Oncological Surgery Flashcards
What does oncological surgery aim to achieve? (5)
Diagnosis, Prevention of spread, Cure, Comprehensive therapy (with chemo) & Palliative Therapy
What are the advantages of oncological surgery as treatment for cancer?
immediate cure, no toxic effects, not immunosuppressive
What are the disadvantages of oncological surgery as treatment for cancer?
Local cure only, Change in cosmesis (appearance of patient), Change in function
What four things must we do to prepare for oncological surgery? (4)
Histological diagnosis
Extent of local disease
Presence of local or distant metastasis
Nutritional Status of patient
Why is it so important to get oncological surgery right the first time?
Untreated tumours have normal regional anatomy which facilitates removal but recurrent tumours have already been interrupted and therefore seeded into previously non involved plane, will have bigger margins and be more unpredictable
also less tissue available in 2nd surgery so closure is more difficult!
The most active and invasive part of the tumour are ….
at the periphery
Would we biopsy a tumour of the thyroid?
No- this area is very vascularised so risks heavy bleeding
What methods can we use to biopsy?
Needle biopsy- FNA, or Core
Incisional- surgical or punch
Excisional biopsy
What’s the difference between an excisional and incisional biopsy?
Excisional- gets rids of entire mass so only done for benign tumours
Incisional- part of normal tissue and part of the mass
In an excisional biopsy, to what skin layer do we aim to remove?
Aims for large margins so cut past fascia plane and into the muscle (even if tumour is just in subcutaneous layer)
What do we preserve biopsy samples in?
10% formalin at a volume ratio of 10:1 (formalin:tumour)
During oncological surgery we should avoid entering the ….
Why?
Pseudocapsule- contains tumour cells so avoid the spread
During surgery you find an adhesion between the tumour and normal tissue, what do you do?
Resect with a good sized margin as adhesions may represent tumour invasion
What are the pros and cons of controlling the veins first in oncological surgery?
Helps prevent venous emboli and nothing unwanted entering the circulation BUT things can still spread via the lymphatics and you risk organ swelling due to venous build up
What are the pros and cons of controlling the arteries first in oncological surgery?
Helps prevent haemorrhage and organ congestion BUT a reduced arterial supply reduces the venous outflow
What do we mean by sentinel lymph node?
The lymph node that immediately drains the area where the tumour is
When would we remove the regional lymph node? (3)
If the…
Lymph node positive for tumour
Lymph node grossly abnormal at surgery
Lymph node is attached to the excised tissue
When would we NOT remove the regional lymph node?
Lymph node is critical to adjacent tissue or if uncertain whether its positive for a tumour
What histological information do we need to provide for an Excisional biopsy lab analysis? (5)
- Type of tumour
- Grade
- Regional lymph node status
- Margins
- Vascular or lymphatic invasion (metastasis)
How do we know where the margins should be during an excisional biopsy?
Finger like projections will show satellite metastases- aim for 1-3 cm around that OR up to Fascia (muscle) as that provides a natural barrier to tumour growth
What is the Pseudocapsule?
a zone of compressed tissue around the tumour containing viable tumour cells
What three areas are of concern when it comes to oncological surgery and metastasis and why?
Platysma (head)
Pectorals
Biceps femoris
in these areas there’s either not enough tissue to remove an adequate margin or no fascia
Local excision tumour removal is used for….
benign tumours or those with no local invasion- allows tumour to be removed through natural capsule
When would we use a radical excision for a tumour?
When we need the margin to extend into fascial planes undisturbed by the tumour e.g. in cases of malignancy
What is a compartmental excision?
tumour is removed in an intact anatomic compartment
