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General Surgery > Formulas and Staging > Flashcards

Formulas and Staging Flashcards

1
Q

Compute for Nitrogen balance.

A

(Nin- Nout) = (protein/6.25) - (24hour urine N + 4g)

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2
Q

Compute for the protein requirement in burn patients.

A

1 to 1.5 g/kg/d + (3 g × %burn)

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3
Q

Compute for the calorie requirement in burn patients.

A

25 kcal/kg/d + (30 kcal/d × %burn)

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4
Q

Determine the excision margin needed in melanomas by T stage (depth).

A

EXCISION MARGIN OF MELANOMAS
T1
Depth of invasion <1mm
Margin 1cm

T2
Depth of invasion 1-2mm
Margin 1cm

T3
Depth of invasion 2.01-4mm
Margin 2cm

T4
Depth of invasion >4mm
Margin 2cm

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5
Q

AJCC Staging for Soft Tissue Sarcoma of the Head and Neck?

A

Tx: Primary tumor cannot be assessed
T1: ≤2 cm
T2: >2 cm to ≤4 cm
T3: >4cm
T4: Invasion of adjoining structures
- T4a: Tumor with orbital invasion, skull base/dural invasion, invasion of central compartment viscera, involvement of fascial skeleton, invasion of pterygoids
- T4b: With brain parenchymal invasion, carotid artery encasement, prevertebral muscle invasion, or CNS involvement via perineural spread.

N0: No regional LN or unknown LN status
N1: Regional lymph node metastasis

M0: No distant metastasis
M1: Distant metastasis

GX: Grade cannot be assessed
G1: Total differentiation, mitotic count and necrosis score of 2 or 3
G2: Total differentiation, mitotic count and necrosis score of 4 or 5
G3: Total differentiation, mitotic count and necrosis score of 6, 7, or 8

Tumor Differentiation:

1: Sarcomas closely resembling normal adult mesenchymal tissue (e.g., lowgrade leiomyosarcoma)
2: Sarcomas for which histologic typing is certain (e.g., myxoid/round cell liposarcoma)
3: Embryonal and undifferentiated sarcomas, sarcomas of doubtful type, synovial sarcomas, soft tissue osteosarcoma, Ewing Sarcoma/primitive neuroectodermal tumor (PNET) of soft tissue

Mitotic Count:

1: 0-9 mitoses per 10 HPF
2: 10-19 mitoses per 10 HPF
3: ≥20 mitoses per 10 HPF

Tumor Necrosis

0: No necrosis
1: <50% tumor necrosis
2: ≥50% tumor necrosis

STAGING
Stage I (Low-grade)
Stage IA: T1 N0 M0 G1,GX
Stage IB: T2-T4 N0 M0 G1,GX

Stage II (Mod-high grade, ≤2 cm)
Stage II: T1 N0 M0 G2,G3

Stage III (Mod-high grade, >2cm)
Stage IIIA: T2 N0 M0 G2,G3
Stage IIIB: T3-T4 N0 MO G2,G3

Stage IV (Concurrent Mets)
Any T N1 M0 Any G
Any T Any N M1 Any G

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6
Q

AJCC Staging for Sarcoma of the Trunk and Extremities?

A 
Tx: Primary tumor cannot be assessed
T1: ≤5 cm
T2: >5 cm to ≤10 cm
T3: >10 cm to ≤15 cm
T4: >15 cm

N0: No regional LN or unknown LN status
N1: Regional lymph node metastasis

M0: No distant metastasis
M1: Distant metastasis

GX: Grade cannot be assessed
G1: Total differentiation, mitotic count and necrosis score of 2 or 3
G2: Total differentiation, mitotic count and necrosis score of 4 or 5
G3: Total differentiation, mitotic count and necrosis score of 6, 7, or 8

Tumor Differentiation:

1: Sarcomas closely resembling normal adult mesenchymal tissue (e.g., lowgrade leiomyosarcoma)
2: Sarcomas for which histologic typing is certain (e.g., myxoid/round cell liposarcoma)
3: Embryonal and undifferentiated sarcomas, sarcomas of doubtful type, synovial sarcomas, soft tissue osteosarcoma, Ewing Sarcoma/primitive neuroectodermal tumor (PNET) of soft tissue

Mitotic Count:

1: 0-9 mitoses per 10 HPF
2: 10-19 mitoses per 10 HPF
3: ≥20 mitoses per 10 HPF

Tumor Necrosis

0: No necrosis
1: <50% tumor necrosis
2: ≥50% tumor necrosis

STAGING
Stage I (Low-grade)
Stage IA: T1 N0 M0 G1,GX
Stage IB: T2-T4 N0 M0 G1,GX

Stage II (Mod-high grade, ≤5 cm)
Stage II: T1 N0 M0 G2,G3

Stage III (Mod-high grade, >5cm)
Stage IIIA: T2 N0 M0 G2,G3
Stage IIIB: T3-T4 N0 MO G2,G3

Stage IV (Concurrent Mets)
Any T N1 M0 Any G
Any T Any N M1 Any G

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7
Q

AJCC Staging for Sarcoma of the Abdomen and Thoracic Visceral Organs?

