Surgical Oncology

Question 1

what are the roles of surgery for cancer management?

Answer 1

diagnosis
cure
metastatectomy
palliation

Question 2

what are the positives of cytology?

Answer 2

low cost
low morbidity
comparatively fast results
good for tumors that exfoliate well

Question 3

what is a negative of cytology?

Answer 3

low diagnostic accuracy

Question 4

what are the indications for surgical biopsy?

Answer 4

when cytology is nondiagnostic
when tumor type/grade may change

Question 5

what are the negatives of surgical biopsy?

Answer 5

adds cost
adds morbidity
adds time
curative intent surgery must include biopsy tract

Question 6

what is a positive of needle core biopsy compared to other biopsy types?

Answer 6

can access deeper lesions

Question 7

what are the negatives of needle core biopsy?

Answer 7

need ultrasound guidance
+/- general anesthesia
training/familiarity needed

Question 8

what are the positives of punch biopsy?

Answer 8

best suited for superficial lesions
easy to perform

Question 9

what are punch biopsies not suited for?

Answer 9

deeper lesions

Question 10

what are the positives of incisional biopsy?

Answer 10

easy to perform
can include normal tissue

Question 11

what is a con of incisional biopsy?

Answer 11

biopsy tract needs to be resected

Question 12

what is cancer staging?

Answer 12

process of determining the extent of the disease

Question 13

what is a positive of excisional biopsy?

Answer 13

may be curative

Question 14

what is a negative of excisional biopsy?

Answer 14

may complicate curative intent surgery

Question 15

when performing cancer staging, how do you evaluate local disease?

Answer 15

tumor size
mobility or fixation of tumor to adjacent tissues

Question 16

what diagnostics are useful for cancer staging?

Answer 16

radiographs: region of interest
ultrasound
computed tomography
MRI

Question 17

what is a sentinel lymph node?

Answer 17

the first lymph node to receive drainage from a tumor

Question 18

how can you identify the sentinel lymph node to a tumor?

Answer 18

lymphoscintigraphy
indirect lymphography

Question 19

how can you screen for distant metastasis?

Answer 19

3 view thoracic radiographs
abdominal ultrasound
nuclear scintigraphy
CT/PET-CT
MRI

Question 20

what are the three options for surgical dose?

Answer 20

marginal
wide
radical

Question 21

what is the common result of marginal surgical dose?

Answer 21

usually leaves microscopic disease

Question 22

what determines the guidelines for surgical margins?

Answer 22

tumor type

Question 23

what are deep/barrier margins?

Answer 23

muscle layers/fascial layers

Question 24

why is revision surgery challenging?

Answer 24

entire previous scar must be resected
scar tissue complicates dissection
additional cost

Question 25

what do you need in order to perform curative intent surgery?

Answer 25

thorough knowledge and familiarity of regional anatomy
proficiency in reconstructive surgery

Question 26

what determines resectability?

Answer 26

diffuse disease or not (multi-organ involvement)
highly invasive
involves a vital organ/anatomic structure

Question 27

when thinking about resecting a tumor, what should you educate the client about?

Answer 27

tumor type/biology
prognosis
do they have realistic expectations?
open to adjuvant treatment?
financial estimates

Question 28

what might you consider placing in the tumor bed for radiation planning during surgery?

Answer 28

hemoclips

Question 29

what are the options with incomplete margins?

Answer 29

revision surgery
close monitoring
radiation therapy

Question 30

what surgical procedures can be performed for palliation?

Answer 30

ostomy procedures
stenting procedures

Question 31

when is adjuvant chemotherapy begun?

Answer 31

7-10 days after surgery

Question 32

if you use neoadjuvant radiation, how long is surgery delayed?

Answer 32

more than 4 weeks