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Principles of Surgery > Surgical Oncology > Flashcards

Surgical Oncology Flashcards

1
Q

what is surgical oncology

A

patient centered approach to tumor management

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2
Q

what are three limitations to consider with surgical oncology

A
  • physical exam
  • knowledge of tumor biology and disease process
  • effectiveness and limits of surgical techniques
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3
Q

what are two goals to know with surgical oncology

A
  • many patients will be at advanced stages
  • palliation vs cure (make sure O is on the same page)
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4
Q

what is staging

A
  • extent of disease
  • determined by pre-operative evaluation (nodes, lungs, etc.)
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5
Q

what is grading of disease

A
  • tumor behaviour
  • requires histopathology
  • associated with propensity to spread elsewhere vs local aggressiveness
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6
Q

what are the 4 questions for surgical oncology

A

1) what is it
2) where is it
3) how bad is it
4) what to do about it

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7
Q

what are two techniques we can use to determine what cancer we are working with

A

cytology and histopathology

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8
Q

what is the difference between cytology and histopathology

A

cytology:
- FNA
- examines individual cells

histopathology:
- biopsy
- examines tissue sections

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9
Q

T/F cytology can help determine whether cancer or not cancer

A

T

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10
Q

what are the 3 main types of cancer

A
  • round cell tumor
  • sarcoma
  • carcinoma
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11
Q

what is the biggest thing to try to minimize when performing an FNA

A

hemorrhage

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12
Q

what size needle and what size syringe should you use for an FNA

A

22 or 25g
3 or 6cc

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13
Q

when doing an FNA, how far should you pass the needle through the mass

A

2/3 of the thickness

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14
Q

why should we avoid the center of the mass when doing an FNA

A

likely necrotic so hard to get an answer from there

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15
Q

why is it recommended to make many slides when doing an FNA

A
  • area of necrosis
  • potential to miss the lesion
  • dx in the adjacent area
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16
Q

T/F when performing an FNA you should typically be able to see gross material in the syringe, and if you don’t you likely did not collect anything

A

F; if you see something, it is probably hemorrhage (not good)

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17
Q

all cutaneous and subcutaneous masses should be ______________ and a ________ should be done

A

aspirated; body map

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18
Q

what are the 6 round cell tumors

A
  • TVT
  • melanoma
  • mast cell tumor
  • lymphoma
  • plasma cell tumor
  • histiocytoma
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19
Q

round cell tumors usually exfoliate (poorly/well)

A

well

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20
Q

T/F you can usually get a specific Dx for round cell tumors off of cytology alone

A

T

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21
Q

carcinomas usually exfoliate (poorly/well)

A

well

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22
Q

with cytology, what can we tell about carcinomas

A

if they are malignant or benign; sometimes specific cell type

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23
Q

sarcomas usually exfoliate (poorly/well)

A

poorly

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24
Q

what type of tumors typically never exfoliate in effusions

A

sarcoma

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25
Q

do we usually get a lot of info from cytology of a sarcoma

A

not really… it does not exfoliate well, the exact type usually requires histology and it can be a really difficult cytologic diagnosis

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26
Q

what are two pros of biopsy

A
  • better planning for Sx
  • getting a definitive Dx enables pre-op radiation
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27
Q

what are two cons of biopsy

A
  • two procedures (cost, progression while waiting for Sx)
  • risk of local recurrence (unless you remove entire biopsy tract during Sx)
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28
Q

what are some indications to perform a biopsy

A

1) you cannot get a good answer from cytology alone (ex. sarcoma)
2) if the grade of tumor would affect the treatment elected

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29
Q

when would biopsy be contraindicated

A

1) if you can get an answer off of cytology alone
2) if surgery approach would not be affected by histopathology
3) if you are unsure of surgical approach and biopsy may compromise the curative intent procedure

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30
Q

what are the 2 types of biopsy

A

incisional and excisional

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31
Q

what is really key with an excisional biopsy

A

to leave the fascial plane intact

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32
Q

in general, the margins for excisional biopsy are

A

<1 cm

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33
Q

what are two benefits and a limitation of incisional biopsy

A

advantages:
1) not changing definitive surgical margins
2) should not change the chances of a clean cut

limitation:
1) always requires a second surgery (including benign)

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34
Q

what is a benefit and two drawbacks of excisional biopsies

A

benefit
1) potentially curative for benign disease

drawbacks
1) increases margins if malignant
2) decreased chances of clean cut

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35
Q

biopsy should never be performed without first doing what

A

cytology

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36
Q

___________ biopsy should be performed over ___________ biopsy except for in what 2 cases

A

incisional; excisional

1) location means you cannot get a larger margin regardless of Sx
2) very small cutaneous masses <1cm

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37
Q

what are two methods for incisional and two methods for excisional biopsy

A

incisional:
- wedge/Keyes punch
- core/tru-cut needle biopsy

excisional:
- surgical excision
- Keyes punch

38
Q

where should you take a biopsy with a wedge or Keyes punch

A

center, not periphery

39
Q

you should close a wedge/punch biopsy with what type of suture

A

non-absorbable (ex. prolene)

40
Q

T/F Keyes punch can be used for incisional and excisional biopsy

A

T

41
Q

a Keyes punch generally requires ___________ whereas a Tru-cut biopsy can be done with _____________

A

anesthesia; sedation

42
Q

when would it not be good to do a Tru-cut or core biopsy? when does it work really well?