A

Tx: Primary tumor cannot be assessed
T1: Organ confined
T2: Tumor extension into tissue beyond organ
- T2a: Invades serosa or visceral peritoneum
- T2b: Extension beyond serosa (mesentery)
T3: Invades another organ
T4: Multifocal involvement
- T4a: Multifocal (2 sites)
- T4b: Multifocal (3-5 sites)
- T4c: Multifocal (>5 sites)

N0: No regional LN or unknown LN status
N1: Regional lymph node metastasis

M0: No distant metastasis
M1: Distant metastasis

GX: Grade cannot be assessed
G1: Total differentiation, mitotic count and necrosis score of 2 or 3
G2: Total differentiation, mitotic count and necrosis score of 4 or 5
G3: Total differentiation, mitotic count and necrosis score of 6, 7, or 8

Tumor Differentiation:

1: Sarcomas closely resembling normal adult mesenchymal tissue (e.g., lowgrade leiomyosarcoma)
2: Sarcomas for which histologic typing is certain (e.g., myxoid/round cell liposarcoma)
3: Embryonal and undifferentiated sarcomas, sarcomas of doubtful type, synovial sarcomas, soft tissue osteosarcoma, Ewing Sarcoma/primitive neuroectodermal tumor (PNET) of soft tissue

Mitotic Count:

1: 0-9 mitoses per 10 HPF
2: 10-19 mitoses per 10 HPF
3: ≥20 mitoses per 10 HPF

Tumor Necrosis

0: No necrosis
1: <50% tumor necrosis
2: ≥50% tumor necrosis

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8
Q

AJCC Staging for Gastrointestinal Stromal Tumor (GIST)?

A 
Tx: Primary tumor cannot be assessed
T0: No evidence of primary tumor
T1: ≤2 cm
T2: >2 cm to ≤5 cm
T3: >5 cm to ≤10 cm
T4: >10 cm

N0: No regional LN or unknown LN status
N1: Regional lymph node metastasis

M0: No distant metastasis
M1: Distant metastasis

Grading for GIST is based on mitotic rate
Low: ≤5 mitoses per 5mm^2, or per 50hpf
High: >5 mitoses per 5mm^2, or per 50hpf

Staging
Gastric GIST (Also: Omentum)
Stage IA: T1-T2 N0 M0, Low MR
Stage IB: T3 N0 M0, Low MR

Stage II: T1-T2 N0 M0, High MR
T4 N0 M0, Low MR

Stage IIIA: T3 N0 M0, High MR
Stage IIIB: T4 N0 M0, High MR

Stage IV: Any T, N1 M0, Any MR
Any T, Any N, M1, Any MR

Small Intestinal GIST (Also: Esophagus, colorectal, mesenteric, peritoneal)
Stage I: T1-T2 N0 M0, Low MR

Stage II: T3 N0 M0, Low MR

Stage IIIA: T1 N0 M0, High MR
T4 N0 M0, Low MR

Stage IIIB: T2-T4 N0 M0, High MR

Stage IV: Any T, N1 M0, Any rate
Any T, Any N, M1, Any rate

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9
Q

AJCC Staging for Sarcoma of the Retroperitoneum?

A 
Tx: Primary tumor cannot be assessed
T1: ≤5 cm
T2: >5 cm to ≤10 cm
T3: >10 cm to ≤15 cm
T4: >15 cm

N0: No regional LN or unknown LN status
N1: Regional lymph node metastasis

M0: No distant metastasis
M1: Distant metastasis

GX: Grade cannot be assessed
G1: Total differentiation, mitotic count and necrosis score of 2 or 3
G2: Total differentiation, mitotic count and necrosis score of 4 or 5
G3: Total differentiation, mitotic count and necrosis score of 6, 7, or 8

Tumor Differentiation:

1: Sarcomas closely resembling normal adult mesenchymal tissue (e.g., lowgrade leiomyosarcoma)
2: Sarcomas for which histologic typing is certain (e.g., myxoid/round cell liposarcoma)
3: Embryonal and undifferentiated sarcomas, sarcomas of doubtful type, synovial sarcomas, soft tissue osteosarcoma, Ewing Sarcoma/primitive neuroectodermal tumor (PNET) of soft tissue

