Blue Book: Principles of surgical oncology

Question 1

What are the 3 main roles of surgery in the management of cancer patients?

Answer 1

Diagnosis
Treatment
Prevention

Question 2

How and why are histology samples acquired for diagnosis?

Answer 2

There are used for accurate histological diagnosis by direct biopsy.

Question 3

Name 4 methods of biopsy.

How do you decide which method to use?

Answer 3

Fine needle aspiration cytology
Try-cut needle biopsy: piece of tumour removed under local anaesthetic.
Incisional biopsy: piece of tumour sampled during surgery
Excisional biopsy: the whole mass is removed.

The surgeon will use the technique for the tumour site and a method that does not jeopardise subsequent tumour clearance.

Question 4

When does surgery play a role in accurate staging?

Answer 4

Surgical axillary node assessment in breast cancer: allows more accurate assessment of risk of future relapse.

Question 5

When is surgical resection of the primary tumour with curative intent applicable?

What if there is regional lymph node involvement?

For many tumours how is the risk of local recurrence reduced?

Answer 5

30% of cancers: cancer must be localised with adequate margins of clearance.

It will depend on the cancer, but commonly lymph node involvement is an indicator of distant micro metastases. (worse prognosis)

Post operative adjuvant radiotherapy or chemotherapy.

Question 6

What is cytoreductive surgery?

When can it be used?

Give an example of cytoreductive surgery.

Answer 6

Cytoreductive surgery reduces the bulk of tumour.

It is likely to be of long term benefit if there is an effective surgery for the residual tumour.

Ovarian cancer + debulking surgery + chemotherapy

Question 7

Usually there is not curative surgery for metasestes. Explain why.

When may curative surgery for mets be possible?

Answer 7

Distant mets usually indicates numerous other undetectable ‘occult’ mets, curative surgery is not indicated and exposes patient to unnecessary surgery and delays effective treatment.

Solitary lung met from sarcoma. Localised liver mets from colon cancer. Effective systemic treatment also required.

Question 8

When is palliative surgery indicated?

Answer 8

Improvement in QoL is greater tan morbidity from surgery (include. hospital stay).

Examples:

• Bypass procedure for intestinal obstruction from intra-abdo tumour
• Orthopaedic pinning of pathological fractures of bones.

Question 9

When is surgery used as a prevention of cancer?

Answer 9

Certain people with high risk of cancer.

eg Colectomy in patients with familial adenomatous polyposis

-Bi-lateral mastectomy in BRAC1/2 positive (Angelina Jolie)