Pre-Op Assessment of the Patient

Question 1

Describe the recommended approach to the cancer patient using the “3 Questions”

Answer 1

1. What is it?
   - cytologic/histologic dx
   - FNA is best tool we have! if it doesn’t tell you, then BIOPSY
2. Where is it?
   - clinical staging: rads, US, cytology, biopsy
3. How bad is it?
   - histologic grading, local anatomy
   - low grade = less bad
   - high grade = bad

Question 2

Describe the term “optimum treatment pathway”

Answer 2

The best treatment pathway in an individual cancer patient that provides:

• optimal local tumor control
• minimal risk of spread of disease
• minimal morbidity
• best QOL
• minimal trauma or hospitalization

Question 3

Explain why the 1st sx to remove a tumor has the best chance for cure

Answer 3

• tumor bed is the smallest
• normal tissue planes are still intact
• most aggressive pop of cells are at periphery
• most tumors have a pseudocapsule –> don’t be fooled!

Question 4

Benign tumors

Answer 4

• expansile growth
• non-invasive
• slow growing
• encapsulated
• differentiated
• non-metastatic

Question 5

Malignant tumors

Answer 5

• invasive growth pattern
• rapidly growing
• ulceration
• non-encapsulated
• undifferentiated
• capable of metastasis

Question 6

Epithelial tumors

Answer 6

exfoliate well

aggregates, clusters or rafts

Question 7

Round cell tumors

Answer 7

exfoliate well

individual cells

varying degrees of anaplasia

Question 8

Mesenchymal tumors

Answer 8

exfoliate poorly

spindle cells

Question 9

Paraneoplastic Syndromes

Answer 9

• cachexia
• hypercalcemia
• anemia
• hypoglycemia
• monoclonal gammopathy
• fever
• hormonal imbalance

Question 10

Therapeutic Options

Local vs systemic dz

Answer 10

Local:

• sx
• radiation therapy
• cryotherapy
• local hyperthermia

Systemic:

• chemotherapy
• immunotherapy