Surgical Oncology Flashcards
Lymphatic system & tumours?
Return excess interstitial uid
Immune filtration system
Tumour cells in lymphatic
channels reach periphery of
node, enter subcapsular sinus
Lymphatic metasases?
- 50-60% cancer cells spread rapidly trough the node
- Minimally effecive barriers o passage of cancer cells
- Nodes mount effective response to limited tumour burden
What is the greatest determinant of clinical lymph node metastasis ?
biology of metastatic cells themselves
T/F Lymphadenopahy causes morbidity not mortality
True
What does Halstead say of spread of cancer?
Cancer cells disseminate in an
orderly anatomic manner of ever larger circles.
Local spread, nodal barrier, nodal disease, blood dissemination
What does Bernard Fisher say abotu cancer spread?
regional LNs ineffective
barriers if cancer
predisposed to spread, large
surgery will not alter effects
of systemic dissemination
Enneking resection classification?
Intralesional resection?
Debulking, piece-meal, capsule broached
Gross and/or microscopic disease remains
Marginal resection?
- Extra-capsular, shelling/ peeling, reactive one
- Microsatellites and skip lesion remain
Describe a wide excision?
- classic 3cm and one facial plane
-> MCR, STS , chest wall - > Fact or dogma
- Modified metric margin for: GI lung liver, oral
What mighjt be left behind even with wide margins?
skip metastases
Wha is a radical resection?
- Entire compartment
- Typically limb or part-of
- 2 facial planes?
Outcome expected for Intra-lesional ?
Recurrence expected. consider adjunctive therapies
Outcome expected for Marginal excision?
- Recurrence possible. difficult to predict. consider adjunctive therapies
Outcome expected for wide excision?
- Recurrence not expected. Curative intent. Consider adjunctive therapy if dirty margins
Outcome for radical excision?
Recurrence rare. curative intent. No further local therapy indicated
Pre-op considerations?
Clip wide
Positioning - consider tension lines, motion areas
Intra-op Considerations?
- Peri-op ABs
- Minimise handling of tumour
- Ligate the venous side first
- Change gloves, instruments, surgical towels
- Lavage
What to do if u realise saving he limb is unrealisic?
- change gloves, drapes and instruments
- Wrap open wound
- Amputate limb
What to do if tumour capsule unintentionally broached?
- Surgery becomes intralesional
- Suture dissection tract closed
- Change gloves, instruments, lavage wound
- Extend resection beyong current position
What to tell pahologist?
- Consise accurrate history
- Maintain proper tissue orientaion -> drawing? place suture on a specified margin? paint margins with ink
- Do not incise the surgical margin
- Fixative incisions through tumour boundaries that will not confuse the pathologist
