Surgical Oncology Flashcards
What are more cancer patients cured with than any other form of treatment?
Surgery!
- The first and best chance to cure cancer is the initial surgery
- However, inappropriate surgery may make a curable cancer incurable!
What 6 questions should the vet be able to answer for the clients about their animal with cancer?
- Identify the cancer
- Explain the expected biological behaviour of the cancer
- Provide options for treatment
- Explain the quality of life before, during and after treatment
- Prognosis, with and without treatment
- Cost of treatment
At minimum, what observations should be recorded about a foreign mass?
- Use a body map to note the location of the mass
- Describe the palpable findings e.g. fixation
- Using callipers, measure the size of the tumour in 3D
- Perform a fine-needle aspirate of the mass
How do you/ your client make a decision on oncologic surgery?
Cost vs Benefits
Costs:
- Surgical morbidity
- Potential for complications
- Loss of function
- Cosmetic effects
Benefits:
- Palliation of clinical signs
- Improved survival times
What is curative intent?
All tumour surgery should be performed with curative intent
- Minimal and gentle handling of neoplastic tissue
- Irrigate wound with sterile saline to expel exfoliated cancerous cells
- Remove previous biopsy tract (if any)
- Ligate the venous drainage early to stop spread of tumour cells
- Handle and cut through normal tissue, not tumour
What are the three types of Excisions made with curative intent…
- Local Excision
- Wide local Excision
- Compartmental excision
Describe a Local Excision…
Surgical dissection plane is directly onto the tumour capsule
- Mass is ‘shelled-out’ from the surrounding tissue
Use for benign tumours only
Describe a Wide Local Excision…
For benign tumours that don’t have a distinct capsule
Excision of tumour with a margin of normal tissue
- 0.5 cm - 3-5cm wide margin
Describe a Compartmental resection…
Tumours within the soft tissue sarcoma group
- grow with aggressive invasion into local tissues
Completely remove all apparently normal tissue including blood vessels and nerves etc contained within one fascial plane
- remember to remove all three dimensions of the tumour
What must you remember about individual patients and their cancers?
- Efficacy of surgery depends on the type of cancer
- There isn’t a generic rule
- Over treatment is better than under treatment
- Every cancer’s interactions with host tissues is very different
What is cytoreductive surgery?
Surgical resection + radiotherapy and/or chemotherapy
- Can be used to avoid a disfiguring or debilitating surgery
- Decision should be made pre-op or immediately post-op
What is radiotherapy good for?
Treating microscopic disease within the tumour bed which remains following a local excision
What is palliative surgery?
Generally for cancers that have a hopeless prognosis
- removal of the tumour burden may restore/ maintain a comfortable quality of life acceptable to the owner until euthanasia is required
e. g. amputation of primary bone tumour
What is prophylactic/ preventative surgery?
Prevention of some common cancers
- e.g. testicular cancer in dogs
What is fine needle aspiration?
A diagnostic procedure involving introduction of a (22- 25) narrow- gauge, rigid hypodermic needle into a tissue or organ and removal of a small amount of tissue by suction
