Surgery Lecture Exam 3

What does palliation mean?

treatments that help with the symptoms but does not cure the illness

What are some examples of surgical oncology ancillary procedures?

• placement of a vascular access port

• spay/neuter

____ - disorders that develop when cancer-fighting antibodies or hormones mistakenly attack healthy cells

paraneoplastic syndrome

What are some aspects to remember when taking a history pertaining to a mass?

• location/number

• duration

• size

• changes in appearance

When completing a cancer work-up, we should map the location and size of the masses using a what?

body map

A thorough general exam can sometimes include what other types of examinations?

• orthopedic

• neurological

What are some clinical pathology tests we can run to help diagnose cancer?

• CBC/Chem

• Urinalysis

• Cytology

• ACTH stim test or Dexamethasone suppression test

• Ionized calcium

• Parathyroid hormone panel

Why do we run radiographs when diagnosing cancer?

We need to see what areas are affected and if it has metastasized yet

What radiographic views do we run when looking for metastasis of cancer cells?

• 3-view thoracic

• 2-view abdominal

_____ - diagnostic imaging test that uses a tiny, safe dose of radioactive liquid to find hidden damage in bones and tissue

nuclear scintigraphy

What are the two ways to diagnose what type of cancer?

• Biopsy

• Surgical removal with histologic examination

What are the indications for biopsying a mass?

• treatment will differ depending on the tumor

• planning for surgical resection

• diagnosis would change owner’s desire to treat

What are two types of tissue sampling techniques?

• impression smears

• fine needle aspirate

What are three types of minimally invasive biopsy techniques?

• needle core biopsy

• punch biopsy

• image-guided biopsy

What are three types of surgical biopsy techniques?

• incisional biopsy

• excisional biopsy

• biopsy via minimally invasive surgical techniques

____ - press a glass slide against open lesion or cut edge of excised lesion. Direct sampling of superficial ulcerated lesions or other exfoliated cells

impression smear

T or F: Sedation is required for an impression smear.

False, it is noninvasive

When making an impression smear, it is important to remember to do what?

Do not squash, twist, or rub the tissues on the slide.

Fine needle aspiration is easy, cheap, and minimally invasive. What is a con?

low diagnostic yield

What size needle and syringe do we use for fine needle aspirations?

• 20-22 gauge needle

• 3-5 cc syringe

Do patients need sedation for FNA?

no

Which FNA technique requires you to place the needle in the mass and quickly stab repeatedly while moving the needle tip direction?

“woodpecker” technique

Which FNA technique requires you to place the needle in the mass and quickly pull the plunger back 1-2 mls? Repeat this in the same spot 3-4 times.

Suction technique

With the FNA suction technique, when should you stop pulling on the plunger?

when you see blood

What are the indications of a needle core biopsy?

• when there is no diagnosis with FNA or impression smear

• when you need more tissue for characterization

Can we use a needle core biopsy on masses on organs?

Yes, organs visible by ultrasound or CT and are near the body wall (liver, kidney)

Tru-cut biopsy needles are used for what kind of biopsy?

soft tissue

Do needle core biopsies require sedation?

Yes, or local anesthetic

T or F: You should wear sterile gloves when performing a needle core biopsy.

True

This is an example of what kind of biopsy method?

Tru-cut (needle core biopsy)

Which bone biopsy needle would we use for smaller samples?

Jamshidi

Which bone biopsy needle would we use for larger samples?

Michele trephine

When using a Michele trephine biopsy tool, you have a higher risk of what?

pathologic fractures

T or F: Bone biopsies require general anesthesia and surgical preparation of the site.

True

What are the 4 locations we can use to retrieve bone biopsies?

• proximal humerus

• ilial wing

• proximal femur

• proximal tibia (for young dogs only)

What are the indications for a punch biopsy?

• cutaneous masses

• focal organ masses (liver, pancreas, spleen)

• intestinal biopsies

What is the proper name for the punch biopsy tool?

Baker skin biopsy punch

What type of biopsy method is this?

punch biopsy

T or F: When collecting a sample using a punch biopsy, you want to get the sample from the middle of the lesion.

False, sample from the edge to include normal tissue

T or F: Punch biopsies do not require sedation.

False, sedation or anesthesia and a surgical prep

The dotted lines indicate the surgical incision. Which diagram shows an excisional biopsy and which shows an incisional biopsy?

• Excisional is on top

• Incisional is on bottom

What are the indications for an incisional biopsy?

• large, superficial lesions

• lesion is located in area where achieving margins and closure might be difficult

• when less invasive techniques fail to yield diagnosis

• type/aggressiveness of tumor would change treatment plan

Which type of surgical biopsy acts as both a diagnosis and treatment?

excisional biopsy

For which type of biopsy is the treatment choice unchanged by the tumor type?

excisional biopsy

For which type of biopsy would the type/aggressiveness of the tumor change the treatment plan?

incisional biopsy

Which type of biopsy is used on benign tumors/lesions?

excisional

T or F: Complete excision of a cancerous mass cures more patients than any other type of treatment.

