Surgery Flashcards
What does multimodal management consist of?
- endoscopic
- surgical
- chemotherapy
- radiotherapy
- physiotherapy
- nutritional support
- CNS & palliative care team
What is addressed in an MDT meeting?
- presentation
- radiology
- pathology
- treatment options
- co-morbidity
- trials
- data management and audits
What are the national targets of the patient pathway?
- 2 week SOPD for urgent referrals
- 62 days to treatment
What is SOPD?
surgical outpatient department
How may a patient first be diagnosed with cancer?
- open access endoscopy
- GP urgent referrals with alarm symptoms
- emergency symptoms (bleeding)
- incidental findings (screenings)
What is the typical patient pathway for a GI patients?
- 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
What is cancer surgery involved with?
- diagnosis (biopsy)
- staging (laparoscopy)
- treatment (primary cure)
- reconstruction (breast reconstruction after mastectomy)
- palliation (tumour debulking)
- resection (local recurrence and metastasis cure)
What are the requirements of biopsy?
- 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
What are the types of biopsy methods?
- transcutaneous
- endoscopic biopsy
- laparoscopic biopsy
- image directed with fine needle aspiration
- open incisional (portion of tumour)
- open excisional (all tumour mass removed)
What are the types of image directed biopsy?
- ultrasonography
- computerised tomography
- magnetic resonance imaging
What is preoperative assessment?
Assessment of risk-to-benefit ratio and identifying and correction of underlying, relevant health problems
What are the common co-morbidities in cancer patients?
- hypertension
- diabetes
- congestive heart failure
- liver or renal insufficiency
- immunosuppression
What is the difference in kinetics between surgical approaches vs. radiotherapy/chemotherapy cancer approaches?
- 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
What are the types of surgery done for cancer?
- local resection
- radical resection of lymph nodes
- supra-radical resections (LN and organs)
- surgery for metastasis
- surgical management of complications
- vascular access surgery
What factors of the disease affect the surgery?
staging and spread
What are the different extents to which cancer can spread?
- direct invasive (adjacent organ)
- bloodstream
- lymphatic system
- implantation
What is staging?
- clinical or pathological assessment of the extent of tumor spread
What is the Duke’s classification?
- 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
What are the benefits of staging of cancer?
- provides useful prognostic information
- allows decisions to be made regarding neoadjuvant and adjuvant therapy
- allows comparison of treatment outcomes between different centres
What changes is staging based on?
Pre-operatively = clinical and radiological Post-operatively = histopathological
What is radical surgery?
- 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
What is curative resection?
- complete removal of tumour
- R0 = removal of all tissue containing tumour with intact covering of unaffected tissue leaving resection margin free from disease
What are the principles of surgical resection of a tumour?
- adequate margin of resection
- prevention of tumour spillage
- minimal manipulation
- anatomical reconstruction
What are the 3 main types of surgery?
- open
- minimally invasive
- image guided
