The Royal Marsden

An expert team: specialised diagnosis

Effective treatment relies on the accurate diagnosis of a tumour type. The Royal Marsden’s Histopathology Department is a crucial factor in this process.
Dr Khin Thway and Professor Cyril Fisher, histopathologists

Dr Khin Thway and Professor Cyril Fisher, histopathologists

Histopathology

Histopathology plays a central role in any cancer diagnosis, accurately diagnosing tissue samples so that patients can start treatment as soon as possible. The Royal Marsden’s Histopathology Department is divided by tumour group, with each pathologist having a specific area of diagnostic expertise linked to the different clinical units.

Dr Andrew Wotherspoon, Consultant Histopathologist and Head of the Pathology Department, says that this approach sets it apart from others: “Because we are so sub-specialised, we have depth of knowledge of all different types of tumours, and so we can provide a high-quality pathological diagnosis. We incorporate pathology into the multidisciplinary team and this allows close interaction between the clinician and the pathologist.”

Haematopathology

Dr Wotherspoon’s specific interests are gastrointestinal cancer pathology and haematopathology – the latter a specialism he shares with Dr Ayoma Attygalle. The Royal Marsden is one of five specialist haematopathology centres in London. Led by Dr Wotherspoon, The Royal Marsden's haematological malignancy diagnostic service covers southwest London, Sussex and Surrey.

Dr Attygalle, a Consultant Histopathologist, is internationally renowned for her work on angioimmunoblastic T-cell lymphoma (a rare type of non-Hodgkin lymphoma), which has resulted in better understanding of the disease. She says: “My work has impacted on the treatment of the disease and we are now hoping it will influence targeted therapies in the future.”

Up to 3,000

sarcomas seen annually

Sarcoma and head and neck

Professor Cyril Fisher, Professor of Tumour Pathology at the Institute of Cancer Research and Consultant Histopathologist at The Royal Marsden, and Dr Khin Thway, Consultant Histopathologist, specialise in the pathology of sarcomas and head and neck cancers. Between them, they have published more than 650 scientific articles on new techniques and the development of new tumour types.

Their particular interest – soft-tissue sarcoma – is a very rare tumour type, for which The Royal Marsden is one of the world’s largest specialist centres. Together, they are a leading team in sarcoma pathology, and Professor Fisher's second opinion practice is one of the largest in the country.

Professor Fisher says: “Because sarcomas are so rare, other hospitals may see an example only once a year, whereas here we may see as many as 3,000. We therefore provide a vast concentration of expertise in one unit, and the unique relationship we have with sarcoma surgeons and clinicians means we are able to provide exemplary patient care.”

Dr Thway adds: “Sarcomas are rare but form a highly significant area of pathology because they can crop up anywhere in the body. So they can present to any pathologist, but only a specialist sarcoma pathologist is able to diagnose them."

24 hours:

the time it takes to turn around a breast biopsy

Breast

Dr Peter Osin and Dr Ashutosh Nerurkar are Consultant Histopathologists and Cytopathologists with a special interest and expertise in breast pathology. The department's diagnostic turn-around times are among the best in the country: 24 hours for breast biopsies and three days for larger specimens.

Dr Nerurkar says: “Most breast cancer surgery patients are not in recovery for long, meaning that they are ready to have a postoperative discussion fairly quickly – so it is important that we have the pathology results ready in time for that.”

Also specific to this department are an advanced molecular test for the HER2 protein, which can affect the growth rate of some cancer cells, and an intraoperative molecular test to identify sentinel node metastasis. This relatively quick test is only offered by a few centres and helps determine whether surgeons need to go ahead with surgery or not.

Gynaecology

Gynaecological pathology is a specialism shared by Dr Attygalle and her colleague, pathologist Dr Stephen Hazell. Because of The Royal Marsden’s reputation as a leading cancer centre, Dr Attygalle and Dr Hazell attract a high volume of the more complex gynaecological specimens with equally complex pathologies.

Dr Hazell likens their work to that of detectives, carrying out forensic examinations of the pathology to try to determine the best course of treatment. This is particularly important with gynaecological pathology, he says: “The right diagnosis changes management and prognosis considerably, more so than with other tumour types, so it really is crucial to get it right – we are an integral part of that.”

Another key area of their work is fertility preservation, which is important in deciding how to treat younger cervical cancer patients.

Urology

Dr Hazell also specialises in urology pathology and sees the most complex cases from Northern Ireland, the Republic of Ireland and southern England. His role includes a lot of second opinion work for testicular tumours from pathologists across the UK.

This is because he has access to a particular molecular test that has been developed in-house at The Royal Marsden for germ cell tumours. Dr Hazell says: “These tumours are quite specific, but diagnosing them is a game-changer in terms of determining treatment and management.”

The Royal Marsden has a high volume of robotic radical prostatectomy cases generated by our leading urological surgeons, which increases the demand for Dr Hazell’s expertise. He is also responsible for taking fresh tissue from consented patients for research.

Dr Hazell says: “Across the entire Histopathology Department, what makes us stand out is the expertise of the sub-specialist consultants and the specialist tests we have available, which are second to none in London for a huge range of tumours.”

Referring to Private Care

For Private Care referrals and enquiries, call our Central Referral and Information Line on 020 7811 8111.