Surgical resection of tumours Flashcards
What are some roles of oncological surgery
What is the significance of prophylactic surgery in relation to mammary neoplasia?
Ovariectomy or ovariohysterectomy reduces risk of mammary neoplasia, with lowest risk when performed before first estrous cycle.
Why is a preoperative biopsy often performed?
To guide treatment by understanding tumour type & grade, which helps determine recommended surgical margins.
What are some cytology biopsy techniques
FNA
Impression smear
What are some histology biopsy techniques
Core biopsy
Punch biopsy
incisional biopsy
Excisional biopsy
What is staging
Looking for metastatic disease /spread
Can use radiographs, ultrasounds, CTs or MRIs
What is surgical dose
How much surgery?
4 categories:
- debulking/intralesional/cytoreduction
- marginal resection
- wide resection
- radical resection
Label the tumour parts
Pseudocapsule = compressed cancer cells (isn’t actual barrier) common in sarcomas
Reactive zone = inflammation
What is Debulking/intralesional/cytoreductive excision (surgical dose)
leaves macroscopic volumes of tumour
will recur unless given adjuvant therapy
- which is less effective if gross vs microscopic tumour remains
What is marginal excision (surgical dose)
excision immediately outside pseudocapsule of tumour
leaves behind microscopic volumes of tumour
local recurrence likely without adjuvant therapy
Often described as local excision - tumour removal with minimal amount of surrounding normal tissue
Why do we do it?
- fear of ability to close resultant wound
- assessment of tumour biology without histological diagnosis & grade
What is wide excision (surgical dose)
removal of tumour with complete margins of normal tissue in all directions
local recurrence unlikely
No skip or satellite metastases
lateral margins are straight forward but deep margins can be difficult to achieve (constrained by anatomy)
What are some effective vs less effective natural barriers to spread of cancer
effective:
- collagen-rich avascular tissues such as fascia, ligaments, tendons & cartilage
less effective:
- fat
- subcutaneous tissue
- muscle
- other parenchymatous organs
What is radical/compartmental excision (surgical dose)
removal of entire anatomical structure/compartment containing tumour
- e.g. limb amputation for primary bone tumour
local recurrence unlikely
often applies for sarcomas which can extend along fascial planes rather than through them
