Surgical Oncology Flashcards
what are the roles of surgery for cancer management?
diagnosis
cure
metastatectomy
palliation
what are the positives of cytology?
low cost
low morbidity
comparatively fast results
good for tumors that exfoliate well
what is a negative of cytology?
low diagnostic accuracy
what are the indications for surgical biopsy?
when cytology is nondiagnostic
when tumor type/grade may change
what are the negatives of surgical biopsy?
adds cost
adds morbidity
adds time
curative intent surgery must include biopsy tract
what is a positive of needle core biopsy compared to other biopsy types?
can access deeper lesions
what are the negatives of needle core biopsy?
need ultrasound guidance
+/- general anesthesia
training/familiarity needed
what are the positives of punch biopsy?
best suited for superficial lesions
easy to perform
what are punch biopsies not suited for?
deeper lesions
what are the positives of incisional biopsy?
easy to perform
can include normal tissue
what is a con of incisional biopsy?
biopsy tract needs to be resected
what is cancer staging?
process of determining the extent of the disease
what is a positive of excisional biopsy?
may be curative
what is a negative of excisional biopsy?
may complicate curative intent surgery
when performing cancer staging, how do you evaluate local disease?
tumor size
mobility or fixation of tumor to adjacent tissues
what diagnostics are useful for cancer staging?
radiographs: region of interest
ultrasound
computed tomography
MRI
what is a sentinel lymph node?
the first lymph node to receive drainage from a tumor
how can you identify the sentinel lymph node to a tumor?
lymphoscintigraphy
indirect lymphography
how can you screen for distant metastasis?
3 view thoracic radiographs
abdominal ultrasound
nuclear scintigraphy
CT/PET-CT
MRI
what are the three options for surgical dose?
marginal
wide
radical
what is the common result of marginal surgical dose?
usually leaves microscopic disease
what determines the guidelines for surgical margins?
tumor type
what are deep/barrier margins?
muscle layers/fascial layers
why is revision surgery challenging?
entire previous scar must be resected
scar tissue complicates dissection
additional cost
what do you need in order to perform curative intent surgery?
thorough knowledge and familiarity of regional anatomy
proficiency in reconstructive surgery
what determines resectability?
diffuse disease or not (multi-organ involvement)
highly invasive
involves a vital organ/anatomic structure
when thinking about resecting a tumor, what should you educate the client about?
tumor type/biology
prognosis
do they have realistic expectations?
open to adjuvant treatment?
financial estimates
what might you consider placing in the tumor bed for radiation planning during surgery?
hemoclips
what are the options with incomplete margins?
revision surgery
close monitoring
radiation therapy
what surgical procedures can be performed for palliation?
ostomy procedures
stenting procedures
when is adjuvant chemotherapy begun?
7-10 days after surgery
if you use neoadjuvant radiation, how long is surgery delayed?
more than 4 weeks
