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Small Animal Surgery > Surgical Oncology > Flashcards

Surgical Oncology Flashcards

1
Q

What roles does surgery play in the management of cancer? What ancillary procedure is commonly done?

A
  • diagnosis with biopsy
  • resection for sure
  • palliation of clinical signs
  • cytoreduction prior to adjunctive therapy
  • prevention/reduce risk of recurrence

vascular access port placement for chemotherapy and radiation therapy

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2
Q

What is the purpose of tumor staging? What system is used?

A

establishes extent of disease and provides information to prognosticate for clients

TNM system

  • T = (primary) tumor size
  • N (regional) node involvement
  • M = metastasis
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3
Q

Once a tumor is found, what is important to evaluate?

A

regional lymph nodes —> size, mobility, consistency

know body mapping for drainage compared to the tumor

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4
Q

When is cytology especially useful? In what 2 cases is it not?

A

round cell tumor malignancies that exfoliate well - MCT, histiocytoma, lymphoma, plasmacytoma, TVT

  1. sarcomas and spindle cell tumors - fibrous, do not exfoliate well
  2. lipoma - washes off with preparation
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5
Q

What can resemble malignancy on cytology? What is done if a sample is not diagnostic?

A

inflammation

pursue biopsy

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6
Q

Whan is diagnostic imaging especially helpful for diagnosing tumors? What can be used?

A
  • intercavitary tumors
  • firm, non-mobile tumors
  • staging for metastasis

radiography, U/S, CT/MRI, nuclear scintigraphy, PET scan

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7
Q

What should not influence aggressiveness of surgeons with intent to cure cancer? What should be minimized?

A

ability to close wound —> need to know margins for tumor types

handling of tumors and penetration of capsules —> protects normal tissues from seeding

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8
Q

How can seeding of healthy tissue be avoided?

A
  • avoid handling tumors
  • do not penetrate capsule
  • lavage tissues, change gloves and instruments, and lavage again before closing
  • avoid using open drains
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9
Q

What are 3 specific indications for biopsies?

A
  1. to indicate treatment protocol based on tumor type
  2. tumor in a difficult location for surgical reconstruction
  3. knowledge of diagnosis would alter owner’s desire to treat
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10
Q

What are some biopsy techniques?

A
  • impression smears of ulcerated masses or other exfoliated cells
  • FNA
  • needle core biopsy
  • punch biopsy
  • incisional
  • excisional
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11
Q

What are 5 keys to obtaining diagnostic biopsies?

A
  1. proper sample size
  2. number of samples - multiple areas for larger masses
  3. take it near the junction of normal/abnormal tissue
  4. handle biopsy gently, moisten, and put in fixative ASAP to avoid artifacts
  5. give the pathologist detailed history and information
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12
Q

What are 3 indications of incisional biopsies? Why does it need to be planned carefully?

A
  1. large, superficial lesions
  2. lesion located in an area where achieving margins and closure might be difficult
  3. when less invasive techniques fail to yield diagnosis

biopsy sites should be selected so that the biopsy tract can be included with the definitive surgical procedure

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13
Q

What makes a proper incisional biopsy?

A

narrow, but deeper wedge - facilitates closure of the biopsy site, especially if tumor is firm and attached to skin

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14
Q

Why do FNAs even need to be planned and done carefully?

A

can result in seeding of biopsy tracts if the tumor exfoliates cells easily —> TCC

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15
Q

What are 2 indications for excisional biopsies?

A
  1. type of treatment would not be altered by tumor type
  2. re-excision with wider margins possible without significant morbidity
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16
Q

What cures the most patients with cancer?

A

complete surgical resection

  • first chance is the best chance
17
Q

What margins are recommended for most tumors? What are 2 exceptions?

A

removal of normal tissue completely around the mass

  1. benign masses with low risk of recurrence - lipomas
  2. masses in body cavities
18
Q

What are 3 types of excisional biopsies?

