Sarcoma Flashcards Preview

General Surgery Oral Boards Review > Sarcoma > Flashcards

Flashcards in Sarcoma Deck (17)
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1
Q

Sarcoma: give 5 factors for prognosis

A
  1. Size (>5cm)
  2. Grade
  3. Location
  4. Able to resect
2
Q

Sarcoma

4 subtypes with clear distinct biology that could alter treatment

A

chemo/radiosensitive
Ewings
Primitive neuroectodermal tumor
Rhabdomyosarcoma

gleevec/targeted therapy
GIST

3
Q

Sarcoma
When to do amputation?
Does it improve survival?

A

invasion with destruction of a joint.

No survival benefit, only local control.

4
Q

Sarcoma

Post op surveillance?

A

CTscan of chest for mets and of primary surgical site for local recurrence.

5
Q

Sarcoma

effect of radiation on survival and local control?

A

no survival benefit

improves local control, debated adjuvant v neoadjuvant.

6
Q

Sarcoma - adjuvant treatment?

first agent for stage IV

A

Not clear benefit over waiting until a recurrence is developed.

If unresectable mets then would use doxorubicin as first line agent.

7
Q

Extremity Sarcoma

How do you biopsy?

A

Core needle biopsy - mark skin site where needle
is placed so it can be excised with the sarcoma.

Open biopsy - incisional if >2cm. Make biopsy
incision parallel to muscle group so can be re-excised
when resection done.

8
Q

Retroperitoneal Sarcoma

How do you biopsy?

A

do not percutaneously biopsy
unless there is a high likelihood this is something else
other than sarcoma

9
Q

Sarcoma: key physical exam points

A

assess for any circulatory or neurologic deficit in the extremities

10
Q

Sarcoma

what is the goal margin?

A

2 cm, but often have to cheat to preserve limbs or vital structures and never has been validated.

11
Q

retroperitoneal sarcoma

how do you get margins?

A

do not remove organs to attempt 2 cm margins.

If the sarcoma is adherent to a structure, carefully dissect it free;

If there is invasion by the sarcoma, resect en bloc.

12
Q

retroperitoneal sarcoma

What do you do after removing specimen?

A

Place clips at the margin of the surgical bed in the event that radiation therapy is needed post-operatively.

13
Q

What are other options besides external beam radiation?

A

brachytherapy
intraoperative radiation therapy

No oncologic benefit, but may have less radiation toxicity.

14
Q

Sarcoma surgery

What structures can be sacrificed?

A

Extremity arteries - can reconstruct
Femoral nerve - tolerable defect
IVC - can reconstruct; create a distal AV fistula?

15
Q

Sarcoma surgery

What structures should be preserved?

A

Sciatic nerve - DE functionalizes leg

Large central veins - causes edema

16
Q

Sarcoma

Perform Pulmonary metastasectomy?

A

Yes! ~60% survival.

17
Q

Sarcoma

Hepatic Metastasectomy?

A

Unclear, would probably perform, extrapolating from pulmonary data.