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SA Sx > Principles of Sx Onco- exam 2 > Flashcards

Principles of Sx Onco- exam 2 Flashcards

1
Q

What is one of the most crucial steps in management of the cancer patient?

A

Properly timed, performed and interpreted bx

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2
Q

When should you perform a pre-treatment biopsy?

A

FNA provided insufficient information and non-dx
Suspicion of false neg
Life/death decision based on results
Tumor changes sx approach
willingness of O would change based on results
Sx is in a difficult anatomical location
Tx has high morbidity

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3
Q

What type of biopsy is performed during pre-treatment biopsy?

A

Incisional biopsy

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4
Q

Why are pre-treatment biopsies performed?

A

Obtain additional information about the tumor prior to definitive tx

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5
Q

What types of incisional biopsy are there?

A

Needle core
Wedge
Punch

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6
Q

What type of biopsy is performed for post-treatment biopsy?

A

Excisional biopsy

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7
Q

T/F: Excisional post-op biopsy allows for a more complete picture of the disease process

A

TRUE

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8
Q

What type of tissue should be avoided for incisional biopsy?

A

Ulcerated/inflamed tissue

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9
Q

What should the orientation of incisional biopsy be in regards to tension lines?

A

Parallel

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10
Q

What are some pros to incisional biopsy?

A

Better planning=better chance for sx cure
Established informed consent w/ client
Appropriate implementation of neoadjuvant and adjuvant tx

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11
Q

What are some cons to incisional biopsy?

A

Two procedures ($$)
More invasive for the patient
Increased risk of local recurrence

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12
Q

What are the six incisional biopsy techniques?

A 
Tru cut
Punch biopsy
Wedge biopsy
Jameshedi/Michelle Trephine
Endoscopic/Laparoscopic
Specialized
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13
Q

What are the sizes of TruCut needles that can be used?

A

14 Ga
16 Ga
18 Ga

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14
Q

What are some pros to performing trucut biopsy?

A

Used on any accessible mass
Maintains structural integrity of tissue
Perfomred under sedation/local anesthesia
Obtain multiple samples

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15
Q

What size punch must be taken for a diagnostic punch biopsy sample?

A

> 6 mm

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16
Q

When should you NOT use punch biopsy?

A

For hypodermal masses- hemorrhage can occur

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17
Q

When is a wedge biopsy the most preferred technique?

A

When there is ulcerated or necrotic tissue and for deeply located mass

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18
Q

When should excisional biopsies be performed?

A

Treatment would NOT be altered by tumor type or grade
Procedure to get to mass is invasive or carries high risk (bleeding)
If the location is permissive of wide margins without compromising the potential for future re-excision

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19
Q

In what situation should an excisional biopsy be perfomred?

A

Splenectomy- don’t biopsy the spleen, just remove the entire organ so you won’t have to go back if the bx confirms malignancy

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20
Q

What are the specific techniques for excisional biopsy?

A

Prevention of tumor seeding- avoid contamination of surrounding tissue
Eliminate all dead space
DON’T PLACE A DRAIN- this allows the travel of tumor cells

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21
Q

What are majority of solid tumors surrounded by?

A

Pseudocapsule- this may contain microscopic tumor extensions or satellite populations of tumor cells

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22
Q

What is the classification system of surgical dosing?

A

Enneking system

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23
Q

What are the four classes of the Enneking system?

A

Intralesional (Intracapsular)
Marginal
Wide
Radical

24
Q

When is the intralesional approach not ideal?

A

For malignant tumors since growth of cells would be left behind

25
Q

When do you use the intralesional approach?

A

Lipomas

26
Q

What is the order of least to most invasive tumor sx approaches?

A

Intralesional - Marginal - Wide- Radical

27
Q

When performing a marginal approach to tumor removal, what are your margins for carcinomas, MCT, soft tissue/bone sarcomas and feline injection site sarcomas?