A
  1. marginal
  2. wide - 2-3 cm of normal tissue three-dimensionally
  3. radical - entire compartment, like an amputation
19
Q

What is the most common neoplasm that calls for a marginal excision?

A

lipoma

20
Q

What typically influences required margins?

A

biological activity —> tumor grade based on mitotic index, differentiation, etc.

  • MCT require wide excisions
21
Q

What should be done if a tumor is fixed to a structure?

A

assume that tissue is also invaded and remove it

  • removal of mammary gland and the entire chain
22
Q

What should be done if a tumor is invaded during a procedure?

A

surgical field should be thoroughly lavaged, gloves changed, and different instruments used for the remainder of the procedure

  • invasion associated with recurrence
23
Q

How are lymph nodes commonly assessed with tumor removal? What else is commonly indicated when sampling later is expected to be difficult?

A

cytology - FNA, removal, even if they are normal on palpation —> lung of GI tumors

removal of the draining lymph node - also helps with more accurate staging

24
Q

What is the purpose of palliative surgery for tumors? What are 3 examples?

A

improve QoL, not necessarily length of life - weight expected morbidity vs. gain

  1. amputation in animals with painful bone tumors
  2. splenectomy for HSA
  3. mastectomy for infected mammary tumors
25
Q

What is the purpose of debulking and cytoreduction surgery? What are some examples?

A

enhance efficacy of other treatments with the goal to reduce tumor burden to microscopic levels prior to chemotherapy or radiation therapy

  • chemotherapy
  • radiation therapy
  • photodynamic therapy
  • cryotherapy
26
Q

When is surgery for metastatic disease indicated? In what patients does it typically prolong survivial?

A

solitary for few metastatic lesions on the lung, liver, or brain

can prolong survival in dogs with OSA, insulinomas, and perianal/anal sac AdCA

27
Q

What is required for assessing completeness of excision?

A

differentiating processing (sectioning) margins for surgical margins —> communicate with pathologist, mark cut edges or questionable areas with indelible dye (India ink) or sutures

  • allow ink to dry before placed in fixative
28
Q

Surgical margins:

A
29
Q

Histopath, inked surgical margin:

A

pathologist will indicate if the margins are clean, close, or dirty

30
Q

What should happen if a pathologist determines the margins to be dirty?

A
  • re-excision
  • adjunctive therapy - radiation, chemotherapy
31
Q

What dogs most commonly have anal sac disease?

A

SMALLER DOGS —> Poodles, Chihuahuas

(rare in cats)

32
Q

What should be done before an anal sacculectomy? Where are the anal sacs found?

A

manage infected or abscessed glands medically until inflammation resolves and the excision can be performed

within the external anal sphincter

33
Q

What equipment is required for closed anal sacculectomies? How is this method performed?

A

blunt probe/instrument, paraffin injection (palpable), catheter

(OUT to IN)

34
Q

How is an open anal sacculectomy performed?

A
  • insert one blade of scissors into sac
  • apply upward pressure to tips to minimize tissue cut
  • insert groove director or probe through duct into anal sac
  • incise over instrument with caudal tension on instrument to minimize damage to sphincter
  • dissect anal sac from anal sphincter
35
Q

What are the 3 most common complications associated with anal sacculectomies?

A
  1. infection
  2. draining tract formation due to incomplete removal - secretory lining is able to regrow, must go back in and remove remaining tissues
  3. fecal incontinence
36
Q

What are the 2 most common perianal gland tumors?

A
  1. adenomas - intact males, castration and resection indicated (neuter can cause involution on its own, too)
  2. adenocarcinomas - females, poor prognosis (look for hypercalcemia)
37
Q

What is the most common anal sac tumor? What 3 signs are associated?

A

apocrine gland adenocarcinomas

  1. paraneoplastic hypercalcemia
  2. PU/PD
  3. renal failure

Small Animal Surgery (34 decks)

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