# The pathology lab triggers a trial referral the day a rare cancer is diagnosed

Source: https://onco.cc/ideas/idea-tr1-pathology-triggered-referral/  
OnCo record `idea-tr1-pathology-triggered-referral` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The pathologist is the first person to know a cancer is rare or has a targetable marker. A rule in the lab system could notify a trial team at that moment, before treatment decisions close the window.

## Summary

Laboratory information systems flag defined diagnoses (rare histologies, MSI-high, NTRK fusion, specific paediatric-type tumours in adults) and send a structured notification to a regional trial coordination office and the treating clinician, with matched trials attached. Consent-to-contact rules govern direct patient contact. Precedents exist in stroke and sepsis alerting; oncology pathology alerting has been used for HER2 and MSI testing completeness.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Pathology-triggered referral will increase the proportion of patients with the flagged diagnoses seen by a trial team before first-line treatment, and enrolment in first-line trials for those diagnoses.
- Rationale: For many rare cancers the only trial is first-line; once standard chemotherapy starts, the patient is ineligible. Diagnosis-time alerting acts before the window closes.
- Proposed test: Implement in one regional pathology network for five diagnoses; compare pre-treatment trial-team contact rate and first-line trial enrolment with neighbouring regions.
- Maturity: speculative
- Actor: clinic

## Sources

- Bottleneck evidence (Trials enrol too few, too slowly): Unger et al., Systematic review of barriers to cancer trial participation (JNCI 2019): https://doi.org/10.1093/jnci/djy221

## Connected records

- cancers: [Neuroendocrine tumours](https://onco.cc/cancers/neuroendocrine/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/)
- technologies: [Digital pathology & AI](https://onco.cc/technologies/digital-pathology-ai/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/)
- terms: [Gene fusion](https://onco.cc/terms/gene-fusion/), [Lines of therapy](https://onco.cc/terms/first-line/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/)
- bottlenecks: [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)

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