Oncology surgery (Yr 4)

Question 1

what is a prophylactic use of surgery in cancer cases?

Answer 1

castration (prevent testicular neoplasia)
ovariohysterectomy (prevents ovarian and uterine neoplasia, reduced mammary neoplasia)

Question 2

does castration prevent prostatic neoplasia?

Answer 2

no (reduces incidence of other prostatic disease)

Question 3

how is ovariohysterectomy useful in oncology?

Answer 3

prevent ovarian and uterine neoplasia
reduce risk of mammary neoplasia

Question 4

what does the success of an FNA largely depend on?

Answer 4

success of exfoliation of cells (good in epithelial masses but poor in mesenchymal masses)

Question 5

what is an incisional biopsy?

Answer 5

removal of part of the masses to be submitted for histopathology

Question 6

when taking a incisional biopsy, should tumour margins be taken?

Answer 6

yes - can see the transition of normal tissue into tumour

Question 7

what is an excision biopsy?

Answer 7

removal of the entire mass to be submitted for histopathology

Question 8

when are excision biopsies indicated?

Answer 8

benign masses (confirmed on cytology)
small masses with wide margins achievable

Question 9

what are the possible approaches to margins of excision?

Answer 9

metric - measured as a distance from tumour
barrier - anatomic boundaries (fascia, cartilage…)
can also use a hybrid of the two above

Question 10

what types of tissue cannot act as a barrier and be used as margins for surgical excision?

Answer 10

fat, subcutaneous tissue, muscle, parenchymal tissue
(these boundaries aren’t tumour resistant)

Question 11

what are the types of surgical margin that can be taken?

Answer 11

intralesional (leaves neoplastic tissue in situ)
magical (on/outside tumour pseudocapsule)
wide margin
radical (entire organ/anatomical region removed)

Question 12

what is intralesional surgery used for?

Answer 12

debulking - cytoreduction (reduce the number of cancer cells present)

Question 13

what needs to be assessed before tumour surgery?

Answer 13

type of neoplasia
biological behaviour (invasion, metastasis, reoccurrence)
staging and size
location
surgical risk/complications
patient suitability
other treatment options and prognosis

Question 14

for wide excisions, what is the recommended margin for benign masses?

Answer 14

1cm lateral/deep margins

Question 15

for wide excisions, what is the recommended margin for most carcinomas?

Answer 15

1cm lateral and 1 deep intact facial plane

Question 16

for wide excisions, what is the recommended margin for low grade soft tissue sarcoma?

Answer 16

1cm lateral and 1 deep intact fascial place

Question 17

for wide excisions, what is the recommended margin for high grade soft tissue sarcoma?

Answer 17

2-3cm lateral and 1 deep intact fascial plane

Question 18

for wide excisions, what is the recommended margin for feline injection site sarcoma?

Answer 18

3-5cm lateral margin and 2 deep intact fascial planes

Question 19

for wide excisions, what is the recommended margin for grade 1-2 mast cell tumours?

Answer 19

1-2cm lateral and 1 deep intact fascial plane

Question 20

for wide excisions, what is the recommended margin for grade 3 mast cell tumours?

Answer 20

3cm lateral and 1 deep intact facial plane

Question 21

when are marginal excisions indicated?

Answer 21

removal of lipoma
preservation of key anatomy
removal of malignant tumour as part of multimodal therapy

Question 22

how much tissue should be submitted for histopathology when excised?

Answer 22

all of it

Question 23

what are some markers of malignancy?

Answer 23

evidence of increased cellular activity
abnormal cell morphology
evidence of metastasis
evidence of local tissue invasion

Question 24

what are the ways surgical margins can be described on histopathology?

Answer 24

complete
complete but narrow
incomplete

Question 25

what is a complete surgical margin?

Answer 25

no neoplastic cells within 3-5mm of the tumour margin

Question 26

what is a complete but narrow surgical margin?

Answer 26

neoplastic cells <3mm from the surgical margin or no normal tissue beyond tumour capsule

Question 27

what are the epithelial tissue that can cause tumours?

Answer 27

epithelial
glandular

Question 28

what suffix do benign tumours end with?

Answer 28

-oma

Question 29

what suffix do being glandular tissue tumours end with?

Answer 29

-adenoma

Question 30

what is the suffix of malignant mesenchymal or round cell tumours?

Answer 30

sarcoma

Question 31

what is the suffix of malignant epithelial tumours?

Answer 31

carcinoma

Question 32

what is the suffix for malignant glandular tissue tumours?

Answer 32

adenocarcinoma