Cancer Surgeries- Mincer PPT Flashcards
What is Lymph Node Dissection?
A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer.
- In Regional lymph node dissection, some of the lymph nodes in the tumor area are removed
- In Radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.
- Also called lymphadenectomy.
What is Sentinel node biopsy?
A surgical procedure used to determine if cancer has spread beyond a primary tumor into the lymphatic system.
Sentinel node biopsy is used most commonly in evaluating breast cancer and melanoma. The sentinel nodes are the first few lymph nodes into which a tumor drains.
Can be minimally invasive or moderate depending on the tumor size. Inject dye into tumor to determine its presence and do a biopsy to determine if cancerous cells present.
What is a Lumpectomy
- A Lumpectomy (lum-PEK-tuh-me) is surgery to remove cancer or other abnormal tissue from your breast. Lumpectomy is also called breast-conserving surgery or wide local excision because — unlike a mastectomy — only a portion of the breast is removed. Doctors may also refer to lumpectomy as an excisional biopsy.
History of breast surgery (previous trends)
- The trend was to take out more and more of the breast and underlying tissue to reduce risk of future cancer (or increase survivorship), but the surgery and its complications were not worth it.
- The new trend is to take out less than a radical mastectomy, but to still take out enough to have high survivorship
Types of Mastectomy (4)
- Simple
- Skin sparing approach
- Modified radical
- Radical
Mastectomy- Skin sparing approach
- Preserves most of the normal breast skin and allows for a reconstruction with more natural contour and less visible scars. The nipple and areola are removed for oncologic reasons as they are intimately associated with the underlying breast tissue.
- The reconstruction after skin-sparing mastectomy can be based on implants or autologous (the patient’s own) tissue and will include a nipple-areola reconstruction as a second stage.
Mastectomy- Modified radical
A procedure in which the entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes; the pectoralis major muscle is spared.
Mastectomy- Radical
A surgical procedure in which the breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla are removed as a treatment for breast cancer.
Mastectomy - Surgical complications (5) WARP- L
- Weakness
-
Axillary web syndrome
- Minor symptom compared to the others, but PTs may see it
- Appears as a cord under the skin of area of treatment (may not see it unless pt. abducts arm)
- What is it? Why is it there? We are not really sure. The “cord” may extend far down arm, maybe even into the hand
- May be painful. Can treat as any other soft tissue restriction.
- Dec. ROM- compensation due to pain (ie. reduced shoulder motion)
- Pain- Proportional to how invasive the surgery is.
-
Lymphedema
- Axillary, more lymph nodes taken out the higher the risk
- Patients who took radiation
True or false- Reconstruction could be either immediate or delayed??
True
- Immediate- reconstruction of breast during surgery
- Delayed- wait for mastectomy to heal then do reconstruction- good for those who have to undergo radiation in that area
What is a simple mastectomy
- procedure that removes the breast tissue, nipple, areola and skin but not all the lymph nodes
Non-autologous breast reconstruction
- Use of saline implants to reconstruct the breast over time
- Tissue expanders are placed under skin or pec major first then gradually filled with saline to allow tissue to adaptively lengthen, once it’s at desired size an implant is permanently placed.
3 types of Autologous procedures
Autologous - using muscle/fat from somewhere else to reconstruct the breast.
- TRAM- Transverse Rectus Abdominal Myocutaneous flap
- DIEP- Deep Inferior Epigastric Perforators
- Lattissimus
TRAM procedure
- The most common method of autogeneous tissue reconstruction
- The entire rectus abdominus muscle is used to carry the lower abdominal skin and fat up to the chest wall. A breast shape is then created using this tissue.
- In order to transfer the flap to the chest, the muscle is tunneled under the upper abdominal skin.
- Since the patient’s own body tissue is utilized, the result is a very natural breast reconstruction. Also, the patient will have the benefit of a flatter looking abdomen.
- The scar on the abdomen is low, and extends from hip to hip. The TRAM flap can be used for reconstructing one or both breasts. In a patient undergoing unilateral reconstruction, the TRAM flap can potentially offer better symmetry than using an implant.
DIEP procedure
- Based on the deep inferior epigastric vessels, an artery and vein at the bottom of the rectus abdominis muscle. These vessels provide the primary blood supply to the skin and fat of the lower abdomen.
- In the DIEP flap, the lower abdominal skin and fat is removed without having to harvest any of the rectus abdominis muscle. Instead, blood supply is provided through the perforator vessels that are teased out from the rectus muscle, using a muscle incision alone. The surgeon will apply judgment in the operating room to determine how many perforators are needed to provide sufficient blood supply for the DIEP flap to survive.
- Once the DIEP flap is raised, a microscope is used to transplant the tissue to a recipient set of blood vessels on the chest wall. The tissue is used to create a breast shape without having to be tunneled under the skin (as in the pedicled TRAM flap).
Latissimus Dorsi Flap
Most commonly combined with a tissue expander or implant, to give the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape as compared to an implant alone. Occasionally, for a thin patient with a small breast volume, the latissimus dorsi flap can be used alone as the primary reconstruction without the need for an implant.
