PRINCIPLES OF SURGICALAL

ONCOLOGY

Surgical oncology is the specific applicationation ofof surgical principles to the oncologic settingting

In many cases the surgeon assumes responsibility for orchestrating the overallrall management of the cancer patient’s careare

The surgical oncologist must be knowledgeableledgeable about all of the available surgical and adjuvantadjuvant therapies for a particular cancer

The role of surgery in cancerncer treatment

Operation may be required for;

Biopsy

Staging

Resection for cure

Palliation

Prophylaxis

Tumor and treatment-related complicationslications

Common Diagnostic Techniquesniques

Fine-Needle aspiration (FNA)

Rapid, minimally invasive

Palpabl superficial tumors

Deeper, nonpalpable lessions (CT or US guideduided))

Cytologic examination of the stained smearar

Useful for enlarged lymph nodes, breast lumpslumps,, thyroid masses and lung nodules.

False (+) rare, sampling errors lead to falsealse ((--)) Inadequate for grading and invasion

Core Needle Biopsy

Utilizes a needle that cuts a sliver of tissueissue forfor analysis

Provides more histologic information thanhan FNAFNA because it allows the pathologist to seee thethe histologic architecture of the sample ratherather thanthan just the cellular characteristics

Used for prostate, breast, and liver massesasses

CT or US guided for deeper and nonpalpablalpabl lesions

Common Diagnostic Techniquesniques

Excisional biopsy is defined as the surgical removalemoval ofof anan entire gross lesion

Incisional biopsy involves sampling a representativentative partion of a suspicious lesion

Biopsy Principles

The positioning of the needle tract or scar should bebe suchsuch thatthat ifif further surgery is required, the biopsy site will be includedincluded inin thethe excised specimen

Hemostasis

Orientation of the pathologic specimen (breast)

If radiation therapy is anticipated, radiopaque clipss shouldshould bebe placed

INVASIVE DIAGNOSTICC

MODALITES

Lymph Node Biopsy

Lymphoma Î Exsicional biopsy

Carcinoma Î FNA, Core biopsy, incisionall

Head and Neck adenopathy Î FNA or corere biopsybiopsy

Biopsy of a tissue-based mass

Mass in the airodigestive tract Îtissue fromom periphery of the lesion

Breast mass Î FNA or core biopsy, excisionalional biopsybiopsy

Mass in the trunk or extremities Î Core (FNA?)(FNA?)

BIOLOGIC BASIS FOR CANCERNCER

SURGERY

Curability of Solid Neoplasms

Micrometastases may occur very early in thethe coursecourse of some cancers

Desease-free intervals of 5 or 10 years afterter treatment of most solid cancers are associatediated withwith so few clinical recurrences that it is safe too assumeassume the patient will never be bothered by thatt tumortumor again

Cure is defined in terms of the tumor-free intervalinterval forfor the spesific cancer associated with a negligibleligible chance of recurrence

Curability of solid Neoplasmss (II)(II)

The risk of microfocal, regional orr distantdistant dissemination generally increases withwith thethe advancing clinical and pathologic stagestage ofof disease

Later the disseminated phase is reachedreached,, better the prognosis