Cancer treatment (Surgery)

Question 1

What are the 3 roles of surgery in oncology

Answer 1

Surgery to Prevent
Surgery to Diagnose
Surgery to Treat

Question 2

6 Principles of Oncological Surgery

Answer 2

1. Resect tumour with an appropriate margin
2. Plan biopsy so tract can be resected with tumour
3. Consider all scars from previous surgery, biopsies and drains as contaminated and ensure resected in primary incision
4. Ligate blood supply early to prevent dissemination
5. Limit contamination of the surgical field – change gloves and instruments between resection and reconstruction
6. Limit the use of drains

Question 3

Options for biopsies of skin tumours

Answer 3

FNA
Core needle
Incisional biopsy
Excisional biopsy

Question 4

What is core needle biopsy

Answer 4

Larger sample than FNA
Spring loaded needle with tissue collection channel and outer cutting sheath
Preserves tissue architecture and allows histological diagnosis

Question 5

Outline incisional biopsy

Answer 5

Wedge of tissue is excised
Ideally composed of normal and abnormal tissue
Incision should be created within the future field of definitive treatment

Question 6

Outline excisional biopsy

Answer 6

Used when treatment won’t be altered by diagnosis
You can excise the whole mass with an appropriate margin.
Saves on repeat surgeries and anaesthetics
Is not appropriate for all masses!
Inappropriate use will result in excision without clean margins
Greatest chance of success is at first surgery

Question 7

Suggest the radial margin for excision

Answer 7

Range from 1mm upto 3cm (occasionally 5cm) depending on tumour type

Question 8

What shape resection should I avoid using

Answer 8

Cone shaped

Question 9

What is Scar resection

Answer 9

Assume all scars contain neoplastic tissue and take appropriate margins around them

Question 10

Types of resection of skin tumours

Answer 10

Marginal resection
Local resection
Wide local resection
Radical resection

Question 11

What type of resection should I use for lipomas

Answer 11

Marginal resection

Question 12

What type of resection should I use for mammary tumours/Histiocytomas

Answer 12

Local resection

Question 13

What type of resection should I use for mast cell tumours/sarcomas

Answer 13

Wide local resection

Question 14

What type of resection should I use for Feline injection site sarcomas

Answer 14

Radical resection

Question 15

What is the typical margin for marginal resection

Answer 15

1-2mm margin

Question 16

What is the typical margin for local resection

Answer 16

1cm radial margin
Deep margin – down to next fascial plane (not through)

Question 17

What is the typical margin for Wide local resection

Answer 17

2-3cm radial margin
Excise 1 deep fascial plane

Question 18

What is the typical margin for Radical resection

Answer 18

Whole limb amputation
3-5cm radial margins
1-2 deep fascial planes

Question 19

Suggest diseases of cancer that amputation may be appropriate

Answer 19

Limb osteosarcoma
Digit scc/melanoma

Question 20

What to excise if a tumour is inside an organ

Answer 20

Excise whole lobe or organ