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Oncology > Principles of Surgical Oncology > Flashcards

Principles of Surgical Oncology Flashcards

1
Q

Surgery for biopsy - Definition

A

Retrieval of cells or tissue from the tumour to allow -
Diagnosis & prognosis (grading and staging)
Indication of appropriate therapy
The owner to make a decision about treatment

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2
Q

Biopsy of: T, N or M

A
  • T: 1y tumour
  • N: Lymph node
  • M: Metastases
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3
Q

when to biopsy

A

If the treatment plan would be changed by the outcome - Type + extent of treatment (Sx vs chemotx vs radiotx), (conservative vs aggressive)
If the owner’s decision to treat would be changed - Tumour type & grade, Clinical stage & Prognosis
If lesion is in a “difficult” area - Head & neck, Distal limb

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4
Q

when not to biopsy

A

treatment plan would not be changed -Mammary masses, single large lung masses
No change in owner’s willingness to treat - Chest wall/limb sarcoma resection
biopsy is difficult - CNS mass lesions, Thyroid tumours, Small intestine tumours

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5
Q

key steps in tumour biopsy

A

biopsy at correct time i.e. early in the course of the disease
use correct technique
submit sample to experienced
read report carefully + speak to the pathologist

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6
Q

Reason for biopsy - Subcutaneous mass on the flank

A

Lipoma vs Mast cell tumour vs Soft tissue sarcoma

Differ in - Surgical margin + Prognosis

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7
Q

Reason for biopsy - Large cranial mediastinal mass

A

thymoma or lymphoma?

Differ in - Necessity for surgery + Prognosis

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8
Q

Reason for biopsy - Mandibular mass

A

Acanthomatous epulis vs fibrosarcoma vs melanoma

Differ in - Surgical margins + Prognosis (cure vs palliation)

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9
Q

information from biopsy

A

Definitive diagnosis of neoplasia
Aggressiveness of neoplasia (Benign/malignant)
Cytologic type of neoplasia (Round cell vs epithelial vs mesenchymal)
Histologic features (histological type +Grade of tumour)
Evaluation of metastases
assessment of margins

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10
Q

considerations for biopsy

A 
Pre-biopsy considerations 
Regional considerations 
Biopsy technique 
Which part of lesion to biopsy 
How to submit samples 
How to read the histology report
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11
Q

Biopsy Techniques

A 
needle
incisional 
excisional
core
punch
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12
Q

prophylactic surgery

A

Reduces the incidence of a particular tumour
Reduces the recurrence rate after treatment
Tissue removed may be - normal tissue: gonads or Abnormal tissue: pre-malignant change
Indications - Increased risk of tumour development, Confirmed dx of pre-malignant change or neoplasia, Surgical excision not associated with high morbidity

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13
Q

definitive excision

A

The use of surgery as the sole treatment, without
adjunctive therapy, to achieve an outright cure
The removal of all the tumour at one surgery
Indications - Localised disease, Regional metastases (occasionally)
N.B. Surgery may not remove 100% of tumour cells The immune response may remove the remainder

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14
Q

advantages of surgery

A 
Immediate cure 
Not carcinogenic 
No local toxic effects 
Not immunosuppressive 
Better for large masses
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15
Q

disadvantages of surgery

A

Local cure only
Change in cosmesis
Change in function

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16
Q

principles of surgical excision

A

establish a diagnosis by biopsy + plan surgery
perform surgery early in course of disease
1st surgery high highest success rate
adequate margins needed in 3 dimensions
margins of excision shouldn’t be compromised by concerns with closure

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17
Q

planning surgery

A

Histological diagnosis
Extent of local disease
Presence of local or distant metastasis
nutritional status of the patient

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18
Q

correct surgery 1st time

A

Untreated tumours have normal regional anatomy which facilitates removal
Recurrent tumours may have seeded into previously non-involved tissue planes making it difficult to predict tumour extension, hence a wider resection is required
most active & invasive parts of the tumour are at the periphery; incomplete excision leaves the aggressive cells behind
less normal tissue after previous surgery making closure more difficult

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19
Q

post-operative changes

A

Cosmetic appearance vs function
cosmesis is our concern, not the patient’s
explain with pictures & contact with other clients

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20
Q

common reasons for failure of definitive tumour excision

A

fail to plan surgery, usually due to lack of biopsy

fail to stick to plan, usually due to closure concerns

21
Q

margins of excision

A

“Normal” tissue around tumour infiltrated by tumour cells
Finger-like projections
Satellite metastases
“Skip” metastases
Removal of the tumour & a margin of normal tissue
The nature of the margin depends on the tumour
Margin given as - Distance e.g. 1-3 cm, Natural barrier to tumour growth e.g. fascia (esp sarcomas)

22
Q

pseudocapsule

A

A zone of compressed tissue around the tumour This zone contains viable tumour cells
Do not enter the pseudocapsule - Do NOT “shell-out”

23
Q

local excision

A

Tumour removed through natural capsule or immediate boundaries
Indications: Benign tumours & no local invasion, lipoma, histiocytoma, sebaceous adenoma
Preservation of adjacent tissue
Thyroid adenoma, CNS
Contraindications - Local invasion, Malignancy

