Surgery Lecture 22

Surgical Oncology II: Staging & Decision Making

What are some general considerations when obtaining samples during surgery?

• Culture/sensitivity (if indicated)

• Change instruments for closure to lower risk of seeding tumor cells

• Submission to pathologist (UTMOST importance)

What information do you want to know about a tumor?

• Neoplastic vs. non-neoplastic

• Benign vs. malignant

• Histologic type and grade

• Status of margins

• Composition

What is the surgeon's role in cancer treatment?

Provide chance to cure → surgery is still the single treatment modality that cures the most cancers

What are the consequences of giving too little or too much surgical dose?

Recurrence/increased risk of metastasis or excess morbidity/less than ideal cosmesis

Microscopic residual disease that becomes a recurrent gross tumor = _________

More invasive and biologically aggressive

What is the aim of palliative surgery?

Ease pain/suffering of the patient

Palliative care _______ improve survival time but ______ improve quality of life

will not;

will

What is definitive or curative-intent surgery?

Most aggressive or gold standard therapy; be honest about what this means with cancer

What does TLC stand for in the context of cancer patients?

Tumor, Location, Condition & Client

What information is needed about the 'T' (Tumor) in TLC?

Is it cancer? Is it benign or malignant? What is the biological behavior of the tumor?

What local and distant considerations are part of the 'L' (Location) in TLC?

Where is it? What lives around it? What can be sacrificed? Where else has it gone or will go?

What considerations are part of the 'C' (Condition & Client) in TLC?

Co-morbidities, age, client considerations

Incisional excision

No macroscopic or microscopic disease removed

Marginal excision

Yes macroscopic and No microscopic disease removed

Wide marginal excision

Yes macroscopic and Yes microscopic disease removed

What are the recommended margins for canine MCT removal surgery?

2 cm lateral margins and 1 fascial plane deep margins.

Most solid tumors expand along the path of ___________

least resistance

Tumors are less likely to invade ___________

distinct tissue barriers

What about a mass increases the concerns for invasion?

Fixation / difficulty to move

What are considered 'good' deep tissue barriers?

Fascia, muscle, bone/cartilage

What are considered 'poor' tissue barriers?

Fat, periosteum, loose connective tissue