Soft Tissue Surgery: Oncological Surgery Flashcards
What are the roles of surgery in managing cancer?
- Prophylaxis
- Biopsy- diagnosis
- Definitive/curative
- Palliative
- Cytoreduction followed by medical oncological treatment
- Treatment of metastasis
What propylactic surgery can be done for oncology?
Castration
* Prevents testicular neoplasia
* Not prostatic
Ovariohysterectomy
* Prevents ovarian and uterine neoplasia
* Reduces risk of developing mammary neoplasia
- What is FNA good and bad for?
- What are FNA advantages?
Good- epithelial, MCT
Poor- mesenchymal- fibrosarcoma
Adv- less invasive, fast, interpretation less expensive
- What is an incisional biopsy?
- When doing an incisional biopsy what should not be compormised?
- Why doe soft tissue masses need to be deep?
- Why do bone tumours nees to be deep?
- Part of mass excised for histopath
- Position for definitive surgery
- Centre may be necrotic- include normal tissue margin
- Peripheral bone may be reactive
- What is an exisional biopsy
- When is it appropriate?
- When should it be avoided?
- Whole mass removed
- Benign masses, small masses
- Avoid as first line surgery without prior diagnosis
- What is a surgical margin?
- What is the ‘metric’ approach?
- What is the ‘barrier’ approach?
- What is the hybrid approach?
- Region of tissue excised as part of an excisional biopsy
- Margin of tissue excised measured by distance from primary tumour in three dimensions- lateral and deep
- Use of tumour resistant anatomic boundaries to create an excisional margin
- Both- 2cm lateral margins, 1 deep intact fascial plane
What are the following types of exision?:
1. Intra-lesional
2. Marginal
3. Wide margin
4. Radical
- Piecemeal removal of neoplastic tissue- macroscopic remains
- En bloc exision on pseudocapsule- microscopic may remain
- All neoplastic tissue excised- no residual
- En bloc removal of tissue/organ compartment-no residual
Must confirm against histopathological margin assessment
What determines the type of excision performed?
The intent of the surgery
* Curative
* Palliative
What is the positive and negative of curative, marginal and cytoreductive surgery?
Curative- radical excision, wide excision
* +ve- complete removal of neoplastic tissue
* -ve- geater surgical dose
Marginal excision
* +ve Lower surgical dose
* -ve margin may be incomplete
Cytoreductive- debulking
* +ve lower surgical dose
* -ve neoplastic tissue will remain
What does the amount of tissue resection depend on?
- Tumour type and grade
- Tumour size
- Biological behaviour
- Local tissue barriers/fascial planes
When is marginal excision appropriate?
- Removal of lipoma
- Preservation of a key local anatomy
- Removal of a malignant tumour
Higher risk of incompletely excised tumours
What is the purpose of palliative surgery?
- To improve qualirt of life in short term
- Removal of tumour burden may restore or maintain QoL until euthanasia is inevitable
What should be done following surgical excision?
- Submit all excised tissue for histopathology
- Consider inking the deep margin to aid assessment
- Consider sutures to help orientate the excised tissue
What do histopathological reports tell you after excision?
- Tissue diagnosis
- Markers of malignancy
- Margin assessment
- Grade
- Prognosis
- Further advised tests
What are the three surgical margin assessments?
Complete
* No neoplastic cells 3-5mm of tumour margin
* Margin contains normal tissue
* Benign- curative, Malignent- reduces risk of recurence
Complete but narrow
* Neoplastic cells < 3mm from surgical margin or margin does not contain normal tissue beyond pseudocapsule
Incomplete
* Tumour cells within edges of surgical margin
* Monitor for recurrence
