Surgical oncology

Question 1

Describe the uses of surgery in oncology

Answer 1

1. Diagnosis and staging - accurate histological diagnosis is required in virtually all patients. Surgical axillary node assessment allows an accurate assessment of lymph node involvement in breast cancer.
2. Treatment of cancer - surgical resection of the primary tumour with curative intent OR surgery to reduce bulk of residual disease, curative surgery for metastases, palliative surgery
3. Prevention of cancer - colectomy in patients with familial adenomatous polyposis coli, or bilateral mastectomy in BRCA

Question 2

Describe some biopsy techniques

Answer 2

Fine needle aspiration cytology
True-cut needle biopsy - a piece of tumour is sampled under local
Incisional biopsy - a piece of the tumour is sampled at surgery
Excisional biopsy - the whole of a mass is removed
Biopsy should never jeopardise subsequent possible surgeries

Question 3

Discuss the principles behind surgery with curative intent

Answer 3

30% of cancers are curable through surgical resection
Cancer must be localised
Adequate margins of clearance are required to minimise the risk of local tumour recurrence

Question 4

Discuss the principles of de-bulking surgeries

Answer 4

Surgery to reduce the bulk of the tumour can have survival benefit
Only of benefit is there is treatment options for the remaining tumour

Question 5

In what cancer does debulking surgery + chemo significantly improve survival?

Answer 5

Ovarian cancer

Question 6

When is curative surgery for metastases possible?

Answer 6

Solitary lung metastases from sarcomas
Localised liver metastases from colon cancer
Will always need adjuvant therapy

Question 7

Discuss some examples of palliative surgery

Answer 7

Bypass for intestinal obstruction from intra-abdo tumour
Ortho pining of pathological fractures
Biliary stent for biliary obstruction