L17: Surgical Oncology (Boston) Flashcards
Three Little Questions***
1) What is it?
2) Where is it? (staging)
3) How bad is it? (prognosis, tx options)
How to determine what it is
- FNA
- Tru-cut biopsy
- incisional biopsy (takes very small sample)
- excisional biopsy
- presumptive diagnosis`
When and why is incisional biopsy done?
- FNA nondiagnostic or non exfoliating
- easy access to mass (externally or via U/S)
- diagnosis and/or grade will change the definitive surgery done
how is incisional biopsy done?***
Needle-Core Biopsy -tru-cut biopsy -Jamshidi biopsy Wedge Biopsy Punch Biopsy ***Principle: the structure of the tumor remains intact. No seeding of the tumor or disruption of fascial planes around the tumor
Tru-cut Biopsy method
- (takes small amt. of core tissue)
- sedation and local anesthesia
- high accuracy rate
- low complication rate
- take multiple samples to improve diagnostic accuracy
Incisional biopsy technique
- wedge or punch biopsy
- sedation w/ local anesthesia or general anesthetic
- aseptic technique
- goal = achieve a histological dx w/ minimal disruption of the mass
- don’t worry about getting junction of normal and abnormal tissue; this may seed tumor into normal tissue!
- go deep, not wide
- don’t aim for center either - may get necrotic material
Wide vs. Marginal Excisional Biopsy
Marginal or Wide:
- Marginal: doesn’t disrupt fascial planes, but may need to come back for wide definitive excision
- Wide: cuts with curative intent
Principles of Excisional Biopsy
- dx will not change the surgical procedure for certain things: ie splenic mass, pulmonary mass, primary bone tumor. The bottom line is they need to be resected!
- high likelihood of incomplete resection
- tissue architecture destroyed
- complete surgical resection more difficult
- recurrent tumors may be more aggressive
Principles of Primary reexcision
-wide excision of the scar including a fascial plane deep
which more important: histologic description or diagnosis?
description
-grade helps us to predict the biological behavior of the tumor
What is STAGE?***
- extent of a cancer in the body
- size of the tumor
- regional LNs contain cancer
- distant spread (mets)
- determined w/ Rads, U/S, CT, MRI
What is GRADE?***
microscopic variables:
- degree of differentiation
- mitotic index
- % necrosis
- invasion of lymphatic or blood vessels
plan is based on what factors
diagnosis
stage of disease
owner’s goals
patient’s overall health
what are the goals of different surgical doses?***
Intralesional excision: palliative
Marginal excision: palliative/curative potential (esp. if combined with radiation)
Wide excision: curative potential (2-3cm margins with fascial layer underneath)
Radical Excision: curative potential (removes an anatomic segment)
Intralesional excision
- residual gross tumor left behind
- “shell out”
- goal is generally palliation
- can consider this approach prior to radiation in certain circumstances
- local control not possible
- recurrence is a certainty
- MACROscopic tumor left behind
