The 2009 Version of the Cancer Protocols of the College of American Pathologists: A Continuing Journey from “Guidelines for Pathologists” to “Standards for Multidisciplinary Comprehensive Cancer Care” (Editorial)
In recent years, breathtaking advances in cancer have occurred at many levels such that the management of patients with cancer often emanates from complex therapeutic decisions that are made based on input from a multidisciplinary team of surgeons, oncologists, radiation oncologists, pathologists, and radiologists. The culmination of the professional assessment of a pathologic specimen resected for cancer is reflected in the form and content of the pathology report. Embodied within the report is a synopsis of the cornerstone of our evaluation–gross pathology, microscopic examination, and use of ancillary diagnostic modalities. (1) The latter have evolved in recent years from being primarily diagnostic to having prognostic and predictive value such that they have become an integral component of the pathology report for some cancers. In the contemporary era of personalized molecular medicine, this list is only apt to grow exponentially. Given the increasing critical role of pathology reports in determining prognosis, adjuvant therapies, and overall management, there has been a greater emphasis on the accuracy, completeness, and timeliness of the pathology report. (2) A little less than 25 years ago, the Cancer Committee of the College of American Pathologists (CAP) recognized the great heterogeneity in the reporting of resected cancer specimen findings such that often critical elements required for patient management were incomplete or missing from the report. To address this issue the Cancer Committee of the CAP, in 1986, published the first set of protocols on breast cancer, bladder cancer, and Hodgkin disease. In the ensuing years, protocols for several major cancer sites were published in the Archives of Pathology & Laboratory Medicine primarily with the aim of being guidelines and a resource tool for pathologists. (3-5) A compendium of several major protocols was first published as a single offering by the CAP in September 19986 (Table 1). In this offering, a conscious effort was made to develop the protocols as a resource tool for pathologists and not as form of marching orders. Reporting in a checklist or synoptic format was encouraged for completeness and consistency.