A

Carcinomas: <1 cm
MCT: <2 cm
STS/BS: <3 cm
Feline injection site sarcomas: <5 cm

28
Q

What is the technique for marginal excision of a tumor?

A

Through the pseudocapsule or perilesional zone surrounding the tumor

29
Q

What type of sx excision method would you use for tumors in these examples?
On extremities, near the eye or perianal region

A

Marginal tumor excision

30
Q

Describe the process for wide sx excision for tumors?

A

Normal tissue outside the pseudocapsule

31
Q

What are the lateral margins for wide tissue biopsy approach?
Carcinoma, MCT, STS, Feline injection site sarcoma

A

Carcinomas: > 1 cm
MCT: >2 cm
Soft tissue/bone sarcomas: > 3cm
Feline injection site sarcoma: > 5 cm

32
Q

What is the minimum plane margins for soft tissue sarcoma for wide surgical excision?

A

1 fascial plane deep or 2 muscle planes deep

33
Q

What is the minimum plane margins for MCT for wide surgical excision?

A

Minimum of 2-3 cm lateral margins and a fascial plane deep

34
Q

What is radical surgical excision?

A

Entire compartment of the tumor is removed

Ex: entire limb/organ

35
Q

What are two common radical excision applications?

A

Amputation or hemipelvectomy

36
Q

What surgical system does Dr. Cav prefer to follow most?

A

Fulcher system

37
Q

What is the Fulcher system?

A

Circle tumor and measure out 1, 2 and 3 cm to determine feasible margins

38
Q

What is the difference between a grade I vs grade II Fulcher tumor?

A

Grade I: 100% clean at 1, 2, and 3 cm

Grade II: 68% clean at 1 cm; 90% clean at 2 cm; 100% clean at 3 cm margins

39
Q

Which system follows the modified proportional margins technique?

A

Pratschke system- MCT excision

40
Q

What is the definition of the Pratschke system?

A

Widest diameter of the tumor used as the lateral margin for excision
If a tumor is > 4cm in diameter, you will not go past this length out

41
Q

What percentage are complete margins obtained?

A

82% of cases complete margins are obtained

42
Q

What are the margins for acanthomatous ameloblastoma vs malignant oral tumors?

A

B9: 1 cm
Malignant: 2 cm

43
Q

Which two tumors constantly change margin sizes?

A

Thyroid tumors

Anal sac tumors

44
Q

Which tumors should be inked and how should this be done?

A

Ink ALL TUMORS
Ink all cut surfaces, NOT SKIN
Prior to breadloafing and fixation in formalin

45
Q

What is the dye system used to ink tumors and which colors should be used?

A

Davidson Dye system

Yellow or Black colors

46
Q

What should be provided on the submission form when submitting a tumor biopsy sample?

A

Signalment
Pertinent clinical infomration about tumor
Anatomical site of sx
Lesion description

47
Q

What is the tissue to formalin ration?

A

1:10

48
Q

What is the ideal tissue thickness for tumors to be placed in formalin?

A

0.5-1.0 cm tissue thickness

49
Q

How far should the breadloaf cuts be made apart?

A

2 cm apart- incomplete cuts

50
Q

What is the optimal method for biopsy submission?

A

Small volume biopsy submission- place sample in screen cassette

51
Q

“Complete but close” refers to what in margin terminology?

A

Tumor cells w/in 1 mm of cut edge

52
Q

“Complete” excision marginal terminology means what?

A

> 2mm of normal tissue between tumor & inked edges in all directions

53
Q

“narrow” excision marginal terminology means what?

A

2-5 mm of normal tissue between tumor and cut edge

54
Q

What is the percentage of diagnostic agreement between 1st and 2nd opinions?

A

52%

55
Q

What is the difference between R0, R1 and R2?

A

R0- no residual tumor
R1- microscopic residual tumor
R2- macroscopic residual tumor

SA Sx (22 decks)

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