EXAM #2: INTRODUCTION TO SURGICAL ONCOLOGY

Question 1

What website is the best resource for understanding the role of surgery in cancer therapy?

Answer 1

www.nccn.org

Specifically, the guidelines/ treatment recommendations.

Question 2

What are the three major cancers that are NOT amenable to surgery?

Answer 2

Leukemia
Lymphoma
Small Cell Lung Cancer

Question 3

What factor makes a cancer non-curable?

Answer 3

Distant metastasis

Question 4

What is a negative margin in surgery?

Answer 4

The normal tissue that is removed with the surgical excision of a tumor, growth, or malignancy

Question 5

What is the negative margin in breast cancer?

Answer 5

1mm

Question 6

What is the negative margin in colon cancer?

Answer 6

5cm

Question 7

What is “formal resection” in cancer?

Answer 7

• In colon resection; removal of the colon/cancerous tissue at the arterial root coming off the aorta to ensure removal of all the “curtains of lymph nodes”

This is in contrast to removal of the colon distal to the aorta for a colon resection to treat diverticulitis.

Question 8

What is a major way to use surgery to diagnose a cancer?

Answer 8

Biopsy

Question 9

How do you decide where to do a biopsy?

Answer 9

Go for the:

1) Most accessible
2) Least invasive

Question 10

What surgical decision do you need to make about metastatic cancers?

Answer 10

Can removing the primary cancer + adjuvant chemotherapy cure, or do I need to take out the mets as well?

Question 11

What is the procedure called that biopsy a breast cancer?

Answer 11

Stereotaxic needle biopsy

Question 12

What is the procedure to determine the metastatic status of a breast cancer?

Answer 12

Sentinel lymph node biopsy

Question 13

When are the two major cancers where surgery is a primary treatment?

Answer 13

Breast cancer

Colon cancer

Question 14

When is surgery used as a secondary treatment?

Answer 14

Advanced stage:

• Esophageal
• Rectal
• Lung
• Breast

But NOT stage 4*

Question 15

What is neoadjuvant therapy?

Answer 15

Chemotherapy/ radiation used prior to surgery to downstage a tumor

Question 16

What is surgery as a palliative measure?

Answer 16

Surgery to alleviate pain and improve quality of life

Question 17

What are indications for palliative surgery in the face of cancer?

Answer 17

Bleeding
Obstruction
Perforation
Pain

Question 18

What is a tumor type that is very amenable to “debulking” without obtaining negative margins?

Answer 18

Neuroendorince tumors e.g. pheochromocytoma

Question 19

What are the hereditary cancer syndromes that warrant prophylactic surgery?

Answer 19

• BRCA (Breast)
• Lynch Syndrome (Colon)
• Gardner Syndrome (Colon)
• MEN

Question 20

What are the major oncologic emergencies?

Answer 20

• SVC Syndrome

- Perforated viscus e.g. esophageal

Question 21

What is SVC Syndrome?

Answer 21

Lung tumor that compresses the SVC

Must the stented and radiated emergently.