Be Seen, Get Screened's Physician Spotlight Q&A series highlights the work of health care professionals on the front line in the fight against colon cancer. In our latest Q&A, we talked to medical Gastrointestinal pathologist Dr. Mohammad Kamal about the importance of screening and its impact on the early detection of colon cancer.
Be Seen, Get Screened: What drew you to a career in medical pathology?
Dr. Kamal: I liked the fact that as a pathologist, I am able to visualize and understand the disease process at the cellular level. Identifying the diagnostic features provides a very high degree of certainty that is not necessarily available to other physicians in other specialties.
Looking into a microscope is not looking at a crystal ball. In fact pathologists apply a meticulous systematic approach that allows them to reach accurate diagnoses.
BSGS: Can you tell us a bit about your professional background and any experience with colon cancer?
Dr. Kamal: I did my pathology residency at Harbor UCLA and was mentored by Dr. Samuel French, who is a legendary pathologist with great groundbreaking work in liver pathology and alcoholic liver disease. My admiration for Dr. French was one of the main driving forces for my decision to pursue a Gastrointestinal Pathology fellowship at UCLA.
This fellowship was founded by the late Dr. Klaus Lewin, another great pathologist who was one of the pioneers in GI pathology. The program is known for its strong clinical focus where GI pathologist worked very closely with a very talented clinical team of gastroenterologists.
As a GI Pathology fellow I was encouraged to attend endoscopy procedures. Being at an internationally recognized academic center like UCLA with its long traditions of excellence, I was fortunate to see the most complex cases of colon cancer many of which came for second opinion consultation.
After my fellowship, I became involved in establishing a few pathology programs. I was the Chief Medical Officer for a large national lab and built their GI pathology program. I founded my laboratory OmniPathology in Pasadena, CA. My practice is focused on GI pathology. In addition to the biopsies we get from our clients, on daily basis, I receive consults from other pathologists asking for my expert opinion. Most of these cases are colon cancer related lesions.
BSGS: Colon cancer is often regarded as the most preventable, yet least prevented cancer. In your professional opinion, what does this mean?
Dr. Kamal: Colon cancer screening allows us to detect precancerous lesions and subsequently prevent them from advancing to cancer. There may be multiple factors responsible for failure to be screened. For example the unavailability of colonoscopy screening in medically underserved areas or lack of patient education on screening programs or other alternatives.
BSGS: As a pathologist, you are involved in the diagnosis and characterization of disease. How does screening impact the diagnosis and staging of colon cancer?
Dr. Kamal: Every day I review GI biopsies obtained from screening colonoscopy procedures. Detecting colon polyps and correctly diagnosing them will help placing the patient into the appropriate follow up category.
Patients with premalignant or high grade lesions can be offered additional options such as removal of additional tissue or closer follow-up to eliminate the risk of progression into advanced cancer. These cases require high level of pathology expertise of a fellowship trained GI pathologist.
BSGS: Can you tell us about a case of colon cancer that you diagnosed and found it to be interesting or challenging?
Dr. Kamal: In my first job out of fellowship, I received a colon polyp taken from a patient in his 50s. The polyp showed one focus with features that, to me, were worrisome for high grade dysplasia and even suspicious for early cancer. As a junior pathologist, I showed the case to a more experienced pathologist who was not as concerned as I was.
So I decided not to ignore it and proceeded to sending the case for a second opinion. The second opinion confirmed my suspicion. This resulted in referring the patient to surgery. The patient had a segmental resection of the area with end-to-end anastomosis. The segment of the colon that was removed showed early invasive cancer that was caught before the tumor got into lymph nodes.
The patient did not need any additional treatment such as chemo or radiation and was expected to have an excellent prognosis. This was one of the most rewarding outcomes that I have experienced in my career. I felt that my persistence paid off and saved a patient from coming back in a couple of years with an advanced cancer potentially spreading out of the colon.
BSGS: Why do you think it’s important for people to be educated about colon cancer, risk factors and available screening options?
Dr. Kamal: Patient education will help them understand the need to be screened and the importance of detecting precancerous lesions or early cancer. Providing the patients with such information can play an important role in motivating patients to participate in screening programs. Individuals with family history of colon cancer are usually easier to convince to be screened mainly because of the knowledge they gain as they watch their loved one go through cancer.
The Internet is now full of resources that provide the patient with enough information on various diseases. I noticed that there is not enough pathology information available to patients in a language that they can understand. I started a website, YourPathReport.com in an attempt to fill in the gap.
BSGS: What do you tell people who want to lower their risk for colon cancer and other diseases?
Dr. Kamal: For individuals with an average risk for colon cancer, I tell them that, in addition to getting screened at age 50, eating low-fat, high-fiber diet rich in fruits and vegetables, regular exercise and maintaining a healthy weight are things they can do to lower their risk.
As for individual family history or genetic predisposition for the disease or with chronic inflammatory conditions such as Crohn’s disease or ulcerative colitis, they need to be screened at earlier age and may require additional measures to lower their colon cancer risk
BSGS: Do you have anything else to share with Be Seen, Get Screened?
Dr. Kamal: There are many occasions in which a polyp presents a diagnostic challenge and requires additional examination either by reviewing additional deeper sections of the tissue block or sending the case out for an expert review.
As a rule, I advise my friends to always ask their doctors if they feel there is a need for a second opinion. Having an expert review is beneficial not only to the patient but to the treating physician as well.