A pathologist must master each and every body organ. So that way, a pathological report is a compilation of the whole body.

When the person comes to you for a particular test, you have to get a comprehensive insight into it. A pathological report is not just a Blood Test. Basically, you have to interact and talk to the patient and get as much insight as possible on the patient's health condition. The reports should contain everything. If you are reporting on a Biopsy specimen that has been sent for a tumour, there you have to tell how bad it looks or what prognosis could be for the diagnosis. There is so much information that an excellent pathological report could provide. It can give insight as to whether cancer has spread or not, and thus it is essential that you go to an ideal pathological laboratory.

Many are working genuinely and tirelessly like yourself towards this noble cause. However, we see that people also get misguided from a few others who make money by giving out false reports. What are your thoughts on this? What precautions can they take? Also, how must we make the underprivileged sections of society aware of this?

You will find good and bad people in every field. I will Stress on the fact that a person should go to an authentic place where the pathologist is available for you and have a word about your diagnosis. Mistakes can happen everywhere. It's just human to err. Although in the medical field we try not to make a mistake because we are dealing with human lives, so there is no space for error, but still, no matter how hard you try, mistakes can happen.

Sometimes, simple errors like a name or age going wrong can happen. So, if a person finds any error, he/she should immediately go back to the place and talk to them and let them explain that what has happened. It's a tough situation to judge, but you should always go to an authentic place and avoid middlemen. Try to find out who is doing your test, so that way, there would be less confusion, and you would get genuine reports. Many a time, the underprivileged are cheated by fraudsters taking advantage of their desperate situation. They resort to cheaper tests to save money but end up only wasting them. The only way to bring an end to this is through extensive awareness programs.

According to you, what would be a healthy lifestyle to follow?

A healthy lifestyle includes not only the food that you eat but also include your mind. Your mental health is as much important as your physical health because you cannot have a healthy body without a healthy mind. So, keeping your mind healthy and doing some mental exercises can do a world of good. All of us are leading a very stressful life, especially in this pandemic, for the last four months, so much so that it has become a part of our life.

Many a time, it's all in our mind, so our healthy lifestyle should start from the mind itself. You should have some 'me time' to care for yourself and do the things that make you feel good. Exercise should be a part of your life, no matter how busy you are. Have a regular exercise regime, a good diet, and sleep. 6-8 hours' sleep a day, drinking lots of water, eating fresh vegetables and fruits are some of the measures to release antioxidants that do us a lot of good. You should always note that health is not only physical health but the whole package, including mental and spiritual health.

Tell us something about the stigmas attached to Cancer.

Only awareness and talking about cancer will help to reduce the stigma because unless people come forward and spread messages, it won't reach out to the greater masses. It's vital to talk about cancer from time to time. A timely diagnosis is critical, and a timely diagnosis can only be made through a routine health check-up, so do not ignore any symptoms that you are having, talk about it and get yourself checked. Have a positive attitude towards life. Medical science has evolved a lot these days that we now have advanced drugs and Cancer Treatment facilities to the extent that cancer is not that scary as it used to be. It's a fight that we will win, so you have to believe in it, and only then will it happen.