Mitotic Count:

1: 0-9 mitoses per 10 HPF
2: 10-19 mitoses per 10 HPF
3: ≥20 mitoses per 10 HPF

Tumor Necrosis

0: No necrosis
1: <50% tumor necrosis
2: ≥50% tumor necrosis

STAGING
Stage I (Low-grade)
Stage IA: T1 N0 M0 G1,GX
Stage IB: T2-T4 N0 M0 G1,GX

Stage II (Mod-high grade, ≤5 cm)
Stage II: T1 N0 M0 G2,G3

Stage III (Mod-high grade, >5cm)
Stage IIIA: T2 N0 M0 G2,G3
Stage IIIB: T3-T4 N0 MO G2,G3

Stage IV (Concurrent Mets)
Any T N1 M0 Any G
Any T Any N M1 Any G

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10
Q

AJCC Clinical Staging for Cutaneous Melanoma?

A

TX: Primary tumor thickness cannot be assessed (diagnosis by curettage)

T0: No evidence of primary tumor

Tis: Melanoma in situ

T1: ≤1 mm, unknown/unspecified

  • T1a <0.8mm, without ulceration
  • T1b <0.8mm, with ulceration
    0. 8-1.0mm, with/without ulceration

T2: >1.0–2.0mm, unknown/unspecified

  • T2a >1.0–2.0mm, without ulceration
  • T2b >1.0–2.0mm, with ulceration

T3: >2.0-4.0mm, unknown/unspecified

  • T3a >2.0-4.0mm without ulceration
  • T3b >2.0-4.0mm with ulceration

T4: >4.0mm, unknown/unspecified

  • T4a >4.0mm, without ulceration
  • T4b >4.0mm, with ulceration

NX: Regional nodes not assessed (SLNB not done, LN previously removed)
*Exception: when there are no clinically detected regional mets in a pT1 cM0 melanoma, assign cN0 instead of pNX

N0: No regional mets detected

N1: One tumor involved node, or in-transit, satellite and/or microsatellite mets with no tumor-involved nodes)

  • N1a one clinically occult (ie, by SLN biopsy)
  • N1b one clinically detected
  • N1c No regional lymph node disease (+in-transit, satellite and/or microsatellite metastases)

N2: Two or three tumor-involved nodes, or in-transit, satellite, and/or microsatellite metastases with one tumor-involved node

  • N2a Two or three clinically occult (ie by SLN biopsy)
  • N2b Two or three, at least one of which was clinically detected
  • N2c One clinically occult or clinically detected (+in-transit, satellite and/or microsatellite metastases)

N3: Four or more tumor-involved nodes or in-transit, satellite, and/or microsatellite metastases with two or more tumor-involved nodes, or any number of matted nodes without or with in-transit, satellite, and/or microsatellite metastases

  • N3a Four or more clinically occult (ie, detected by SLN biopsy)
  • N3b Four or more, at least one of which was clinically detected, or presence of any number of matted nodes
  • N3c Two or more clinically occult or clinically detected and/or presence of any number of matted nodes (+in-transit, satellite and/or microsatellite metastases)

M0: No evidence of distant mets

M1: Evidence of distant mets

  • M1a Distant mets to skin, soft tissue including muscle, and/or nonregional lymph node
  • -M1a (0) Normal LDH
  • -M1a (1) Elevated LDH
  • M1b Distant metastasis to lung with or without M1a sites of disease
  • -M1b (0) Normal LDH
  • -M1b (1) Elevated LDH
  • M1c Distant metastasis to non-CNS visceral sites with or without M1a or M1b sites of disease
  • -M1c (0) Normal LDH
  • -M1c (1) Elevated
  • M1d Distant metastasis to CNS with or without M1a, M1b, or M1c sites of disease
  • -M1d (0) Normal LDH
  • -M1d (1) Elevated LDH

Stage 0: Tis N0 M0

Localized Disease with No Evidence of Metastases:
Stage IA: T1a N0 M0
Stage IB: T1b-T2a N0 M0
Stage IIA: T2b-T3a N0 M0
Stage IIB: T3b-T4a N0 M0
Stage IIC: T4b N0 M0

Regional Disease
Stage III: Any T, Tis ≥N1 M0

Distant Metastatic Disease
Stage IV: Any T, Any N, M1

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11
Q

Compute for sodium deficit.

A

(normal serum sodium − observed serum sodium) × 0.6 × (total body weight)

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General Surgery (34 decks)

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