24
Q

wide local excision

A

Tumour removed with substantial margin of normal tissue
Indications: Benign tumours/local invasion, Malignancy/limited local invasion
Contraindications - More invasive malignancies, Higher grade tumours

25
Q

radical excision

A

Margins extend into fascial planes undisturbed by tumour growth
Indications - Malignancy & local invasion

26
Q

4 types of radical excision

A

Radical local excision
compartmental excision
Muscle group excision
Amputation

27
Q

radical local excision

A

Tumour removed with extensive margins of tissue
including 1 or 2 fascial planes beyond gross tumour
Invasive sarcomas of the abdominal or chest wall - Chest or abdominal wall resection
Invasive carcinoma of the nasal planum - Nasal planum resection & premaxillectomy
Invasive tumours involving eyelids - Excision of eyelids & orbital contents
Invasive orbital/periorbital tumours - Orbitectomy

28
Q

compartmental excision

A

Tumour removed in an intact anatomic compartment

Indications - Invasive tumours involving limbs, Invasive tumours on the trunk

29
Q

muscle group excision

A

Tumour removed along with the muscle it involves
Indications - Small tumours involving muscle bellies, No breach of fascial plane, or breach which is
excised

30
Q

amputation

A

Tumour removed with the entire limb
Indications - Large tumours - other method not possible, If radical excision impairs function - bone/joint excision, Management of recurrences - disturbed fascial planes

31
Q

inadequate excision

A

leads to: Local recurrence, Persistence of tumour & increased chance of metastasis
Usually due to - Inadequate surgical plan (failure to biopsy), Failure to follow surgical plan (concerns re closure)
Options - Re-operate – wider margins, Adjunctive therapy, Radiotherapy, Chemotherapy

32
Q

preparation for histology

A

Anatomically relevant - Lay out as in vivo +/- sutures
Indicate margins of interest -Closest to tumour
Methods of marking margins - Suture tag, Paint with ink, Draw a picture to orientate
Provide a history - Relevant & detailed

33
Q

evaluation of the tissue

A

Not optional item
If worth removing - worth histopathology
not sole way of identifying the tumour - i.e. care with excisional biopsy – incomplete excision

34
Q

excisional histology info

A

Histological type of tumour - Confirms pre-op knowledge of tissue type
Histological grade of tumour - Mitotic index, differentiation, necrosis
Regional lymph node status - access
Staging of disease
Margins – adequacy of excision, Predicts local recurrence
Vascular or lymphatic invasion - Predicts distant metastasis

35
Q

evaluations of margins

A

False negative - Tumour present at margins - but not the one examined
False positive - Tumour present - but edge examined is not a margin
Specimen incorrectly oriented

36
Q

cytoreductive surgery - define

A

The planned incomplete removal of the tumour

To improve the efficacy of other modalities

37
Q

cytoreductive surgery - indications

A 
Essential structures (CNS tumours) 
Surgical management of recurrences 
Unknown tumour borders 
Local recurrence likely (SA distal limb) 
Highly malignant tumours 
Vaccine-associated sarcomas
38
Q

Adjunctive therapies - pre-op therapy

A

To reduce tumour bulk prior to surgery e.g. sarcoma

39
Q

Adjunctive therapies - intra-op therapy

A

To gain access to tumours e.g. bladder tumour

40
Q

Adjunctive therapies - post-op therapy

A

treat small no. of rapidly proliferating, well-oxygenated cells e.g. mast cell tumour

41
Q

Adjunct Treatments for Cancer

A 
chemotherapy 
radiation therapy 
immunotherapy 
hyperthermia 
photodynamic therapy
42
Q

chemotherapy

A

treat invasive or metastatic tumours not completely removed by surgery
used before or after surgery
debulk at least 90% of the tumour
potential complications-delayed wound healing, vomiting, diarrhoea, nephrotox., bone marrow
suppression

43
Q

radiation therapy

A

fractions of radiation directed at the tumour
used before, during or after surgery
shrink the tumour before or destroy any remaining cells after surgery
potential for early or late moist desquamation or ulceration of tissues

44
Q

immunotherapy

A

elements of the immune system used against
tumours
interleukins, cytokines, interferons, CSF, monoclonal antibodies
rapidly developing area of research to find very specific effect on tumours

45
Q

hyperthermia

A

hyperthermia used to destroy tumour cells that are sensitive to temperature changes
used locally or systemically
often combined with chemo. or radiation therapy
currently not a very practical method

46
Q

photodynamic surgery

A

the use of various wavelengths of light to destroy tumour cells
sensitising agents given to the patient are taken up by tumours cells
the tumour is exposed to light causing a reaction with the sensitising agent
the result is destruction of tumour cells

47
Q

Palliative surgery - Definition

A

Surgery performed to improve quality of life, for pain relief, improved function of the affected part, or to eliminate life-threatening complications
Consider balance between potential gain vs morbidity

48
Q

palliative surgery - indications

A

Tumour with metastasis

Complete excision impossible

49
Q

palliative surgery - examples

A 
Limb amputation for osteosarcoma 
Splenectomy for haemangiosarcoma 
Placement of a cystostomy catheter for TCC 
Removal of ulcerated mammary tumours 
Mandibulectomy for oral melanoma 
Pericardectomy

Oncology (5 decks)

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