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Surgery + Procedural Interventions Flashcards

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1
Q

What are the primary roles of
surgery/procedures in palliative care?

A
  • Prevent symptoms/negative outcomes
  • Relieve symptoms
  • Improve QOL
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2
Q

What biochemical measure is a broad predictor of good surgical outcome in PC?

A

Albumin

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3
Q

What is the primary procedural approach
to managing functional neuroendocrine ca?

A

RFA (esp. liver lesions)

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4
Q

Which are the 2 most common cancers associated with malignant bowel obstruction?

A

Colon ca
Ovarian ca

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5
Q

Which patients would benefit from
surgical opinion in MBO?

A

All

except not within GOC
except prognosis <days to short weeks

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6
Q

What are 5 contraindications to surgical
intervention in MBO?

A
  1. Multilevel obstruction
  2. Palpable abdominal mass(es)
  3. Peritoneal carcinomatosis
  4. Poor function (not quantified)
  5. Short prognosis
  6. Ascites (relative)
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7
Q

What is the success rate of stenting for
reachable MBOs?

A

> 70%, higher in colorectal

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8
Q

What are the 3 most common
complications of endoscopic stenting?

A
  • Perforation
  • Stent migration
  • Stent occlusion
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9
Q

What procedure is available for
fungating breast wounds?

A

“Toilet” (i.e. hygiene) mastectomy

total chest wall debridement and reconstruction

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10
Q

Which 3 cancers are most likely to cause
malignant skin issues?

A
  • Primary skin ca (obviously)
  • Breast
  • Soft-tissue sarcoma
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11
Q

List 3 surgical methods of bypassing
the biliary tract (i.e. not ERCP)

A
  1. Choledochojejunostomy
  2. Choledochoduodenotomy
  3. Cholecystojejunostomy

i.e. drain liver into bowel

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12
Q

Which is superior for GOO–stent or surgery?

A

Stenting (10% failure)
vs.
Surgery (40-90% failure)

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13
Q

Which is superior for biliary tract obstruction?

A

Stenting

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14
Q

What is the infection risk with abdominal PleurX insertion?

A

20-30%

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15
Q

Which dangerous procedure is rarely done
for refractory ascites?

A

Peritoneovenous shunting

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16
Q

What is the cutoff prognosis for
splenectomy vs. radiation in heme malig.?

A

> 6mo, do surgery

2* increased recurrence risk w. radiation

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17
Q

Is bony pain inflammatory or neuropathic?

A

Neither–different marker profile

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18
Q

What features of physical exam are essential in the patient with bony mets and back pain?

A

NEUROLOGICAL EXAM

SLR
deep tendon reflexes
strength testing

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19
Q

Which bony changes must be present for a
metastasis to appear on X-ray?

A

50% medulla loss
30% cortical loss

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20
Q

What are the 2 (3ish) types of bony mets?

A

Sclerotic (osteoblastic)
Lytic (osteoclastic)
Mixed

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21
Q

Which cancer is most associated with
sclerotic bony mets?

A

Prostate

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22
Q

Which cancers are ass’d with lytic bony mets?

A

Lung
Renal
Thyroid
Myeloma

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23
Q

What is the sensitivity of a bone scan?

24
Q

Which bony lesions tend not to
appear on bone scan?

Study These Flashcards
A

Highly aggressive mets (lung, melanoma)
Mets that are not healing (myeloma)

25
PET vs. bone scan for which bony mets?
PET–lytic (95% sens.) bone scan–sclerotic (100% sens.)
26
Which patients with impending/actual pathological #s should be referred to ortho?
All except the extremely ill
27
What is the median prognosis for a patient with bony metastases?
8 months higher in breast, thyroid lower in lung
28
What is another common cause of fracture in malignancy, other than pathological?
Osteoporosis * androgen deprivation therapy * older patients
29
What are the 4 features of the Mirels score to predict pathological # risk?
* Pain * Site * Blastic vs. lytic * Proportion of cortex involved
30
How is the Mirels score calculated?
Each item is scored 1-3 Pain (mild, moderate, impairing function) Site (UL, LL, trochanteric) Cortex (<⅓, ⅓-⅔, >⅔) Type (blastic, mixed, lytic)
31
Which 2 components provide most of a bone’s strength?
Calcium hydroxyapatite (compression) Collagen (tension)
32
What forces is bone weakest to?
Shear Torsion
33
How do small bony mets increase # risk?
Small surface defects → disproportionate drop in shear strength 20% of bone diameter → 60% drop >50% → 90% drop
34
Most common limb site of pathological #
Proximal femur (90% of femur #, 60% of limb #)
35
What is the weakest form of bony fixation?
Plate fixation with screws
36
Which ortho option is most successful?
Hemi- or total arthroplasty
37
How should epiphyseal # be managed?
Arthroplasty
38
How should diaphyseal # be managed?
Intramedullary fixation
39
What is the hardest location to fix an appendicular bone?
Metaphysis 2* many tendon attachments
40
What force causes the majority of humeral #?
Torsion
41
Are metallic or plastic stents more successful for biliary obstruction?
Metal–90% vs. 70%
41
What function loss is expect with both shoulder and elbow surgery for #?
Reduced abduction/overhead Reduced extension
42
What is the advantage of a plastic stent?
It can be replaced metal stents must be stented over
43
What did plastic-coated metal stents for esophageal obstruction replace?
Rigid plastic tubes inserted under GA
44
What are 4 reasons to embolise in palliative care settings?
* Hemostasis * Analgesia * Tumour shrinkage * Reduce hormone release from func. ca
45
What is the risk of embolising hormone-secreting tumours?
++ hormone release in short term consider prophylactically treating | (e.g. phenoxybenzamine)
46
Which organ is especially appropriate for tumour embolisation?
Liver, esp. HCC
46
In which liver population should you avoid arterial embolisation?
Cirrhosis–consider direct tumour lysis instead
47
What is the post-embolisation syndrome?
1. Fever 2. Increased pain 3. WBCs 4. Malaise * reflects tumour necrosis * if longer than a few days, consider infx * if CRP markedly elevated, consider infx
48
What is the rate of vertebroplasty complication in malignant disease?
<10%
49
What are the risks of vertebroplasty?
* Spinal cord damage * Bleeding at injection site * Allergic reaction * Infection
50
What are the three forms of tissue ablation?
* Heat (laser, RFA, U/S, etc.) * Cold (liquid N2) * Chemical (EtOH, acetic acid)
51
What are the limitations of EtOH ablation?
Can only diffuse c. 3cm, so no bigger tumours unless you inject multiple sessions
52
Which technique is the main option for ablation?
Radiofrequency (i.e. heat)
53
What features of a renal cell ca would make it more appropriate for RFA?
* Small tumour * Peripheral location * Poor surgical candidate

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