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Small Animal Surgery > 1 - Surgical Oncology > Flashcards

1 - Surgical Oncology Flashcards

1
Q

What are 6 examples of multimodal treatment of the cancer patient?

A
  1. Surgery
  2. Chemotherapy
  3. Immunotherapy
  4. Radiation therapy
  5. Interventional oncology
  6. Palliation
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2
Q

What is surgical oncology?

A

Utilizing surgical techniques in the diagnosis and treatment of cancer;

Understanting the preoperative, intraoperative, and postoperative decision-making and treatment options and possible outcomes to most effectively treat neoplastic disease

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3
Q

Surgical oncology is a subspecialty with emphasis on the _____ as a whole.

A

patient

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4
Q

What is the most effective management of a cancer patient?

A

An integrated team approach

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5
Q

What are 6 patient considerations we have to make preoperatively?

A
  1. Overall health status
  2. Comorbidities
  3. Type and stage of cancer
  4. Adjuvant therapies available
  5. Owner goals
  6. Expected prognosis
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6
Q

What 5 preoperative considerations should be made when assessing a mass?

A
  1. Location (anatomic, dermal vs. SQ)
  2. Size
  3. Gross appearance
  4. Consistency
  5. Degree of fixation
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7
Q

What diagnostic procedures can be done preoperatively?

A

Fine needle aspiration and/or pretreatment biopsy

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8
Q

What is the overall sensitivity and specificity of fine-needle aspiration? How often does histopath agree with these?

A

Sensitivity = 80%

Specificity = 100%

Histopath agreement = 91%

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9
Q

What are 3 techniques that can be used for fine needle aspiration?

A
  1. Open needle technique (easiest)
  2. Suction technique
  3. Ultrasound or CT-guided
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10
Q

Why would you want to use a body map?

A

Good to keep track of growths and their sizes, appearances, etc. over time

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11
Q

What is staging based on?

A

The location where neoplasia has already spread

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12
Q

What are 5 common diagnostics that can be used to help with staging?

A
  1. Blood work
  2. Thoracic radiographs (3-view)
  3. Abdominal ultrasound
  4. +/- CT scan
  5. Fine needle aspiration
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13
Q

What is a sentinel lymph node?

A

First LN within lymphatic drainage basin that drains the primary tumor reliably

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14
Q

T/F: A sentinel LN always indicates that the tumor is metastatic.

A

False

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15
Q

What is the next step if sentinel LN testing is negative?

A

Additional LN assessment is unnecessary

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16
Q

What is the next step if sentinel LN testing is positive?

A

The LN needs to be removed

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17
Q

What are 5 preop sentinel LN mapping techniques?

A
  1. Radiographic lymphography
  2. CT lymphography
  3. MR lymphography
  4. Contrast-enhanced ultrasound
  5. Single-photon emission CT and PET
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18
Q

What are 3 intraop sentinel LN mapping techniques?

A
  1. Lymphoscintigraphy
  2. Colorimetric SLN mapping
  3. Near-infrared imaging
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19
Q

What does each letter stand for in TNM staging?

A

T = tumor

N = node

M = metastasis

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20
Q

When should staging be performed?

A

Before you go to surgery

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21
Q

At stage T1, the tumor is _____ in diameter, superficial, or exophytic.

A

<2cm

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22
Q

At stage T2, the tumor is _____ in diameter or with minimal _____ irrespective of size.

A

2-5cm, invasion

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23
Q

At stage T3, the tumor is _____ in diameter or with invasion of the _____, irrespective of size.

A

>5cm, subcutis

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24
Q

At stage T4, the tumor is _____ other structures such as _____, _____, _____, or _____.

A

invading, fascia, muscle, bone, cartilage

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25
Q

At stage N1, there are _____ affected _____ nodes.

A

movable, ipsilateral

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26
Q

At stage N2, there are _____ affected _____ or _____ nodes.

A

movable, contralateral, bilateral

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27
Q

At stage N3, there are _____ nodes.

A

fixed

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28
Q

At stage M0, there is _____ of distant metastasis.

A

no evidence

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29
Q

At stage M1, there is _____.

A

distant metastasis detected

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30
Q

In stage 1 of cancer, what are the TNM stages?

A

T1, N0, M0

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31
Q

In stage 2 of cancer, what are the TNM stages?

A

T2, N0, M0

32
Q

In stage 3 of cancer, what are the TNM stages?

A

T3, N0, M0

33
Q

In stage 4 of cancer, what are the TNM stages?

A

Any T, N1 (positive), M0

34
Q

In stage 5 of cancer, what are the TNM stages?

A

Any T, Any N, M1 (metastasis)

35
Q

What are 2 other names for LN removal?

A

Lymphadenectomy

LN extirpation

36
Q

What are 2 reasons to perform a biopsy and what 2 things change when this is done?

