Oncology Flashcards
How is a tumour classified?
Benign vs malignant
tissue of origin
location
List the four categories of tumour
epithelial
mesenchymal
round cell
melanoma
What tumours can you get that are epithelial in origin?
Squamous cell carcinoma Adenoma/adenocarcinoma Basal cell carcinoma Carcinoma Begin lesions (warts, cysts,)
What tumours can you get from mesenchymal origin?
Lipoma/liposarcoma Fibroma/fibrosarcoma Haemangiosarcoma/haemangioma Leiomyoma/ leiomyosarcoma (soft tissue) Soft tissue sarcoma Begnin and malingnent nerve sheath tumour
what tumours can you get that are round cell in origin?
Lymphoma
Histiocytic tumours (mononuclear phagocytes)
Mast cell tumours
Plamactoma (monoclonal cells)
How should we deal with cuteanous and subcutaenous masses?
History
When did it occur, rate of growth, change in apperance, any other masses
FNA
biopsy
How do yo preform a FNA?
21g-23g needle
aspirate
submit cytology
aim for multiple angles
How and when should you preform a biopsy for masses?
Failure of FNA determines tumour grade Tru-cut biopsy Incisional biopsy excisional biopsy (entire abnormality removed)
What do we need to know before surgery of a mass?
Metastasis (chest radiographs) Type of tumour (Begin malignant) Cell type involved Tumour grading (TNM) T- size and extent of main tumour N_ the number of local lymph nodes M-metastasised
When assessing TNM what should we look at for T?
Size of tumour type of cell (Histological) rate of growth location local invasion Histological grade
When assessing TNM what must be considered for N?
Assess draining nodes
palpation
FNA
surgical biopsy
What should we look at when assessing metastasis in tumour grading?
Inflated lung radiographs
abdomen, lymph nodes, liver, spleen
bone skin brain
What must be considered before surgery to remove a mass?
Tumour type and grade
tumour stage
size and location
List the four common types of tumours
Mammary tumour
mast cell tumour
soft tissue sarcoma
lipoma
What are the five types of surgery that can be preformed on tumours?
Incisional biopsy
Debulking/ intracapsular recection
Excisional/ marginal excision
wide/oncological excision (resection margin)
Radical excision (removal of lymph nodes, blood supply adjacent structures)
What must you do when filling out a histopathology form?
Ink the margins the tumour was removed from
Positive-cancer cells lye within that margin
negative- no cancer cells are found within the ink
close margin anything that lie between the two
How do you close a tumour removal wound?
May require skin graft avoid too much tension may need drain to minimise dead space post-op adjuvent therapy radiation and chemo
What two types of drains can be used to minims dead space after tumour removal?
Passive-penrose
active-grenade, creates negative pressure
What are the intrinsic and extrinsic factors of wound breakdown?
Intrinsic-concurrent disease, nutrition
Extrinsic-chemotherapy, steroids, radiotherapy
Why does wound break down occur?
infection tension(dehiscence) Patient interference motion tissue handling/haemostasis sutures
What are the common areas that cause problems during wound healing?
distal limb
axilla /inguinal region
over boney prominences
consider axial pattern flaps
How should wound break down be managed?
do not re-suture
allow to heal via secondary intention
How do you prevent seroma formation after tumour removal?
Minimise dead space, drain Halstead principles rest leave alone pressure bandage provide further drainage
What are the seven halstead principles?
Limit tension Haemostasis gentle tissue handling preserve blood supply strict aspesis appose tissues accurately eliminate dead space
what should you do when a tumour wound becomes infected?
Swab, culture and sensitivity Anti-biotics increase drainage allow healing via secondary intention explore the wound
When does tumour recurrence occur?
Dirty margins
Revision surgery
radiotherapy
