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Oncology Midterm > Surgical Oncology > Flashcards

Flashcards in Surgical Oncology Deck (47)
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1
Q

Goal of surgery

A

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

2
Q

Surgery depends on:

A

size
location
morbidity - effects on neighboring organs and structures

3
Q

Onc Surgery uses:

A

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)

4
Q

Surgical diagnosis

A

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

5
Q

Surgical diagnosis complications

A

inadequate tissue

FNA (fine needle aspiration)

6
Q

Types of biopsies

A

Fine Needle Aspirate (FNA)

Core Needle Biopsy

7
Q

FNA

A

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

8
Q

Core needle biopsy

A

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

9
Q

Treatment plans

A

may require chemo first if tumor mass is large

10
Q

Sentinel lymph node biopsy (SLNB)

A

radioactive isotope 1st one from tumor is biopsied

“sentinel node” - first one next to

11
Q

Node Mapping

A

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

12
Q

Excisional Biopsy

A

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

13
Q

Surgical Cytoreduction

A
  • 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

14
Q

Cryosurgery

A

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

15
Q

Thermal surgery

A

minimizes operative blood loss

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

16
Q

Radiofrequency ablation

A

radiowaves

17
Q

Laser surgery

A

aims beams of monochromatic light

focused energy on precise spot

18
Q

Lung cancer

A
Wedge resection (part removed)
Lobectomy
Multiple lobectomies
pneumonectomy
minimally invasive
19
Q

Mohs Micrographic surgery

A

removes in stages, chunks until margins clear

-a skin cancer excisional procedure

20
Q

major ablative surgery

A

aggressive strategy

an amputation or a pelvic examination

21
Q

interventional radiologic procedures

A

CT guided biopsy

22
Q

Breast Cancer

A
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)
23
Q

Surgical: Colorectal cancer

A
hemicolectomy
low anterior resection
abdominal peritoneal resection
ant/post exenteration
pelvic exenteration
transanal excision
ostomy - now reversible
24
Q

Surgical: anorectal

A

squamous cell - wide local excision

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

25
Q

Colorectal cancers surgery

A

ostomy reversible

26
Q

Prostate cancer

A

surgery robotic and nerve sparing
brachytheapy
Gleason’s scale (1-5) - higher score may require surgery

*try to avoid surgeries, affects sexual heath

27
Q

Gleason Scale

A

1-5

higher requiring surgery

28
Q

Urological cancer

A

Bladder

Kidney

29
Q

Bladder cancer surgery

A

cystectomy with ileal conduit
continent reservoirs
segmental cystectomy

30
Q

Kidney cancer

A

nephrectomy

partial nephrectomy

31
Q

Stomach cancer surgery

A

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

32
Q

Esophageal cancer surgery

A

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

33
Q

Pancreatic cancer surgery

A

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

34
Q

Liver cancer surgery

A

?

35
Q

Surgical Approach Esophagectomy

A

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

36
Q

Pancreatic surgical treatment

A

for: Adenocarcinoma
- –cystic malignancies

Whipple procedure
Total Pancreatectomy
Distal Pancreatectomy

37
Q

Gynecologic onc surgey

A
Fertility sparing surgery:
--trachelectomy
--ovarian resections
Radical Hysterectomy
Exenteration (total vs anterior)
38
Q

Soft tissue: Sarcoma

A
high and low grade
site: 
-soft tissues
-retroperitoneal
-gastric/SB/LB/gyn
Surgery:
-adjuvant chemo/XRT
-radical amputation
-palliation
39
Q

Soft tissue: melanoma

A
depends on:
-depth of invasion
-LN involvement
-distant mets.
Surgery initial treatment
40
Q

Head and neck cancer

A

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)
41
Q

Brain tumors

A
200,000 new tumor cases annually
170,000 mets. brain tumors
30,000 primary
15,00o astrocytic/glial
9,000 GBM
42
Q

Brain tumor surgical coals

A
  • 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
43
Q

Neurosurgery

A

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

44
Q

Orthopedic cancers

A
adamantinoma
angiosarcoma
chondrosarcoma
chordoma
clear cell
classic osteosarcoma
ewing's sarcoma
fibrosarcoma
giant cell tumor
45
Q

Orthopedic cancer treatments

A

resection
joint replacement
bone grafts
amputations

46
Q

Malignant muscle tumors

A

leomyosarcoma

rhabdomyosarcoma

47
Q

APRN role with surgical oncology

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