Surgical Oncology Flashcards by Linda Armstrong

Goal of surgery

remove the malignant tumor
leave margin of adjacent normal tissue
minimal structural, functional, and cosmetic changes

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Surgery depends on:

size
location
morbidity - effects on neighboring organs and structures

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Onc Surgery uses:

prevention
diagnosis of primary site or metastatic disease
staging
cure with resection of disease (if local, DCIS)
reconstruction
vascular access (port, PIC, triple lumen cath)
control of disease (debulking)
onc emergencies (spinal cord compression)
paliation (reduce suffering, make comfortable)

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Surgical diagnosis

tissue Required for new malig. diagnosis (except wilms in peds)
tissue for 1st recurrence for diagnosis
surgical biopsy required for tissue

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Surgical diagnosis complications

inadequate tissue

FNA (fine needle aspiration)

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Types of biopsies

Fine Needle Aspirate (FNA)

Core Needle Biopsy

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FNA

small needle to aspirate cells from lesion
guided by palpation or imaging
used in head and heck cancers
preservation of future radiation field is needed
breast and lymph nodes

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Core needle biopsy

larger needle to take cores of tissue
guided by palpation or imaging
yields adequate tissue for histology, little cosmetic problem
Clips may be inserted as landmarks

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Treatment plans

may require chemo first if tumor mass is large

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Sentinel lymph node biopsy (SLNB)

radioactive isotope 1st one from tumor is biopsied

“sentinel node” - first one next to

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Node Mapping

radioactive dye injected into breast at tumor site
scan performed to visualize location of nodes
time of surgery - blue dye injected near tumor
scanner is used to find “hot nodes”
less invasive than tradiational dissection

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Excisional Biopsy

completely removes suspicious lesion during surgical procedure (incision, laprosopic, thorascopic)
goal to remove lesion with a margin of normal around

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Surgical Cytoreduction

goal to reduce the overall tumor burden
ultimate goal to remove all visible tumor and leave behind only nodules as small as 1-2mm

*debulking, removing some mass so chemo can work better

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Cryosurgery

good results
brief period of subfreezing, cells dehydrate and metabolically deranged, resulting in apoptosis
does not ensure complete destruction, rarely used for cancer

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Thermal surgery

minimizes operative blood loss

cells heated up to 140F, damages membrane and cell dies

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Radiofrequency ablation

radiowaves

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Laser surgery

aims beams of monochromatic light

focused energy on precise spot

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Lung cancer

Wedge resection (part removed)
Lobectomy
Multiple lobectomies
pneumonectomy
minimally invasive

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Mohs Micrographic surgery

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removes in stages, chunks until margins clear

-a skin cancer excisional procedure

major ablative surgery

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aggressive strategy

an amputation or a pelvic examination

interventional radiologic procedures

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CT guided biopsy

Breast Cancer

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multimodality therapy
lumpectomy
wider excision
mastectomy
modified Radical mastectomy
sentinal lymph node detection and removal
newer cell markers guide therapy: 
---HER2 (Herceptin)
--- ER + (aromatase inhibitor)

Surgical: Colorectal cancer

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hemicolectomy
low anterior resection
abdominal peritoneal resection
ant/post exenteration
pelvic exenteration
transanal excision
ostomy - now reversible

Surgical: anorectal

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squamous cell - wide local excision

benign anal diasease - hemorrhoids, fissures, anorectal abcess, fissure-in-ano, rectal prolapse

Colorectal cancers surgery

ostomy reversible

Prostate cancer

surgery robotic and nerve sparing brachytheapy Gleason's scale (1-5) - higher score may require surgery *try to avoid surgeries, affects sexual heath

Gleason Scale

1-5 | higher requiring surgery

Urological cancer

Bladder | Kidney

Bladder cancer surgery

cystectomy with ileal conduit continent reservoirs segmental cystectomy

Kidney cancer

nephrectomy | partial nephrectomy

Stomach cancer surgery

Radical Gastronomy -distal, proximal, palliation, gastrojejunostomy, duodenostomy Bypass disease: Billroth I -II

Esophageal cancer surgery

esophagastrectomy --.> pilmonary complications, leaks, poor nutrition esophageal obstructions --> balloon, photodynamic therapy, celestin tube

Pancreatic cancer surgery

Whipple (pancreoduodenectomy) --> poor nutrition, poor prognosis + node distal pancreatectomy total pancreatectomy --> sugical diabetic, rare

Liver cancer surgery

Surgical Approach Esophagectomy

Left transthoracic approach Three holes Esophagectomy Ivor-Lewis (belly and right chest) Transhiatal (no chest incision)

Pancreatic surgical treatment

for: Adenocarcinoma - --cystic malignancies Whipple procedure Total Pancreatectomy Distal Pancreatectomy

Gynecologic onc surgey

``` Fertility sparing surgery: --trachelectomy --ovarian resections Radical Hysterectomy Exenteration (total vs anterior) ```

Soft tissue: Sarcoma

``` high and low grade site: -soft tissues -retroperitoneal -gastric/SB/LB/gyn Surgery: -adjuvant chemo/XRT -radical amputation -palliation ```

Soft tissue: melanoma

``` depends on: -depth of invasion -LN involvement -distant mets. Surgery initial treatment ```

Head and neck cancer

dissection modified - radical extended with or without free flap - losing airway - loss of flap - necrosis of wound - major vessel bleed - infection (respiratory, wound vs URT, wound collection)

Brain tumors

``` 200,000 new tumor cases annually 170,000 mets. brain tumors 30,000 primary 15,00o astrocytic/glial 9,000 GBM ```

Brain tumor surgical coals

- to achieve image complete resection (ICR) of enhancing tumor to impact prognosis - reserve incomplete resections for diagnosis or buying time for other therapies to have effect

Neurosurgery

Benign tumors: Meningioma, acoustic neuroma, pituitary tumor Malignant: Glioblastoma, Astrocytoma, Ependyoma Mets

Orthopedic cancers

``` adamantinoma angiosarcoma chondrosarcoma chordoma clear cell classic osteosarcoma ewing's sarcoma fibrosarcoma giant cell tumor ```

Orthopedic cancer treatments

resection joint replacement bone grafts amputations

Malignant muscle tumors

leomyosarcoma | rhabdomyosarcoma

APRN role with surgical oncology

``` education support therapy helping adjustment body image issues/scars fatigue eating/absorption - GI ostomy/catheter care ```

Surgical Oncology Flashcards

(47 cards)