A

very small mass; works well when you have a very deep mass

43
Q

T/F properly performed biopsies may increase the likelihood of future metastasis or decrease the likelihood of future control

A

F

44
Q

what does staging account for

A

1) local disease (T)
2) local metastasis (N)
3) distant metastasis (M)

45
Q

staging =

A

extent of disease

46
Q

how can staging help define the extent of disease

A
  • aids in planning treatment
  • allows more accurate prognostication
  • assists in evaluation of patient response to therapy
47
Q

T/F bloodwork will generally be normal in a patient with early stage cancer (the exception being liver tumors)

A

T

48
Q

what are 3 ways to assess distant metastasis

A

1) thoracic radiographs
2) abdominal ultrasound
3) bone marrow

49
Q

how do we evaluate local metastasis

A

by evaluating lymph nodes
1) identify the draining node
2) cytology
3) histopathology

50
Q

what is a limitation of radiographs for assessing thoracic metastases and how can we get around this?

A

won’t catch mets <7mm in size; use CT (more sensitive)

51
Q

if you are going to take RADS, what is absolutely critical

A

3 views!

52
Q

prognosis is based on (3)

A

tumor type, grade and stage

53
Q

why do we consider prognosis both pre and post op

A

1) may impact surgical approach pre-op
2) may change based on histopathology results post-op

54
Q

current cancer therapies in SA include (4)

A
  • surgery
  • radiation
  • chemotherapy
  • investigational
55
Q

what are the 2 local treatment modalities for cancer

A
  • surgery
  • radiation (local)
56
Q

what are the 3 systemic treatment modalities for cancer

A
  • radiation
  • chemotherapy
  • immunotherapy
57
Q

what should you consider when planning positioning of the animal for excision sx

A
  • tension lines
  • motion areas
58
Q

what are 4 surgical considerations when doing an excision sx

A

1) minimize tumor handling
2) ligate venous side first
3) change gloves and instruments often
4) lavage

59
Q

what happens to tissues following excision, and what effect does this have

A
  • retract
  • makes defect appear larger
60
Q

what is the pseudocapsule

A

layer of compressed neoplastic cells encapsulating the tumor

61
Q

what is the reactive zone

A

reactive host cells surrounding the tumor (outside the pseudocapsule)

62
Q

what is a satellite tumor

A

neoplastic cells outside the pseudocapsule

63
Q

what is a skip metastasis

A

neoplastic cell distant to the tumor in the same compartment (rare)

64
Q

what are the two types of non-curative surgical excisions

A

intracapsular and marginal

65
Q

what are the two types of curative surgical excisions

A

wide and radical

66
Q

you should only ever do intracapsular surgery for ______ tumors

A

benign

67
Q

what are the margins for intracapsular surgery

A

there are no margins

68
Q

what are the margins for marginal surgery

A

minimal

69
Q

marginal surgery leaves _________ disease behind whereas intracapsular surgery leaves ________ disease behind

A

microscopic; gross

70
Q

what would be two instances where you might elect for marginal surgery

A

location does not allow wide margins; benign tumor

71
Q

T/F wide surgery addresses skip mets

A

F

72
Q

what are three types of cancers where we would elect for wide surgery

A

sarcomas, mast cell tumors, GI tumors

73
Q

margins need to consider both ______ and ___________

A

deep and lateral

74
Q

what are typical margins

A

1-3cm depending on the tumor type

75
Q

how do you do wide surgery

A

skin incision, then extend deep and evenly until you reach the fascial plane

76
Q

what makes up the deep margin for a wide surgery

A

the fascial plane

77
Q

what is the most common reason for a dirty margin

A

lack of fascial plane

78
Q

T/F if the tumor is stuck to the fascial plane it is no longer a barrier

A

T

79
Q

what are the fascial planes (4)

A

fascia, bone, tendon/ligament, muscle

80
Q

what area tends to have limited fascial planes

A

distal limbs

81
Q

T/F the cutaneous trunci is uniform in dogs

A

F

82
Q

why is elliptical incisions not recommended

A
  • extends cancer field
  • not great for malignant lesions
83
Q

why do we want to avoid a seroma or hematoma for a patient with cancer

A

it can disperse residual tumor cells

84
Q

why is it not recommended to put in a drain for a cancer sx

A

increases the cancer field if you had to recut

85
Q

what are examples of radical surgery

A

amputation, splenectomy, lung lobectomy

86
Q

you should submit tumor samples in formalin in what radio

A

10:1, depending on size

87
Q

you should ink what

A

lateral and deep margins

88
Q

it is best to ink your deep margin where

A

directly below the tumor (not the whole surface because bleeding can occur)

89
Q

what is the benefits of submitting your tumors to a pathologist

A
  • grade
  • margins
  • diagnosis and certainty
90
Q

T/F histologically clean margin = clinically clean margin

A

F: may be a clean margin according to the pathologist but does not indicate that you took a fascial plane

91
Q

in any situation with a dirty margin, it is a good idea to consider

A

referral

92
Q

T/F it is best to have a diagnosis prior to surgical intervention

A

T

Principles of Surgery (8 decks)

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