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Surgery > oncology 1 > Flashcards

oncology 1 Flashcards

1
Q

cancer staging tells us what? determined by what?

A

 Extent of disease
 Determined (mostly) based on
preoperative evaluation
 Lymph nodes
 Lungs
 Other

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2
Q

cancer grading tells us what? requires what and associated with what?

A

 Determination of tumour behaviour
 Requires histopathology
 CANNOT be determined on cytology
 Associated with propensity to spread elsewhere vs. local aggressiveness

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3
Q

how many FNA slides should we make? how deep should we go into the lump?

A

at least 5 (8-12 not unusual !!!)
 2-3 separate collections- different areas
 Pass needle through 2/3 of the thickness

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4
Q

how do we avoid blood dilution with FNA?

A

¡ Don’t use large bore needle
¡ 22-gauge maximum !

¡ Don’t over-aspirate
¡ if you see it, it’s blood

¡ Imprints: blot blood off of tissue first
¡ make it stick

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5
Q

characteristics of round cell tumours

A

round cell tumours
 Lymphoma (LSA), Mast cell tumour (MCT), histiocytoma, plasma cell tumour, melanoma, transmissible venereal tumour (TVT)

 Usually exfoliate well
> Solid tissue aspirates usually highly cellular
> Neoplastic cells often are in effusions

 Usually can get a specific dx (tumour type)

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6
Q

characteristics of epithelial cell tumours

A

 i.e. Carcinoma
 Usually exfoliate well
> Aspirates of solid tissue usually exfoliate well
> +/- in effusions

 How specific a diagnosis?
> benign (normal/hyperplastic/adenoma) vs. malignant (carcinoma)
> sometimes specific cell type

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7
Q

mesenchymal tumour characteristics

A

 i.e. Sarcoma
 Often exfoliate poorly
> solid tissue aspirate may be acellular
>virtually never exfoliate in effusions

-usually need histology to determine exact tumour type

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8
Q

pros and cons of biopsy

A

PROS
-better planning
-definitive Dx enables pre-op radiation

CONS
-two procedures
>progression while waiting to do definitive sx
-increased risk of local recurrence

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9
Q

when to biopsy

A

 If you cannot get a definitive answer from cytology alone
 If the grade of the tumour would affect the treatment elected
>esp in areas where wide surgical margin will be hard to obtain

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10
Q

when not to biopsy

A

 If you can get a definitive answer off cytology alone (eg: MCT) and surgical approach would not be affected by histopathology
 If you are unsure of surgical approach and biopsy may compromise curative intent procedure

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11
Q

incisional vs excisional biopsy definitions

A

incisional - take a piece of the tumour to get a diagnosis

excisional - remove the entire tumour with a narrow margin of normal tissue (leave fascial plane intact)

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12
Q

advantages and limitations of incisional biopsy

A

 Advantages:
> Won’t change definitive surgical margins
> Doesn’t decrease the chance of a clean cut (if taken properly!)

 Limitations:
> Second surgery required in all instances (including benign disease)

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13
Q

advantages and limitations of excisional biopsy

A

 Advantages:
> potentially curative with benign
disease

 Limitations:
> Increases re-cut margin if malignant
> Can decrease chances of clean cut
- First cut is always likeliest cure!

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14
Q

should we typically do incsional or excisional biopsies? when is each appropriate? what should we do first in either case?

A

 INCISIONAL biopsy should be performed rather
than excisional biopsy in all cases, except:
> Very small cutaneous masses <1cm
> Unable to get larger margin regardless of surgery (e.g. splenectomy)

 Should NOT be performed without cytology first (particularly when excisional)

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15
Q

methods for an incisional biopsy

A

 Wedge/ Keyes punch
 Core/Tru-cut needle biopsy

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16
Q

methods for an excisional biopsy

A

 Surgical excision
 Keyes punch

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17
Q

what is a Wedge/Keyes Punch? how do we take the biopsy? benefits and limitations?

A

 Take at the centre (avoid necrosis) NOT
periphery
 Benefit: Large samples
 Limitation: Generally requires anesthesia
 Biopsy tract needs to be taken at definitive surgery

 Can be used for incisional biopsy (in the centre of the mass)
OR
 Excisional biopsy (for very small lesions)

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18
Q

what is a core/tru-cut needle biopsy? where do we use it? benefits and drawbacks?

A

Core/Tru-cut Needle Biopsy
 Large tumours that would be difficult to get deep enough to obtain a sample
 Benefit: Can be done under sedation
 Limitation: Small samples

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19
Q

do properly performed biopsies increase the likelihood of future metastasis?

