Dr Thomas Giles, Cytopathologist
My day begins at 8.30 in the morning.
I review samples taken from the cervix to screen for abnormal tissue that increases the risk of developing cervical cancer. Most of these samples are normal, and are reported by highly trained scientists, but a small proportion is too difficult for them to interpret or appears to be abnormal and require my advice. I determine if the specimen is normal, has a mild abnormality or a severe abnormality. I decide if any further tests or treatment are required and what the patient should be told.
Later in the morning...
I will look at a variety of samples from patients who have symptoms. The samples may be fluids that contain cells, such as collections in the chest or abdomen, cells brushed from an abnormal area of tissue, or a small amount of blood and cells sucked out of a lump with a needle. A trainee pathologist sees many of the specimens first so that I can help them learn how to do my job. I advise if the cells sent to the laboratory explain the patient’s problem. The abnormality can often be diagnosed by just looking at the cells but sometimes other tests need to be performed. These can be stains for bacteria, tests for abnormal proteins or an examination of the genes in the cells. Many of these specimens are discussed in meetings with the clinical team – surgeons, radiologists and clinical trials nurses. During these meetings each member will present their information and discuss the options available for treatment. We agree what treatment the patient will receive during the meeting.
The afternoon is often spent in the ultrasound department assessing patients.
A consultant radiologist scans the patients, who usually have lumps in their neck, and I take a sample from the lump. The ultrasound machines are used to make sure the needle is in the correct place and to avoid the major blood vessels in the neck. When I have taken the sample it is stained quickly and I assess the material with a microscope. I write the diagnosis in the case notes so the patient can see the surgeon straight away and be told the result. The purpose of this test is often to decide if the patient has cancer or not, and to determine if they need a major operation or radiotherapy.
When I return to the laboratory at the end of the day I check the reports on the laboratory computer system to ensure they have been typed correctly before authorising them so that they are released to the clinician. I will also review any additional tests which have been performed during the day and decide if these determine the diagnosis.
Why did you choose this specialty?
I chose cytology because I enjoy the detailed and methodical assessment of tissue appearances to make a diagnosis, and it allows me to continue to meet patients and make them feel better.
What do you enjoy most about your chosen specialty?
The ability to see a patient in a clinic, take a specimen, assess it, and tell them they don’t have cancer within half an hour is extremely rewarding. This skill takes a long time to learn, however, and the pressures are high. I cannot get the diagnosis wrong.
Do you have any professional or personal achievements that you would like to share or highlight?
As well as my work diagnosing and treating patients I also teach in regional training centres, help to write national guidance on training and laboratory standards and assess laboratories to ensure all patients receive a high standard of service. This requires careful planning with my colleagues to ensure the patients continue to receive their care whilst I am away from the department. It is a true team service. It is unavoidable that much of this work is done during evenings, weekends and holidays but I have learnt to become very protective of ‘me’ time to maintain my enthusiasm and drive.