1 - Surgical Oncology Flashcards
What are 6 examples of multimodal treatment of the cancer patient?
- Surgery
- Chemotherapy
- Immunotherapy
- Radiation therapy
- Interventional oncology
- Palliation
What is surgical oncology?
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
Surgical oncology is a subspecialty with emphasis on the _____ as a whole.
patient
What is the most effective management of a cancer patient?
An integrated team approach
What are 6 patient considerations we have to make preoperatively?
- Overall health status
- Comorbidities
- Type and stage of cancer
- Adjuvant therapies available
- Owner goals
- Expected prognosis
What 5 preoperative considerations should be made when assessing a mass?
- Location (anatomic, dermal vs. SQ)
- Size
- Gross appearance
- Consistency
- Degree of fixation
What diagnostic procedures can be done preoperatively?
Fine needle aspiration and/or pretreatment biopsy
What is the overall sensitivity and specificity of fine-needle aspiration? How often does histopath agree with these?
Sensitivity = 80%
Specificity = 100%
Histopath agreement = 91%
What are 3 techniques that can be used for fine needle aspiration?
- Open needle technique (easiest)
- Suction technique
- Ultrasound or CT-guided
Why would you want to use a body map?
Good to keep track of growths and their sizes, appearances, etc. over time
What is staging based on?
The location where neoplasia has already spread
What are 5 common diagnostics that can be used to help with staging?
- Blood work
- Thoracic radiographs (3-view)
- Abdominal ultrasound
- +/- CT scan
- Fine needle aspiration
What is a sentinel lymph node?
First LN within lymphatic drainage basin that drains the primary tumor reliably
T/F: A sentinel LN always indicates that the tumor is metastatic.
False
What is the next step if sentinel LN testing is negative?
Additional LN assessment is unnecessary
What is the next step if sentinel LN testing is positive?
The LN needs to be removed
What are 5 preop sentinel LN mapping techniques?
- Radiographic lymphography
- CT lymphography
- MR lymphography
- Contrast-enhanced ultrasound
- Single-photon emission CT and PET
What are 3 intraop sentinel LN mapping techniques?
- Lymphoscintigraphy
- Colorimetric SLN mapping
- Near-infrared imaging
What does each letter stand for in TNM staging?
T = tumor
N = node
M = metastasis
When should staging be performed?
Before you go to surgery
At stage T1, the tumor is _____ in diameter, superficial, or exophytic.
<2cm
At stage T2, the tumor is _____ in diameter or with minimal _____ irrespective of size.
2-5cm, invasion
At stage T3, the tumor is _____ in diameter or with invasion of the _____, irrespective of size.
>5cm, subcutis
At stage T4, the tumor is _____ other structures such as _____, _____, _____, or _____.
invading, fascia, muscle, bone, cartilage
At stage N1, there are _____ affected _____ nodes.
movable, ipsilateral
At stage N2, there are _____ affected _____ or _____ nodes.
movable, contralateral, bilateral
At stage N3, there are _____ nodes.
fixed
At stage M0, there is _____ of distant metastasis.
no evidence
At stage M1, there is _____.
distant metastasis detected
In stage 1 of cancer, what are the TNM stages?
T1, N0, M0
In stage 2 of cancer, what are the TNM stages?
T2, N0, M0
In stage 3 of cancer, what are the TNM stages?
T3, N0, M0
In stage 4 of cancer, what are the TNM stages?
Any T, N1 (positive), M0
In stage 5 of cancer, what are the TNM stages?
Any T, Any N, M1 (metastasis)
What are 2 other names for LN removal?
Lymphadenectomy
LN extirpation
What are 2 reasons to perform a biopsy and what 2 things change when this is done?
Perform: 1) Unable to perform FNA, 2) Non-diagnostic FNA
Changes: 1) Treatment plan, 2) Owner decision
How is the animal prepared for a biopsy?
Sedation and local analgesia, wide clip, aseptic technique
All removed tissue for a biopsy is put in _____ and submitted.
formalin
What is the most common incisional biopsy and what is the desirable shape?
Wedge;
Should be narrow and deep to take margins of normal AND abnormal
What should you ALWAYS consider when taking an incisional biopsy?
Future surgical margins;
Do not take normal tissue if it will make your future margins bigger
What is a tru-cut biopsy used for?
Beneficial for masses that are hard to get to
What type of biopsy is this?
punch
What are 5 minimally invasive ways by which we can obtain biopsies?
- Image-guided (ultrasound or CT)
- Endoscopic (GI)
- Cystoscopic (bladder, urethra, prostate)
- Laparascopic (liver, spleen, kidney)
- Thoracoscopic (lung, LN, pleura, cardiac)
What is an excisional biopsy? Why is it frowned upon?
Taking the entire tumor;
Frowned upon because if you remove it and find out it was malignant then you may have missed margins
When should you use an excisional biopsy?
When you are confident you can get entire margins, such as with tiny masses
What are 3 goals of surgical oncology?
- Curative intent
- Cytoreduction
- Palliative intent
What is surgical dose in oncology?
Aggressiveness of surgical resection applied to a tumor
A
pseudocapsule
B
skin
C
wide zone/margin
D
reactive zone
E
satellite tumor
F
marginal zone
G
fascia
H
muscle
What margins of fascial planes should we consider?
Muscle and muscle fascia, cartilage, bone
What two fascial planes are considered barriers to tumors?
cartilage and bone
What do surgical skin margins depend on?
primary tumor
How deep and wide do skin margins need to be?
1 fascial plane deep
2-3 cm wide
When would you use neoadjuvant therapy?
For very large tumors or tumors in difficult locations
What are 2 types of neoadjuvant therapy?
Chemotherapy and radiation therapy
When would you perform a curative intent surgery?
You know the tumor type prior to surgery and can get wide margins or radical excision
What are the 7 steps to the curative intent technique?
- Wide clip and drape
- Remove FNA/biopsy tract
- Use separate “clean” and “dirty” instruments
- Wide incision
- Maintain margin to deep plane
- Avoid tumor manipulation
- +/- lavage wound bed
In curative intent wound closure, you would use _____ techniques.
tension-relieving
T/F: You can manage an open wound if needed after removal.
True
What 4 things do we NOT want to do in oncologic surgery?
- Tissue undermining
- Flaps/grafts if dirty resection
- Drains
- Cosmetics
What are 2 techniques used in cytoreductive surgery and what do they do?
- Debulking = intralesional; macroscopic disease left behind
- Shell out = marginal resection; leaves microscopic disease
What is palliative intent surgery and when should it be performed?
Surgery to relieve pain or discomfort and/or to improve function;
Done only when necessary
In palliative surgery, we remove as much _____ as possible and leave as much _____ as possible.
tumor, tissue
What risk does palliative surgery have?
Dehiscence
What are 4 techniques used to mark the specimen after removal?
- Sectioning
- Suture placement
- Adjacent tissue submission
- Inking
What is the best dye to ink the surgical margin with and what colors?
Alcian Blue dye;
Best colors = yellow, black, blue
What should be done prior to inking margins on a tissue?
Keep tissues moist
How long should ink dry before fixation and what do we use for fixation?
10-15 min;
Use 10% buffered formalin fixation (1 : 10)
What 4 things are reported on a histopath report?
- Tumor type
- Tumor grade
- Cellular characteristics and invasiveness
- Surgical margins
What can we do when the margins are incomplete?
- Re-excision
- Radiation therapy
- Chemotherapy
- Monitor for recurrence
How long after wound healing does radiation therapy start?
~10-14 days
