Oncological Surgery

Question 1

What does oncological surgery aim to achieve? (5)

Answer 1

Diagnosis, Prevention of spread, Cure, Comprehensive therapy (with chemo) & Palliative Therapy

Question 2

What are the advantages of oncological surgery as treatment for cancer?

Answer 2

immediate cure, no toxic effects, not immunosuppressive

Question 3

What are the disadvantages of oncological surgery as treatment for cancer?

Answer 3

Local cure only, Change in cosmesis (appearance of patient), Change in function

Question 4

What four things must we do to prepare for oncological surgery? (4)

Answer 4

Histological diagnosis
Extent of local disease
Presence of local or distant metastasis
Nutritional Status of patient

Question 5

Why is it so important to get oncological surgery right the first time?

Answer 5

Untreated tumours have normal regional anatomy which facilitates removal but recurrent tumours have already been interrupted and therefore seeded into previously non involved plane, will have bigger margins and be more unpredictable
also less tissue available in 2nd surgery so closure is more difficult!

Question 6

The most active and invasive part of the tumour are ….

Answer 6

at the periphery

Question 7

Would we biopsy a tumour of the thyroid?

Answer 7

No- this area is very vascularised so risks heavy bleeding

Question 8

What methods can we use to biopsy?

Answer 8

Needle biopsy- FNA, or Core
Incisional- surgical or punch
Excisional biopsy

Question 9

What’s the difference between an excisional and incisional biopsy?

Answer 9

Excisional- gets rids of entire mass so only done for benign tumours
Incisional- part of normal tissue and part of the mass

Question 10

In an excisional biopsy, to what skin layer do we aim to remove?

Answer 10

Aims for large margins so cut past fascia plane and into the muscle (even if tumour is just in subcutaneous layer)

Question 11

What do we preserve biopsy samples in?

Answer 11

10% formalin at a volume ratio of 10:1 (formalin:tumour)

Question 12

During oncological surgery we should avoid entering the ….
Why?

Answer 12

Pseudocapsule- contains tumour cells so avoid the spread

Question 13

During surgery you find an adhesion between the tumour and normal tissue, what do you do?

Answer 13

Resect with a good sized margin as adhesions may represent tumour invasion

Question 14

What are the pros and cons of controlling the veins first in oncological surgery?

Answer 14

Helps prevent venous emboli and nothing unwanted entering the circulation BUT things can still spread via the lymphatics and you risk organ swelling due to venous build up

Question 15

What are the pros and cons of controlling the arteries first in oncological surgery?

Answer 15

Helps prevent haemorrhage and organ congestion BUT a reduced arterial supply reduces the venous outflow

Question 16

What do we mean by sentinel lymph node?

Answer 16

The lymph node that immediately drains the area where the tumour is

Question 17

When would we remove the regional lymph node? (3)

Answer 17

If the…
Lymph node positive for tumour
Lymph node grossly abnormal at surgery
Lymph node is attached to the excised tissue

Question 18

When would we NOT remove the regional lymph node?

Answer 18

Lymph node is critical to adjacent tissue or if uncertain whether its positive for a tumour

Question 19

What histological information do we need to provide for an Excisional biopsy lab analysis? (5)

Answer 19

• Type of tumour
• Grade
• Regional lymph node status
• Margins
• Vascular or lymphatic invasion (metastasis)

Question 20

How do we know where the margins should be during an excisional biopsy?

Answer 20

Finger like projections will show satellite metastases- aim for 1-3 cm around that OR up to Fascia (muscle) as that provides a natural barrier to tumour growth

Question 21

What is the Pseudocapsule?

Answer 21

a zone of compressed tissue around the tumour containing viable tumour cells

Question 22

What three areas are of concern when it comes to oncological surgery and metastasis and why?

Answer 22

Platysma (head)
Pectorals
Biceps femoris

in these areas there’s either not enough tissue to remove an adequate margin or no fascia

Question 23

Local excision tumour removal is used for….

Answer 23

benign tumours or those with no local invasion- allows tumour to be removed through natural capsule

Question 24

When would we use a radical excision for a tumour?

Answer 24

When we need the margin to extend into fascial planes undisturbed by the tumour e.g. in cases of malignancy

Question 25

What is a compartmental excision?

Answer 25

tumour is removed in an intact anatomic compartment