Surgical Oncology - Exam 1 Flashcards
What is Multimodel treatment of Cancer Patient
This is utilizing all treatment methods in conjuncture. - Surgery -Chemotherapy - Immunotherapy - Radiation Therapy - Interventional oncology
What is surgical oncology
Utilizing surgical techniques in the diagnosis and treatment o cancer. - Surgical subspecialty with emphasis on the patient as a whole
What are some patient considerations for preoperative surgical oncology?
Overall health status Comorbidities Type and stage of cancer ADjuvant therapies Owner goals expected prognosis
FNA
fine needle aspirate -overall sensitivity is 80% specificity 100%
Staging
This measures the level of disease spread. Incorporates the potentail metastasis to the lungs
Sentinel Lymph node
First lymph node within lymphatic drainage basin that drains the primary tumor reliably - If negative, additional LN assessment unnecessary - May be unpredictable anatomic location
What ares ome techniques for sentinel lymph node maping
- Radiographic lymphogram - CT lymphogram -Contrast-enhanced ultrasound -Lymphoscintigraphy
What is TNM
Tumor node metastasis staging system. - Tumor size is prognostic - The higher the stage, the lower the prognosis
Lymph node extirpation
Surgical removal of a lymph node
How to prepare an area for a biopsy
Sedation , and local block Wide clip, aseptic technique
What is the goal of an incisional biopsy
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
Features of excisional biopsy, and indications of when to NOT use this technique
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
What are the 3 surgical goals of oncology
Curative intent
Cytoreduction - reduce disease down to microscopic level
Palliative intent- make the animal feel better to get more time
What is Surgical Dose in relation to oncology?
This is the aggressiveness of surgical resection applied to a tumor
- Marginal excision leaves reactive zone behind
When getting surgical margins from a tumor/lump removal, what are the goal in relation to fascial planes?
- Fascial planes:
- Muscle and muscle fascia
- Cartilage
- Bone
- Skin margins depend on primary tumor
- Minimum 1 fascial plane deep and 2-3cm wide
What is neoadjuvant therapy
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
Curative intent surgery
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
Mast cell tumor surgical techniques
- Goal: curative intent 2-3cm, 1 fascial plane deeep
Tissue undermining- not often used due to seeding
-Flaps/grafts if dirty resection
Avoid drains
Cryoreductive Surgery
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.
What are the goals of Palliative intent surgery
- 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)
Postoperative Considerations for Oncology
Always submit the entire tumor
Inking of the surgical margin helps the histopathologist.
- Provide a good report!
What is the most common surgical margin to found to be “dirty”?
The deep margin
What is the next step if you are unable to get complete surgical margins?
Re-excision
- Radiation therapy
- Chemotherapy
- Monitor for recurrence
How long after tumor rescection can adjuvant therapy such as radiation therapy begin?
10-14 days
(after would healing)
