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Cancer > Surgery > Flashcards

Surgery Flashcards

1
Q

What are the different ways to treat cancer

A 
– Endoscopic/ EUS
– Surgical
– Chemotherapy
– Radiotherapy
– Physiotherapy
– Nutritional support
– CNS & palliative care team
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2
Q

What are then national targets for cancer

A

2 Week SOPD for urgent referrals - 2 weeks from GP referral to when they are seen in clinic

62 Days to treatment

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3
Q

describe the cancer pathway

A
  1. diagnosis
  2. 1st UGI MDT meeting
  3. specialist clinics (surgical and oncology)
  4. Neoadjuvant therapy - e.g. chemotherapy before surgery in order to shrink the cancer
  5. re staging CT/PET and 2dn UGI MDT meeting
    6, surgery in about 3 months from diagnosis
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4
Q

what are the type of cancer surgery’s that can take place

A

Diagnosis – biopsy

Staging – eg Laparoscopy –for small metastasis

Treatment - for cure of primary

Reconstruction - for example, breast reconstruction after a mastectomy

Palliation and tumour debulking

Resection for cure of metastasis and local recurrence

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5
Q

How do you diagnose cancer before surgery

A

microscopic diagnosis of the cancer is compulsory before surgery takes place

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6
Q

Name the types of biopsy methods

A

Transcutaneous

Endoscopic Biopsy

Laparoscopic Biopsy

Image-directed (with fine-needle aspiration or cutting needle)
–Ultrasonography
–Computerized tomography
–Magnetic resonance imaging

Open incisional (A portion of the tumor)

Open excisional (All tumor mass removed

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7
Q

what do you have to undertake in order before surgery takes place

A
  • assessment of the risk to benefit ratio = this is to make sure that they are fit for surgery and will recover from the surgery
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8
Q

What things do you look for in assessment of the risk to benefit ratio before surgery

A

Nutritional status - have to increase there nutritional status, can do this by PEG or PN feeding

Co-mordbities 
–Hypertension
–Diabetes
–Congestive heart failure
–Liver or renal insufficiency
–Immunosuppresion
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9
Q

what are the two approaches to surgery in cancer and describe what they mean

A
  • Zero order kinetics - 100% of cells are at risk and are killed with a single treatment
  • first order kinetics - this is when you have radio and chemotherapy before hand - only a portion of cells at risk are killed during treatment which is followed by regrowth
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10
Q

what is a local resection used for

A
  • this is form limited cancer than hasn’t grown or spread therefore you just take the cancer out
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11
Q

What is a radical resection

A
  • this is resection of the cancer and the lymph nodes
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12
Q

What is a supra-radical resection

A
  • this is when you remove the cancer, the lymph nodes and the organs that surround the cancer
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13
Q

How do spreads of cancer happen

A

Direct invasive - adjacent organ

Bloodstream.

Lymphatic system.

Implantation - avoid cutting/handling

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14
Q

What factors do you have to take into account for surgery

A
  • spread of cancer

- stage of cancer

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15
Q

where does breast cancer spread and metastasis to

A
  • spreads through the lymph nodes

- then goes through the blood stream and spreads into the lung and liver

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16
Q

What is staging

A

Staging is the clinical or pathological assessment of the extent of tumor spread

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17
Q

what does clinical and pathological mean in staging

A

Clinical = stage at onset

pathological = microscopic biopsy diagnosis and more specific stage

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18
Q

what is the most common stage system used

A

TNM

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19
Q

describe Dukes classification as a staging system

A

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

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20
Q

What is dukes classification used for

A
  • it is used for colon cancer
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21
Q

What is the benefits of staging cancer

A

Provides useful prognostic information

Allows decisions to be made regarding Neoadjuvant & adjuvant therapy

Allows comparison of treatment outcomes between different centres

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22
Q

How do you stage cancers pre operative and post-operative

A

Pre-operative

  • Clinical
  • Radiological

Post-operative
- Histopathological

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23
Q

Why do we do clinical and radiological pre op staging of cancer

A

This is mainly done to determine treatment options

  • neoadjuvant chemo/radiotherpay
  • curative surgery
  • palliative surgery
  • not for surgery
24
Q

what does Post operative staging of cancer do

A
  • Provides useful prognostic information
  • Allows decisions to be made regarding adjuvant therapy
  • Allows comparison of treatment outcomes between different centres
25
Q

When is radical surgery be done along

A

It may be used alone or along with chemotherapy or radiation therapy, which can be given before or after the operation.

26
Q

what is the complete removal of the surgery termed

A

Ro

27
Q

What is Ro

A

this involves removal of all the tissue containing the tumour with an intact covering of unaffected tissue to leave the resection margin free from disease

28
Q

Why can curative resection unsuccessful

A

Invasion of vital, unresectable structure

Seeding of tumour in peritoneal cavity

Undetectable micrometastasis in distal organ – imaging only picks up a certain amount of disease

Distal metastasis which cannot be safely removed

29
Q

what are the principles for surgical resection of a tumour

A

Adequate margin of resection

Prevention of tumor spillage elsewhere

Minimal manipulation

Anatomical Reconstruction

30
Q

What does TNM stand for

A

T describes the size of the original (primary) tumor and whether it has invaded nearby tissue,

N describes nearby (regional) lymph nodes that are involved,

M describes distant metastasis (spread of cancer from one part of the body to another).

