surgical approaches to cancer

Question 1

What are the general principles of biopsy?

Answer 1

• Position biopsy site within probable surgical or radiotherapy field
• Incision should be as small as possible
• Handle specimens carefully
• Obtain samples from different areas of the lesion including junction of abnormal-normal tissue
• Avoid local dissemination of neoplastic tissue

Question 2

When might you perform an incisional biopsy?

Answer 2

• When mass will not work well for an FNAB and can’t perform a core biopsy either
• Very solid tumours that won’t allow effective core biopsy to be taken
• When cytology/ ore biopsy results non diagnostic
• Lack of core biopsy equipment

Question 3

What is more desirable an excisional or incisional biopsy?

Answer 3

-Incisional- you ideally want to have a diagnosis BEFORE surgery. Excisional- risk of not taking enough margins.

Question 4

What is the problem with debulking/ intralesional/ cytoreductive excision?

Answer 4

-It leads macroscopic volume of tumour, meaning it will recur unless given adjuvent therapy. It is less effective if gross vs microscopic tumour remains)

Question 5

Why would you chose to do a debulking/ intralesional/ cytoreductive excision?

Answer 5

• Worries about not having enough tissue to close wound
• Vital structures must be avoided and this can’t be done with full excision
• Tumour was assessed without histologic diagnosis and grading

Question 6

What is marginal excision?

Answer 6

Excision occurs immediately outside pseudocapsule.

• Microscopic volume of tumour remain
• Local recurrance without adjuvent therapy.

Question 7

What is the pseudocapsule made up of?

Answer 7

Compressed tumour cells NOT connective tissue

Question 8

What is wide excision?

Answer 8

Removal of the tumour with COMPLETE margins or normal tissue, local recurrence is unlikely

Question 9

What are the most effective tissue barriers to cancer cell spread?

Answer 9

• collagen rich, avascular tissues, e.g. fascia, ligaments, tendons, cartilage
  (fat, subcut tissue, muscle are all poor at resisting invading cancer cells)

Question 10

What is radical (or compartmental) excision?

Answer 10

Removal of entire anatomical structure or compartment containing the tumour. E.g. limb amputation
- Often applies for sarcoas

Question 11

What things do you need to think about pre-surgery?

Answer 11

• What is the diagnosis/ staging?
• How am I going to excise the mass?
• How am I going to close/ reconstruct the wound?
• Is any additional treatment needed?