A

no

20
Q

current therapies for cancer treatment in pets

A

 Surgery
 Radiation therapy
 Chemotherapy
 Investigational

21
Q

surgical considerations for tumour removal

A

 Minimize the handling of the tumour
 Ligate the venous side first
 Change gloves, instruments & towels
 Lavage

22
Q

what happens after excision that makes the defect appear larger?

A

tissues will retract

23
Q

current treatment therapies for cancer in pets

A

 Surgery
 Radiation therapy
 Chemotherapy
 Investigational

24
Q

what simple tool can help you plan a surgical excision?

A

sterile marker

25
Q

anatomy of a tumour from outsde in

A

-normal tissue (eg. muscle) > may contain skip metastasis
-reactive zone > may contain satellite tumours
-pseudocapsule
-tumour

26
Q

what is the pseudocapsule?

A

compressed neoplastic cells encapsulating the tumour

27
Q

what is the reactive zone?

A

reactive host cells surrounding the tumour

28
Q

what is a satellite tumour?

A

neoplastic cells outside the pseudocapsule

29
Q

what is a skip metastasis?

A

rare. Neoplastic cells distant to the tumour (in the same compartment)

30
Q

types of surgical excisions. which have curative intent?

A

-intracapsular
-marginal

curative intent:
-wide
-radical

31
Q

what is an intracapsular excision? when should it be performed?

A

 No margins
 Should only ever be performed with benign disease
 Leaving gross disease behind
> Lipoma
> Bone cyst

32
Q

what is a marginal excision? when should it be performed?

A

 Minimal margins
 Leaving microscopic disease behind
> Benign tumours
> certain locations

-take out pseudocapsule

33
Q

what is a wide excision? when do we do it?

A

 Curative intent
 Does not address skip metastases

-take out reactive zone

34
Q

what margins do we need to consider with a surgical tumour excision?

A

both deep and lateral

35
Q

how do we define our margins for a wide surgical excision?

A

Lateral Margins
 Metric
 Based on distance from the peripheral edge of the tumour
 Typically 1-3cm depending on the tumour type

 Skin incision first
 Then extend deep and evenly (as if you are
coring an apple!) until you reach the fascial plane
 Continue incision at same margin through the fascial plane

36
Q

in terms of tumour excisions, what is a fascial plane?

A

 Deep margin
 Barrier to tumour penetration
 “sheaths, sheets or other dissectible connective tissue aggregations visible to the unaided eye”Wendell-Smith 1997
 Tumour should be moveable above it
 Lack of fascial plane is most common reason for a“dirty margin”

37
Q

practically, what is a fascial plane made of?

A

 Barrier to tumour invasion
 Practically…
 Fascia
 Tendon/ligament
 Muscle
 Bone

38
Q

what do available fascial planes vary with?

A

-location
>distal limbs have limited fascial planes
>junction of fascial planes can be challenging

39
Q

what type of incision can improve cosmesis? what are drawbacks?

A

 Elliptical excision may improve cosmesis
> Beneficial in instances of palliation
 HOWEVER
> Extends cancer field
> Not recommended for malignant lesions

40
Q

to drain or not to drain, after tumour excision?

A

 Seroma/hematoma can disperse residual tumour cells
 HOWEVER – use of drains increases the cancer field
> AVOID if possible
> If necessary locate in area that can be easily resected or included in RT field

41
Q

what is a radical excision?

A

 Removes entire compartment
 Prevents any chance of local recurrence
> Amputation
> Splenectomy
> Lung lobectomy

42
Q

what should we do with excised tumours?

A

 ALL TUMOURS SHOULD BE SUBMITTED OR SAVED
 Submit the whole thing, not just a piece
 Submit samples in formalin 10:1
 If the sample is too large for formalin- call your lab for advice

43
Q

when submitting a sample, what should we include? how should we prepare it?

A

 Concise, accurate history
 Maintain proper orientation of tissue:
> Provide a drawing
> Place a suture on a specified margin
 Ink your lateral and deep margins
 Do not incise the surgical margin
 Fixative incisions “bread-loafing” through tumour boundaries that will not confuse the pathologist

44
Q

how to ink your sample

A

 Typically 2 colours
> Lateral margins
> Deep margin
 Best to ink your deep margin directly below the tumour

45
Q

what is a clean vs dirty excision?

A

clean - no tumour cells contact the margins
dirty - tumour cells contact the margins

Surgery (8 decks)

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