Cancer surgery

Question 1

What specialists are invovled in the MDT for cancer management?

Answer 1

Surgeons
Physicians
Oncologists
Radiologists
Pathologists
Specialist nurses
Others
Data clerks

Question 2

What are the features of a malignant tumour?

Answer 2

Direct invasion - directly extend into nieghbouring tissues
Metastatic spread: liver, bone, lungs, brain, any other site

Question 3

How does cancer cause illness?

Answer 3

Interference with function
Erosion - bleeding
Obstruction
Cachexia - wt loss
Metabolic effect

Question 4

Example of cancer interfering with function

Answer 4

e.g. tumour in apex of lung
pressure on brachial plexus - severe shoulder pain
weakness of hand on affected side

Question 5

Example of cancer causing erosion?

Answer 5

GI tumour
in stomach or SI
often presents as anaemia or upper GI haemorrhage

Question 6

Example of cancer causing obstruction

Answer 6

Malignant large intestine

Question 7

What is cachexia?

Answer 7

Uniintentional weight loss
Progressive muscle wasting
Loss of appetite
Caused by nausea, tumour metabolism, chronic inflammatory changes

Question 8

What is the purpose of cancer screening?

Answer 8

To find disease at early stage
To remove disease at an early stage
To prevent cancer deaths

Question 9

What are the UK national screening programmes?

Answer 9

Bowel cancer screening:
men and women 60-74, 2 yearly
Cervical cancer screening:
all women 25-64, 3-5 yearly
Breast cancer screening:
All women 50-70, 3 yearly

Question 10

What is palliation?

Answer 10

Improves QoL without necessarily affecting survival
Mostly not surgical

Question 11

How will breast cancer present?

Answer 11

• Firm, irregular painless lump
• Pain - 10%
• Axillary/supraclavicular lymph nodes
• Nipple retraction and/or bloody discharge
• Paget’s disease - alteration of bone tissue
• Peau d’orange
• Signs of metastatic disease
• Asymptomatic presentation following screening

Question 12

What are the investigations of breast cancer?

Answer 12

Mammography
US
Fine needle aspiration cytology
Trucut biopsy
Excision biopsy
Wire guided biopsy
Chest x-ray, bone scan, CT, MRI

Question 13

How may surgery be involved in breast cancer?

Answer 13

Control of local disease: mastectomy, wide loacl excision
Reconstruction after breast surgery

Question 14

What is the significance of axillary LN in breast cancer?

Answer 14

Mode involvement is an expression of poor outcome rather than the determinant
Sentinel LN biopsy determines whether further treatment is required

Question 15

What are the prognostic factors of breast cancr?

Answer 15

Grade of tumour
LN metastasis
Size of tumour

Question 16

How can breast cancer be prevented? Who should be targeted for prevention?

Answer 16

Target high risk groups - BRCA1 and BRCA2 genes, strong family history, premalignant markers
Drug prevention
Oopherectomy
Bilateral risk reducing mastectomy

Question 17

What are the symtpoms of bowel cancer?

Answer 17

Rectal bleeding
Change in bowel habit
Iron deficiency anaemia
Abdominal mass
Bowel obstruction
Acute abdomen
Incidental finding
Screening

Question 18

What investigations are there for bowel cancer?

Answer 18

Colonscopy
CT colonoscopy’
Contrast CT - chest, abdomen, pelvis
MRI - pelvis
USS - liver

Question 19

What type of surgery is performed for colon cancer?

Answer 19

Laparoscopic
Open surgery

Question 20

What are the different operations for bowel cancer?

Answer 20

Right hemicolectomy
Extended right hemicolectomy
Left hemicolectomy
Sigmoid colectomy
Anterior resection
Abdomino-perineal resection

Question 21

When is a stoma necessary?

Answer 21

• To divert waste away from an obstruction which cannot be removed
• To allow bowel anastomoses to heal
• Patient high risk of leak from anastomoses
• There is no distal bowel to connect to

Question 22

Colorectal cancer screening

Answer 22

Males and females
60-74 years old
2 yearly
FIT - faecal innumohistochemical test
If patient positive, invited for colonscopy

Question 23

Polyp-cancer sequence

Answer 23

95% of cancer begin as adenomas
Evolution of polyp to cancer is 5-10 years
Remove polyp = reduce risk of cancer

Question 24

What are the risks of colonscopy?

Answer 24

Bleeding
Bowel perforation
Sedation effects
Bowel prep effects
Missed pathology