Cancer surgery Flashcards
What specialists are invovled in the MDT for cancer management?
Surgeons
Physicians
Oncologists
Radiologists
Pathologists
Specialist nurses
Others
Data clerks
What are the features of a malignant tumour?
Direct invasion - directly extend into nieghbouring tissues
Metastatic spread: liver, bone, lungs, brain, any other site
How does cancer cause illness?
Interference with function
Erosion - bleeding
Obstruction
Cachexia - wt loss
Metabolic effect
Example of cancer interfering with function
e.g. tumour in apex of lung
pressure on brachial plexus - severe shoulder pain
weakness of hand on affected side
Example of cancer causing erosion?
GI tumour
in stomach or SI
often presents as anaemia or upper GI haemorrhage
Example of cancer causing obstruction
Malignant large intestine
What is cachexia?
Uniintentional weight loss
Progressive muscle wasting
Loss of appetite
Caused by nausea, tumour metabolism, chronic inflammatory changes
What is the purpose of cancer screening?
To find disease at early stage
To remove disease at an early stage
To prevent cancer deaths
What are the UK national screening programmes?
Bowel cancer screening:
men and women 60-74, 2 yearly
Cervical cancer screening:
all women 25-64, 3-5 yearly
Breast cancer screening:
All women 50-70, 3 yearly
What is palliation?
Improves QoL without necessarily affecting survival
Mostly not surgical
How will breast cancer present?
- Firm, irregular painless lump
- Pain - 10%
- Axillary/supraclavicular lymph nodes
- Nipple retraction and/or bloody discharge
- Paget’s disease - alteration of bone tissue
- Peau d’orange
- Signs of metastatic disease
- Asymptomatic presentation following screening
What are the investigations of breast cancer?
Mammography
US
Fine needle aspiration cytology
Trucut biopsy
Excision biopsy
Wire guided biopsy
Chest x-ray, bone scan, CT, MRI
How may surgery be involved in breast cancer?
Control of local disease: mastectomy, wide loacl excision
Reconstruction after breast surgery
What is the significance of axillary LN in breast cancer?
Mode involvement is an expression of poor outcome rather than the determinant
Sentinel LN biopsy determines whether further treatment is required
What are the prognostic factors of breast cancr?
Grade of tumour
LN metastasis
Size of tumour
How can breast cancer be prevented? Who should be targeted for prevention?
Target high risk groups - BRCA1 and BRCA2 genes, strong family history, premalignant markers
Drug prevention
Oopherectomy
Bilateral risk reducing mastectomy
What are the symtpoms of bowel cancer?
Rectal bleeding
Change in bowel habit
Iron deficiency anaemia
Abdominal mass
Bowel obstruction
Acute abdomen
Incidental finding
Screening
What investigations are there for bowel cancer?
Colonscopy
CT colonoscopy’
Contrast CT - chest, abdomen, pelvis
MRI - pelvis
USS - liver
What type of surgery is performed for colon cancer?
Laparoscopic
Open surgery
What are the different operations for bowel cancer?
Right hemicolectomy
Extended right hemicolectomy
Left hemicolectomy
Sigmoid colectomy
Anterior resection
Abdomino-perineal resection
When is a stoma necessary?
- To divert waste away from an obstruction which cannot be removed
- To allow bowel anastomoses to heal
- Patient high risk of leak from anastomoses
- There is no distal bowel to connect to
Colorectal cancer screening
Males and females
60-74 years old
2 yearly
FIT - faecal innumohistochemical test
If patient positive, invited for colonscopy
Polyp-cancer sequence
95% of cancer begin as adenomas
Evolution of polyp to cancer is 5-10 years
Remove polyp = reduce risk of cancer
What are the risks of colonscopy?
Bleeding
Bowel perforation
Sedation effects
Bowel prep effects
Missed pathology
