Vmc 932 Lecture 5 - Principles Of Cancer Surgery

Front 1

What should you always do before proceding with any part of tx, sx planning

Back 1

Biopsy

Front 2

What is an incisional biopsy, when is it used

Back 2

Use a scalpel blade or punch biopsy, sample usually taken at junction btwn normal/abnormal tissues
Used for diagnostic or debulking purposes

Front 3

What is the biggest mistake you can make when performing an incisional biopsy

Back 3

Biopsy tract must be excisable
Taking the biopsy in such a way that you spread contamination

Front 4

What methods are used to identify neoplastic cells

Back 4

Cytological techniques

Front 5

What methods are used to identify mass type and grade

Back 5

needle core, incisional, punch or grab techniques

Front 6

What methods are used to identify surgical margins

Back 6

Excisional techniques

Front 7

What is an excisional biopsy, when is it used

Back 7

Remove all diseased tissue plus a margin of healthy tissue.
Used when obtaining biopsy is just as difficult as removing mass, when you are sure you can obtain clear margins

Front 8

What instrument should you never use when performing excisional biopsy

Back 8

Electrocautery

Front 9

When dealing with a MCT what information does FNA not give you

Back 9

Grade

Front 10

What are the margins for removing a Grade 1 MCT, Grade 2

Back 10

Grade 1 - cured with 1 cm margins
Grade 2 - cured with 2 cm margins
always go one fascial layer deep

Front 11

What pretreatment is used with MCT

Back 11

Antihistamines

Front 12

If site of mass is not amenable to wide surgical excision what is the ideal procedure

Back 12

Cytoreductive surgery and radiotherapy/chemotherapy

Front 13

If site of mass is not amenable to wide surgical excision what is the alternative procedure

Back 13

Amputation, radiotherapy alone, systemic chemotherapy

Front 14

If mass is amenable to wide surgical incision what is the procedure

Back 14

Excision with wide surgical margins

Front 15

If surgical margins are incomplete what are your two options

Back 15

Reexcision
Adjuvant radiotherapy (first choice), systemic chemotherapy (second choice)

Front 16

What method is used to dx MCT

Back 16

Fine needle aspirate

Front 17

What methods are used to dx STS

Back 17

Needle core sample collection technique - Tru-cut, menghini, jamshidi
Incisional - punch, grab sample tech

Front 18

How many samples should you take of a biopsy

Back 18

take samples until you have solid 'chunks' of tissue, take samples from different areas

Front 19

Where should samples be taken from

Back 19

At center for bone tumors, periphery for others

Front 20

What should be avoided when sampling

Back 20

Areas of necrosis

Front 21

What is the required margin and met rate of a grade one STS

Back 21

1 cm margin, 0-10% met rate

Front 22

What is the required margin and met rate of a grade two STS

Back 22

2 cm margin, 10-20% met rate

Front 23

What is the required margin and met rate of a grade three STS

Back 23

2-3 cm margin, up to 50% met rate

Front 24

When excising an STS once the biopsy is confirmed and a wide surgical exclusion is performed what is the procedure when the margins are not histologically complete

Back 24

Either re-excision of the wound or adjuvant radiation therapy (for High grade 3 consider adjuvant chemotherapy), perform a follow up exam, exam local site and thoracic 'met check' radiographs at 1, 3, 6, 9, 12, 15 month ect.

Front 25

When excising an STS once the biopsy is confirmed and a wide surgical exclusion is performed what is the procedure when the margins are histologically complete

Back 25

Perform a follow up exam, exam local site and thoracic 'met check' radiographs at 1, 3, 6, 9, 12, 15 month ect.

Front 26

Does surgical margin affect the outcome of surgery

Back 26

The choice of surgical margin will profoundly affect the success of the surgery as a curative procedure

Front 27

What attributes of patient prep need to be considered when providing access to the surgical margin

Back 27

Appropriate clip, appropriate draping, surgical approach/visualization

Front 28

What always needs to be planned before preparing patient for surgery

Back 28

Closure, this helps you be confident about gaining appropriate margins

Front 29

What needs to be done to minimize risk of recontamination after mass removal and before closure

Back 29

Change gloves, instruments, drapes
Never drag tumor cells into uninvolved areas

Front 30

What indications are there for local excision

Back 30

Benign tumors with no tendancy to local infiltration (lipoma, histiocytoma, thyroid adenoma, sebaceous adenoma)
Tumors where it is not possible to resect surrounding tissue (brain tumors)

Front 31

What indications are there for wide local excision

Back 31

Benign tumors with local infiltration (infiltrating lipoma)
Malignant tumors with limited infiltrative potential (sq cell carcinoma (SCC), MCT, some STS)

Front 32

What are the required margins for a low-grade SCC

Back 32

1 cm

Front 33

What can provide a deep margin if gaining a 2-3 cm margin on all sides is impossible

Back 33

Fascial plaes are barriers to tumor progression, especially in early disease, they act as deep 'clean' margins
if fascia is adherent, go to the next fascial layer

Front 34

What should be avoided during closure

Back 34

Extensive reconstruction techniques

Front 35

What types of closure should be used

Back 35

Primary closure, or leave wound open and close later when margins have been evaluated

Front 36

What are some indications of radical local excision (compartmental)

Back 36

Malignant tumors with considerable potential for local infiltration (sarcomas)

Front 37

How do we mark the margins of interest for histopathology

Back 37

India ink (black best), speciality margin marking inks (Shandon tissue marking dyes)

Front 38

What are the three outcomes of histopathalogical examination of resected margins

Back 38

Clean margins
Close margins
Incomplete margins

Front 39

What procedure is performed so that we 'know what we are dealing with'

Back 39

Biopsy appropriately to give the necessary information

Front 40

What are three ways to define the precise role of the surgical procedure

Back 40

Palliative
Curative
Part of multimodal therapy (eg surgery and radiation)

Front 41

What are the aspects of excision planning

Back 41

Palpation, imaging, anatomical review, required margins

Front 42

What is a very important step to remember during oncological surgery

Back 42

Communicate with the owner

Front 43

What analgesic therapy would you consider for prepatial MCT

Back 43

Pre-operative: hydromorphone IM + NSAID
Local: SQ
Post: NSAID

Front 44

What analgesic therapy would you consider for vx associated fibrosarcoma located between the scapulae of a cat

Back 44

Pre-op: IV opioid
Local: local anesthetic infusion tube
Post: IV drip ketamine for a few days, discharge with metacam

Front 45

What analgesic therapy would you consider for distal femoral osteosarcoma in a giant breed dog

Back 45

Pre-op: opioid
Epidural: local anesthetic (lidocaine)
Post: opioid

Front 46

When dealing with a vx fibrosarcoma why do marginal excision fail

Back 46

Fingerlike projections of tumor

Front 47

What are some advantages of preoperative irradiation

Back 47

Decreases tumor spread by surgery, blood supply not disturbed, no delay in radiotherapy from unsatisfactory wound healing, smaller radiation field (post op - entire surgical field must be included), surgery is easier if tumor is smaller

Front 48

What are some disadvantages of preoperative irradiation

Back 48

decreased stability of tissues, delayed wound healing, increased morbidity associated with radical surgery (dehiscence)

Front 49

Where are the most likely places to find osteosarcomas, are they highly metastatic

Back 49

Away from elbow, towards the knee
85%, highly metastatic

Front 50

Are chondrosarcomas highly metastatic

Back 50

15%, less metastatic than osteosarcomas