31
Q

describe the T part of the TNM staging

A

made up of four parts T1, T2, T3 and T4

32
Q 
describe
- T1 and T2
- T3 
- T4
surgical options
A

T1 and T2
- Radical surgery, the aim is to cure the disease and usually has a good prognosis if you have this

T3

  • when the tumour has invaded some of the tissues underneath
  • combined chemotherapy and radiotherapy and radical surgery

T4

  • When the tumour has invaded distant organs
  • radical and palliative surgery and combination treatment
  • aim is to acheieve longer disease free survival
  • minimise adverse effects from local recurrence
33
Q

what are the N stages in the TNM staging system

A

NO - no spread to lymph nodes
N1 - spread to regional lymph nodes
N2 - spread between an extent to N1 and N3
N3 - spread to more distant and regional lymph nodes

34
Q

What are the surgical treatment for the N stages of the TNM staging system

A

Node -ve (N0) – Usually don’t get any additional treatment

Node +ve (N1 – N2) – Usually get combination treatment with curative intent.

Node +ve (N3) - get combination treatment with palliative intent.

35
Q

What are the M stages in the TNM system

A

M0 - no metastasis

M1 - Metastasis to distant organs beyond regional lymph nodes

36
Q

how do you surgical treat the M1 stage in the TNM system

A

M1 – Usually need combination of Surgery, Radiotherapy and Chemotherapy.

37
Q

What are the benefits of open surgery in cancer treatment

A
  • get good access
  • see all the tissues
  • being able to feel the tissue
38
Q

what are the advantage of minimally invasive surgery in cancer treatment

A
  • lower mordbitiy

- go home much quicker and recover much more easily

39
Q

What are the type of minimally invasive surgery in cancer treatment

A

Hand Assisted (MIS)

Laparoscopic Surgery

Robotic Assisted Surgery

Natural Orifice Surgery

40
Q

what do you do in laparoscopic surgery

A
  • less invasive surgery

- put gas in perineum in order to get a better view of the organs

41
Q

what are the three types of complications of surgery

A

Anaesthetic

General

Specific

42
Q

what are the complications with anaesthetics

A

Local trauma – teeth, throat from intubation

Drug related - reaction/Allergy

Aspiration of oesophageal/gastric contents

Anaesthetic line complication

  • Arterial line – bleeding
  • Central venous line complication
  • Epidural catheter complication

Lung injury from high pressure ventilation

43
Q

What are the general complications with surgery

A

Bleeding

Infection including hospital acquired infection

UTI

DVT/PE

Respiratory

Wound infection

Scar/Adhesion(scars withint he abdomen and can lead to small bowel obstruction as the bowel gets stuck where the scars are formed

Psychological

44
Q

what are the specific things that can go wrong when doing surgery on the abdomen

A

Damage to liver/spleen/intestine – laproscopic intruments – need to make a hole in the abdomen and the risk is that you can just put it into the bowel

Abdominal adhesions & obstruction

Incisional hernia -

Nutritional deficiency

45
Q

what are the specific complications that can go wrong when doing surgery on the chest

A

Anastomotic leak

Broncho-oesophageal fistula

Thoracic duct injury

Recurrent laryngeal nerve injury

Broncheal injury

Pericardial/heart injury

Rib fractures

Chest infection/effusion/collection

46
Q

Where do solid cancers spread

A

Solid tumours spread to the lungs, bones, liver, and brain.

47
Q 
where does
- lung cancer
 - colon cancer 
- prostate cancer 
- breast cancer 
metastasis to
A

Lung cancer often metastasizes to the brain or bones

Colon cancer frequently spreads to the liver.

Prostate cancer tends to spread to the bones.

Breast cancer commonly spreads to the bones, lungs, liver, or brain.

48
Q

What can cause cancer recurrence

A

Micro-metastasis

New primary

Local excision of tumour and lymph node was inadequate

Primary tumour disrupted during operation

Exfoliated cancer cells implanted into

  • the wound
  • tumour bed
  • anastomosis
49
Q

How do you control recurrence of cancer

A

Adjuvant Treatment – additional treatment after potentially curative surgery

Neo-adjuvant Treatment - additional treatment before potentially curative surgery - therefore this is surgery and chemo or radiotherapy

50
Q

What is the treatment that can be used for metastasis

A 
Surgical 
Radiotherapy
Chemotherapy
Hormonal manipulation
Combination
51
Q

What does the treatment for metastasis depend on

A

Depend on tumour type, extent of metastasis, the patient overall condition etc.

52
Q

What are the principles of treatment of metastasis

A

Curative

Palliative if cure not possible, relapse, or alleviate the symptoms of cancer.

53
Q

what are the aims of palliative surgery

A

It is not intended to cure the cancer.

Used to treat complications of advanced cancer.

Must improve quality of life.

54
Q

What are the goals of palliative surgery

A

Adequate control of pain

Relief gastrointestinal and biliary obstruction

Stop haemorrhage

Supplement poor nutrition

Airway obstruction

Renal failure

Rectal or urinary incontinence

55
Q

What are alternative invasive treatments

A

Percutaneous radiofrequency ablation

Cryoablation

Embolisation

Photodynamic therapy

Endoscopic Treatment – Stenting/Laser etc

56
Q

What does cryoablation involve

A
  • The ablation of tumour by delivering subfreezing temperatures via penetrating or surface cryoprobes.
  • be cooled –20º C to –30º C
  • cell death by denaturing cellular protein, rupturing the cell membrane, dehydrating the cell, and causing ischemic hypoxia
57
Q

What are the factors that influence the outcome of treatment

A

Patient related factors

Health care provider related factors

Socio-Environment related factors eg: cultural, socio-economic, ethical factors

Cancer (13 decks)

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