True

____ - the amount of normal tissue removed with the tumor

margins

What are the margins for cutaneous carcinomas?

1 cm

What are the margins for mast cell tumors?

2-3 cm

What are the margins for cutaneous sarcomas?

3-5 cm

For which kind of masses do we not need proper margins?

• benign tumors with low risk of recurrence (lipoma)

• masses in the body cavities

____ - this type of margin collection is classified by the removal of the mass from within the capsule or pseudocapsule

intracapsular

____ - this type of margin collection is classified by the removal of the mass at the margin of tumor

marginal

____ - this type of margin collection is classified by removal of the mass with margins of normal tissue surrounding the tumor

wide excision

____ - this type of margin collection is classified by the removal of the entire affected tissue compartment

radical excision

If the capsule is entered during surgical removal what should you do?

• lavage surical field

• change gloves

• new instruments

T or F: When painting margins, you should not double-dip the applicator.

True

We should fix tissue in ___% formalin.

10%

1 part tissue to ___ parts buffered formalin.

10

How deep does formalin penetrate?

1 cm

What technique should we use to fix tissues that are larger than 1 cm?

bread loafing

When labeling slides, why should we not use pen or sharpie?

They tend to come off during staining

What should be included when labeling a sample?

• date

• patient name and ID number

• location of lesion

With ____ surgery, the majority of the mass is removed and it is intended to be followed up with other therapies such as chemo or radiation.

debulking surgery

____ surgery is meant to improve the quality of life and not meant to offer a cure or extend the patient’s life

palliative

____ - a therapy where you inject an ionophore and it goes straight to the tumor. You then shine a light of a specific wavelength on the tumor, and the ionophore heats up and kills the tumor cells.

photodynamic therapy

T or F: When evaluating lymph nodes on a cancer patient, cytologic evaluation by FNA is recommended even if lymph nodes are normal on palpation

True

Spaying will reduce the incidence of ____ tumors.

mammary

Castration can treat/prevent what kind of cancers?

• perianal adenomas

• testicular tumors

• prostatic adenoarcinoma

You should handle biopsies gently to aviod ____

artifacts

Which biopsy technique is used primarily for external skin and oral masses?

punch biopsy

____ represents one of the simplest methods for cytologic evaluation of a mass.

fine-needle aspiration

____ closure is the immediate closure of a wound.

Primary

What types of wounds do we use primary closure for?

• clean

• clean-contaminated

With ____ closure, the wound is left open for 2-5 days and is closed prior to granulation tissue formation. Permits repeated lavage and debridement to convert the wound to clean-contaminated status appropriate for closure.

delayed primary

With ____ closure, granulation tissue is allowed to form in the wound prior to closure.

Secondary

With secondary wound closure, closure should take place after at least ___ days

5

Secondary wound closure should be performed before ____ has begun

epithelialization

With ___ closure, we don’t physically close the wound. We allow for granulation, epithelialization, and contracture to occur.

Second intention healing

What type of wounds do we allow to heal through second intention?

dirty or infected

How do we close medium-large mildly contaminated wounds?

delayed primary

What is the first action you should complete in initial wound management?

stabilize the patient

Basic concepts for wounds: We want to prevent further wound ____

contamination

Basic concepts for wounds: We want to provide ____ of dead tissue

debridement

Basic concepts for wounds: We want to remove foreign ___ and contaminants

debris

Basic concepts for wounds: We want to provde adequate wound ____

drainage

Basic concepts for wounds: Promotion of a viable ____

vascular bed

Basic concepts for wounds: Selection of appropriate method of ____

closure

What are the first three steps after receiving a wound patient?

• stabilize the patient and assess other injuries

• cover the wound with bandage during assessment

• provide analgesia

Local anesthetics should not penetrate the wound in order to avoid what?

bacterial spread

T or F: When scrubbing the skin, you should also use the chlorhexidine or dilute iodine to clean the actual wound for best results.

False, always avoid actual wound bed with regular scrub solutions

Wound lavage can remove up to ___% of bacteria

90%

What kind of solution should be use to lavage wounds?

saline or balanced electrolyte solution

We should lavage wounds with what psi of pressure?

7-8

___% povidone iodine can be used as a wound lavage

1%

What is the dilution ratio for 1% povidone-iodine being used for sound lavage?

1:10 or 100ml in 1 L

What are some disadvantages of using 1% povidone-iodine as a wound lavage solution?

• forms inactive complexes with organic matter

• systemic absorption (cats are sensitive)

1% povidone iodine has residual activity for up to how long?

4-6 hours