Surgery

Question 1

What does multimodal management consist of?

Answer 1

• endoscopic
• surgical
• chemotherapy
• radiotherapy
• physiotherapy
• nutritional support
• CNS & palliative care team

Question 2

What is addressed in an MDT meeting?

Answer 2

• presentation
• radiology
• pathology
• treatment options
• co-morbidity
• trials
• data management and audits

Question 3

What are the national targets of the patient pathway?

Answer 3

• 2 week SOPD for urgent referrals

- 62 days to treatment

Question 4

What is SOPD?

Answer 4

surgical outpatient department

Question 5

How may a patient first be diagnosed with cancer?

Answer 5

• open access endoscopy
• GP urgent referrals with alarm symptoms
• emergency symptoms (bleeding)
• incidental findings (screenings)

Question 6

What is the typical patient pathway for a GI patients?

Answer 6

• diagnosis
• 1st GI MDT Meeting
• 2 specialist clinics (surgical and oncology)
• neoadjuvant therapy (before surgery radiotherapy/oncological therapy)
• re-staging CT/PET at 2nd GI MDT meeting
• surgery in 3 months from diagnosis

Question 7

What is cancer surgery involved with?

Answer 7

• diagnosis (biopsy)
• staging (laparoscopy)
• treatment (primary cure)
• reconstruction (breast reconstruction after mastectomy)
• palliation (tumour debulking)
• resection (local recurrence and metastasis cure)

Question 8

What are the requirements of biopsy?

Answer 8

• select appropriate method and site
• ensure tissue reaches pathologist timely and properly
• communicate results to patient/family/physicians
• provide initial prognosis and info. on follow up care

Question 9

What are the types of biopsy methods?

Answer 9

• transcutaneous
• endoscopic biopsy
• laparoscopic biopsy
• image directed with fine needle aspiration
• open incisional (portion of tumour)
• open excisional (all tumour mass removed)

Question 10

What are the types of image directed biopsy?

Answer 10

• ultrasonography
• computerised tomography
• magnetic resonance imaging

Question 11

What is preoperative assessment?

Answer 11

Assessment of risk-to-benefit ratio and identifying and correction of underlying, relevant health problems

Question 12

What are the common co-morbidities in cancer patients?

Answer 12

• hypertension
• diabetes
• congestive heart failure
• liver or renal insufficiency
• immunosuppression

Question 13

What is the difference in kinetics between surgical approaches vs. radiotherapy/chemotherapy cancer approaches?

Answer 13

• surgery has zero order kinetics as amount done does not correspond to cells killed
• radiotherapy/chemotherapy have first order kinetics as only a portion of cells at risk of being killed during treatment and followed by regrowth

Question 14

What are the types of surgery done for cancer?

Answer 14

• local resection
• radical resection of lymph nodes
• supra-radical resections (LN and organs)
• surgery for metastasis
• surgical management of complications
• vascular access surgery

Question 15

What factors of the disease affect the surgery?

Answer 15

staging and spread

Question 16

What are the different extents to which cancer can spread?

Answer 16

• direct invasive (adjacent organ)
• bloodstream
• lymphatic system
• implantation

Question 17

What is staging?

Answer 17

• clinical or pathological assessment of the extent of tumor spread

Question 18

What is the Duke’s classification?

Answer 18

• Duke’s A: spread into submucosa but not through muscle
• Duke’s B: spread through muscle but nodes negative
• Duke’s C: lymph node metastases present

Question 19

What are the benefits of staging of cancer?

Answer 19

• provides useful prognostic information
• allows decisions to be made regarding neoadjuvant and adjuvant therapy
• allows comparison of treatment outcomes between different centres

Question 20

What changes is staging based on?

Answer 20

Pre-operatively = clinical and radiological
Post-operatively = histopathological

Question 21

What is radical surgery?

Answer 21

• done when tumour confined to 1 area and all of it can be removed
• lymph nodes draining affected area removed with primary tumour
• used alone or along with chemo/radiation

Question 22

What is curative resection?

Answer 22

• complete removal of tumour
• R0 = removal of all tissue containing tumour with intact covering of unaffected tissue leaving resection margin free from disease

Question 23

What are the principles of surgical resection of a tumour?

Answer 23

• adequate margin of resection
• prevention of tumour spillage
• minimal manipulation
• anatomical reconstruction

Question 24

What are the 3 main types of surgery?

Answer 24

• open
• minimally invasive
• image guided