A

Perform: 1) Unable to perform FNA, 2) Non-diagnostic FNA

Changes: 1) Treatment plan, 2) Owner decision

37
Q

How is the animal prepared for a biopsy?

A

Sedation and local analgesia, wide clip, aseptic technique

38
Q

All removed tissue for a biopsy is put in _____ and submitted.

A

formalin

39
Q

What is the most common incisional biopsy and what is the desirable shape?

A

Wedge;

Should be narrow and deep to take margins of normal AND abnormal

40
Q

What should you ALWAYS consider when taking an incisional biopsy?

A

Future surgical margins;

Do not take normal tissue if it will make your future margins bigger

41
Q

What is a tru-cut biopsy used for?

A

Beneficial for masses that are hard to get to

42
Q

What type of biopsy is this?

A

punch

43
Q

What are 5 minimally invasive ways by which we can obtain biopsies?

A
  1. Image-guided (ultrasound or CT)
  2. Endoscopic (GI)
  3. Cystoscopic (bladder, urethra, prostate)
  4. Laparascopic (liver, spleen, kidney)
  5. Thoracoscopic (lung, LN, pleura, cardiac)
44
Q

What is an excisional biopsy? Why is it frowned upon?

A

Taking the entire tumor;

Frowned upon because if you remove it and find out it was malignant then you may have missed margins

45
Q

When should you use an excisional biopsy?

A

When you are confident you can get entire margins, such as with tiny masses

46
Q

What are 3 goals of surgical oncology?

A
  1. Curative intent
  2. Cytoreduction
  3. Palliative intent
47
Q

What is surgical dose in oncology?

A

Aggressiveness of surgical resection applied to a tumor

48
Q

A

A

pseudocapsule

49
Q

B

A

skin

50
Q

C

A

wide zone/margin

51
Q

D

A

reactive zone

52
Q

E

A

satellite tumor

53
Q

F

A

marginal zone

54
Q

G

A

fascia

55
Q

H

A

muscle

56
Q

What margins of fascial planes should we consider?

A

Muscle and muscle fascia, cartilage, bone

57
Q

What two fascial planes are considered barriers to tumors?

A

cartilage and bone

58
Q

What do surgical skin margins depend on?

A

primary tumor

59
Q

How deep and wide do skin margins need to be?

A

1 fascial plane deep

2-3 cm wide

60
Q

When would you use neoadjuvant therapy?

A

For very large tumors or tumors in difficult locations

61
Q

What are 2 types of neoadjuvant therapy?

A

Chemotherapy and radiation therapy

62
Q

When would you perform a curative intent surgery?

A

You know the tumor type prior to surgery and can get wide margins or radical excision

63
Q

What are the 7 steps to the curative intent technique?

A
  1. Wide clip and drape
  2. Remove FNA/biopsy tract
  3. Use separate “clean” and “dirty” instruments
  4. Wide incision
  5. Maintain margin to deep plane
  6. Avoid tumor manipulation
  7. +/- lavage wound bed
64
Q

In curative intent wound closure, you would use _____ techniques.

A

tension-relieving

65
Q

T/F: You can manage an open wound if needed after removal.

A

True

66
Q

What 4 things do we NOT want to do in oncologic surgery?

A
  1. Tissue undermining
  2. Flaps/grafts if dirty resection
  3. Drains
  4. Cosmetics
67
Q

What are 2 techniques used in cytoreductive surgery and what do they do?

A
  1. Debulking = intralesional; macroscopic disease left behind
  2. Shell out = marginal resection; leaves microscopic disease
68
Q

What is palliative intent surgery and when should it be performed?

A

Surgery to relieve pain or discomfort and/or to improve function;

Done only when necessary

69
Q

In palliative surgery, we remove as much _____ as possible and leave as much _____ as possible.

A

tumor, tissue

70
Q

What risk does palliative surgery have?

A

Dehiscence

71
Q

What are 4 techniques used to mark the specimen after removal?

A
  1. Sectioning
  2. Suture placement
  3. Adjacent tissue submission
  4. Inking
72
Q

What is the best dye to ink the surgical margin with and what colors?

A

Alcian Blue dye;

Best colors = yellow, black, blue

73
Q

What should be done prior to inking margins on a tissue?

A

Keep tissues moist

74
Q

How long should ink dry before fixation and what do we use for fixation?

A

10-15 min;

Use 10% buffered formalin fixation (1 : 10)

75
Q

What 4 things are reported on a histopath report?

A
  1. Tumor type
  2. Tumor grade
  3. Cellular characteristics and invasiveness
  4. Surgical margins
76
Q

What can we do when the margins are incomplete?

A
  1. Re-excision
  2. Radiation therapy
  3. Chemotherapy
  4. Monitor for recurrence
77
Q

How long after wound healing does radiation therapy start?

A

~10-14 days

Small Animal Surgery (17 decks)

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