Daily photo by Gary Cosby Jr.|
Dr. Monita Soni uses a microscope to check for the presence of cancerous cells in the lab at Parkway Medical Center.
Parkway physician plays vital role in area’s colon cancer battles
By Eric Fleischauer
You may not have met Dr. Monita Soni, but there’s a good chance she has met you.
She operates the pathology laboratory, PrimePath PC, at Parkway Medical Center, and along with one other doctor and a small staff, she evaluates about 14,000 biopsy and cytology specimens a year.
Dr. Soni showed a pink and blue design under a microscope, sort of a chaotic paisley. It looked like it would work on a tie, until she explained it was a cluster of malignant cells from someone’s colon.
She is screening more colon samples this month as people respond to National Colorectal Cancer Awareness Month. Dr. Soni grimaces when she sees cells exhibiting this pattern, but she knows that the discovery is fortunate. Caught early, colon cancer is treatable.
“See this? That’s enough tissue for me to see cancer if it’s there,” she said. She’s pointing at a glass microscope slide with four pinhead-size clusters of cells — stained purple from processing — that are free of colon cancer. Sometimes a single cell clinches a diagnosis.
Dr. Soni’s laboratory processes about 50 colon biopsies — usually suspect tissue removed during a colonoscopy — a month. From two to five of those samples prove malignant. Dr. Soni, who grew up in Bombay, India, trained at premier cancer institutions in India and the United States. She has in nine years developed from scratch one of the most advanced laboratories in the area. In 1998, Parkway had marketing reasons for an in-house pathologist, but lacked the volume to support one. That meant Dr. Soni was nearly a one-woman show.
Immediately after advanced cancer research at Sloan-Kettering Cancer Center, Cornell University, Vanderbilt University and a National Institute of Health fellowship, Dr. Soni ran around town picking up tissue samples.
She processed them. She analyzed them. She typed in reports of her findings. She called doctors to explain her findings.
State of the art lab
And somehow in the midst of her 16-hour days, she strategized on how to use the financial resources she generated to create a state-of-the-art laboratory.
Her strategy worked, although the lab shows its humble origins.
She could use more space. She could use more people. But crammed into the space she has are some of the most advanced laboratory devices available anywhere, along with people who have the expertise to use them.
“It’s hard to find trained people,” Dr. Soni said, her employees scurrying from a DAKO automated immunostainer to a Beckman Coulter flow cytometer to a host of other devices that look like they could beam up Scotty.
“We’ve trained these people ourselves. This is sort of a school we’ve started.”
She keeps tabs on her employees even after they leave, a proud professor.
“I try to transfuse energy, sincerity and ethics to them,” she said. “It’s all about patient care. They have to learn to be fastidious, to be careful. I think they become better people in the process.”
For the clinician — that’s your doctor — Dr. Soni’s accumulation of equipment and talent means test results that could take weeks if they had to be sent off to the lab at a research hospital are available in a day or so if processed at PrimePath.
Typically, Dr. Soni receives specimens in small bottles of formaldehyde.
Pap smears — taken from a woman’s cervix by her gynecologist — are among the most common, although most are evaluated through highly automated equipment. Some still are done the old-fashioned way.
The formaldehyde “fixes” the specimen so it does not change before analysis. At this step, the sample looks like grains of salt floating in clear liquid.
The tissue is processed, hardened, cleared and embedded in a wax mold.
The technician uses a machine — a bit like the meat slicer at Publix — to peel layers of wax off the mold until the sample is on the surface.
Technicians stain the processed biopsy or cytology slides with an assortment of dyes that makes you wish you had an Easter egg.
The stains turn the nucleus blue and cytoplasm pink, assisting in the microscopic analysis.
Chaotic paisley patterns
If it’s a colon biopsy, you hope Dr. Soni’s slide does not reveal the chaotic paisley pattern. But if it’s there, you want her to see it — early diagnosis means life for cancer patients — and Soni’s lab, she said, has never missed a malignancy.
That’s an educated assessment, because the lab undergoes multiple annual reviews by a host of different acronym-embued accreditation agencies.
While Dr. Soni prides herself on her turnaround time, speed is not that important on most analyses.
Tension noticeably mounts, however, when a frozen sample arrives. Whether it’s a sample from a bowel resection or a mastectomy, a surgical team and an unconscious patient are waiting while Dr. Soni and her assistants evaluate the removed tissue.
The main issue is whether the margins of the removed tissue are free of malignancy. If not, the surgeons need to remove more.
The surgeons can eyeball it pretty well in colon cancer, but breast cancer is more difficult. Microscopic analysis detects cancer cells not visible to the surgeon’s eye.
If Dr. Soni finds no cancer, sew the patient up.
If she detects malignant cells on the margin of the removed tissue, the surgeon needs to cut more.
Your family doctor may have no problem understanding the significance of a cancer diagnosis — he’s seen your face, talked to you, maybe even shared a hymnal with you at church — but what about a doctor sitting behind a microscope in a sterile lab?
Every sample important
As Soni’s associate, Dr. Karla Garcia, explains it, everyone at PrimePath understands there is a face behind the tissue sample, even if they’ll never see it. “We may not know the person, but we know our work could be life or death for them.”
That sounds plausible until you look in PrimePath’s closet of archives.
Thousands upon thousands of slides, categorized by number. Almost every one represents a patient and family overwhelmed with concern. “Do I have cancer?”
But then you confront Dr. Soni’s overwhelming energy. Tall, attractive and intense; missing her family in India but overwhelmed by the support she’s discovered in Decatur.
The numbers for her are people, and she thrives on people.
Phones are ringing, doctors are paging, and the slides are piling up beside her microscope. But she says, “Do you have children?” Then, “How old are they? What schools?” That your 11-year-old loves theater is grand, she says. Soni’s main passion involves tissue samples of those she’ll never meet, but she also is an accomplished painter, poet and author of short stories.
Who cares? You do, if your cells happen to be framed by her glass slide. She sees a story in every slide, and you’re the protagonist. She may hate pink paisley, but she’s determined to save your life.
Screening best colorectal defense
Colorectal cancer is preventable, treatable and often curable when detected early. The best approach is to begin a screening regimen at age 50. Steps to take:
Have a fecal occult blood test yearly.
Have a sigmoidoscopy every five years, or a colonoscopy or double-contrast barium enema every five to 10 years.
Have a digital rectal exam every five to 10 years.
If you have a personal or family history of colorectal cancer, colorectal polyps or inflammatory bowel disease, talk with your doctor about earlier screening.
For more information, go to www.preventcancer.org/colorectal.
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