Surgical Oncology - Exam 1

Question 1

What is Multimodel treatment of Cancer Patient

Answer 1

This is utilizing all treatment methods in conjuncture. - Surgery -Chemotherapy - Immunotherapy - Radiation Therapy - Interventional oncology

Question 2

What is surgical oncology

Answer 2

Utilizing surgical techniques in the diagnosis and treatment o cancer. - Surgical subspecialty with emphasis on the patient as a whole

Question 3

What are some patient considerations for preoperative surgical oncology?

Answer 3

Overall health status Comorbidities Type and stage of cancer ADjuvant therapies Owner goals expected prognosis

Question 4

FNA

Answer 4

fine needle aspirate -overall sensitivity is 80% specificity 100%

Question 5

Staging

Answer 5

This measures the level of disease spread. Incorporates the potentail metastasis to the lungs

Question 6

Sentinel Lymph node

Answer 6

First lymph node within lymphatic drainage basin that drains the primary tumor reliably - If negative, additional LN assessment unnecessary - May be unpredictable anatomic location

Question 7

What ares ome techniques for sentinel lymph node maping

Answer 7

• Radiographic lymphogram - CT lymphogram -Contrast-enhanced ultrasound -Lymphoscintigraphy

Question 8

What is TNM

Answer 8

Tumor node metastasis staging system. - Tumor size is prognostic - The higher the stage, the lower the prognosis

Question 9

Lymph node extirpation

Answer 9

Surgical removal of a lymph node

Question 10

How to prepare an area for a biopsy

Answer 10

Sedation , and local block Wide clip, aseptic technique

Question 11

What is the goal of an incisional biopsy

Answer 11

Get both normal tissue in dermis but don’t alter potential surgical margins.

• if it is a tumor, avoid the center of it! The center is generally necrotic

Question 12

Features of excisional biopsy, and indications of when to NOT use this technique

Answer 12

This technique is frowned upon when you don’t know what it is

• This technique is okay if you know its benign ahead of time

Question 13

What are the 3 surgical goals of oncology

Answer 13

Curative intent

Cytoreduction - reduce disease down to microscopic level

Palliative intent- make the animal feel better to get more time

Question 14

What is Surgical Dose in relation to oncology?

Answer 14

This is the aggressiveness of surgical resection applied to a tumor

• Marginal excision leaves reactive zone behind

Question 15

When getting surgical margins from a tumor/lump removal, what are the goal in relation to fascial planes?

Answer 15

• Fascial planes:
• Muscle and muscle fascia
• Cartilage
• Bone
• Skin margins depend on primary tumor
• Minimum 1 fascial plane deep and 2-3cm wide

Question 16

What is neoadjuvant therapy

Answer 16

This is when additional therapies are used before surgery

• These techniques are used when the tumors are very large, in a difficult location

Examples of therapies: chemotherapy, radiation therapy

Question 17

Curative intent surgery

Answer 17

You know the tumor type prior to surgery

• Very wide margins, or radical excision (3cm margin) (maintain margins deep to the plane
• Use separate “clean” and “dirty” instruments

Avoid tumor manipulation

Question 18

Mast cell tumor surgical techniques

Answer 18

• Goal: curative intent 2-3cm, 1 fascial plane deeep

Tissue undermining- not often used due to seeding

-Flaps/grafts if dirty resection

Avoid drains

Question 19

Cryoreductive Surgery

Answer 19

Debulking intralesional - macroscopic disease left behind

Shell out- marginal resection

• Attempt to remove all gross disease, leaves microscopic disease. Large margins not attempted or achieved.

Question 20

What are the goals of Palliative intent surgery

Answer 20

• Surgery to relieve pain or discomfort
• Surgery to improve function
• Only use this technique when necessary
• Remove as much tumor as possible
• Leave as much tissue to close as possible (higher risk of dehiscence, avoid complications)

Question 21

Postoperative Considerations for Oncology

Answer 21

Always submit the entire tumor

Inking of the surgical margin helps the histopathologist.

• Provide a good report!

Question 22

What is the most common surgical margin to found to be “dirty”?

Answer 22

The deep margin

Question 23

What is the next step if you are unable to get complete surgical margins?

Answer 23

Re-excision

• Radiation therapy
• Chemotherapy
• Monitor for recurrence

Question 24

How long after tumor rescection can adjuvant therapy such as radiation therapy begin?

Answer 24

10-14 days

(after would healing)