Surgical Oncology Flashcards
surgery is the most important component of treatment for small animals with _________ tumors
Solid
the best chance of curative surgery is _________
the first attempt
roles of surgery in caner treatment
obtaining a diagnosis - biopsy
curative surgery/long term control
palliation of clinical signs
debulking surgery prior to adjunctive therapy
prevention/reduction of risk recurrence
ancillary procedures (vascular access port placement)
components of physical exam
thorough general exam
body mapping - size and location of masses, mobility, consistency
evaluate regional lymph nodes - palpate and measure
cytology can be useful for diagnosing certain ______
round cell tumor malignancies
- for all other tumors interpret cautiously! inflammation may resemble malignancy*
- if not diagnositic = recommend biopsy*
imaging of primary tumors is important for:
intracavitary tumors
firm, non-mobile tumors (Sq, intramuscular and body wall tumors)
CT is used for:
more detail for treatment planning, especially 3D reconstructions
what is the gold standard for diagnosing neoplasia
biopsies
how does a histopathologic diagnosis help guide treatment
type of treatment
extent of treatment
consider location of mass
T/F if the mass is large, you should consider multiple samples from various areas within the mass
True!
ideally, biopsy sample should contain ______
junction between normal and abnormal tissue
types of biopsies
impression smears - ulcerated masses, other exfoliated cells (TCC)
needle core biopsies
punch biopsies
endoscopic/laproscopic
incisional
excisional
when should excisional biopsies be considered
best chance of cure is at first surgery
gingival lesions
known to be benign
small (< 5mm)
treatment not altered by tumor type
re-excision possible without great morbidity
indications of incisional biopsy
location, size, or tumor type/grade could affect treatment planning
less invasive techniques have not yielded a diagnosis
disadvantages of incisional biospy
require a second surgery
may create communication between neoplastic and normal tissue (cell seeding)
T/F ability to close wound should not influence agressiveness if intent is to cure
True
must know approproate mrgins for tumor type
what should be done before closing with surgical oncology
lavage tissues, change gloves and instruments, and lavage again
what should be avoided if possible with surgical oncology
use of drains
T/F removal of normal tissue completely around mass is indicated for most tumors
True
exceptions: benign masses with low risk of recurrence; masses in body cavities
excision classifications
intracapsular
marginal/cytoreductive
wide
radical
characteristics of wide excision
removal of 2-3cm normal tissue 3-D (metric approach)
removal of 2-3cm of normal tissue laterally and 1 fascial plane deep (metric/barrier hybrid)
when is marginal/cytireductive excision used
lipomas and benign masses
malignant lesion - goal is microscopic disease
margins for wide excision should be based on
imaging and histopathology report from biopsy - grade, mitotic index, degree of differentiation
what type of tumors should be removed with wide margins
mast cell tumors (high grade)
soft tissue sarcomas - higher grade tumors more likely to recur locally and/or metastisize; vaccine assiciated sarcomas
when is cytoreductive surgery performed
enhance efficacy of other treatments
T/F if a tumor is “fixed” to a structure, assume that tissue is invaded and remove it also
True
what types of tumors is local LN excision prognostic for
mammary carcinoma
mast cell tumors
apocrine gland adenocarcinoma of the anal sac
T/F palliative treatment will improve quality of life but not extend life or alter course of disease
True
with adjuvant therapy disease prgression may be slowed in some cases
surgical margins be identified by ____
dye covering excised area
sutures
excising additional tissues from surgical bed
how long should ink be allowed to dry before fixing
1 hour
when can immunohistochemistry be useful
determining cell of origin as tumors becomes less differentiated
what can you do if your margins are “dirty”
wait and see depending on remainder of report
re-excision with margins based on surgical scar
adjunctive therapy - chemo, radiation
