-
Why is the first surgery you best chance to cure/ remove cancer? (4)
- less time to metastasis
- less seeding
- microscopic disease (dirty margins- cells left behind and regrowth of cancer)
- more tissue for closure (if you have to go back and remove more, you have less tissue)
-
What are overarching surgical principals for oncologic surgery? (6)
- remove biopsy tract (b/c it's contaminated with cancer cells)
- early vascular ligation (so cancer cells don't disseminated through venous system)
- surgical planning
- wide margins
- gentle tissue handling
- change instruments/ gloves after touching cancer (cancer is like contamination)
-
Measure lateral margins in ____________; measure deep margins in ____________.
centimeters; terms of fascial planes
-
What are the principals of biopsy techniques? (6)
- don't place a drain in a biopsy site! remove the biopsy tract (contaminated)
- incisions of the extremities should be made longitudinally
- take large pieces to optimize chance of getting an answer
- no cautery or laser (ruins tissue for pathologist to assess)
- don't deform sample
- properly fix biopsy in formalin
-
What are types of incisional biopsies? (5)
- tru-cut
- wedge biopsy
- punch biopsy
- jamshidi biopsy
- michele trephine
-
You ____________ before an excisional biopsy.
should have a diagnosis (by FNA or punch)
-
When can you utilize a tru-cut biopsy?
palpable lesion OR by US or CT-guided technique
-
Describe a tru-cut biopsy needle.
- needle with slot, sheath that cuts
- insert entire sheath, then exit slotted needle from sheath, traps biopsy, return needle to sheath
-
When can you do a wedge biopsy?
visible, superficial lesion [create wedge with scalpel]
-
When can you perform a punch biopsy?
visible, superficial lesion
-
What is jamshidi biopsy useful for?
bone biopsy; must be palpable lesion, found by radiography/ fluoroscopy/ US/ CT-guided
-
What is michele trephine used for?
- visible lesion, guide with imagining
- painful
- used in large animal
-
Once you identify a mass, what is the next important step before surgery?
stage the lesion- what is it, where is it, how bad is it, TNM system
-
What is debulking?
- margins: intracapsular, removed in pieces--> macro- and microscopic disease left behind
- least ideal way to treat cancer
- usually just palliative OR combined with adjunctive therapy
-
What is marginal surgery?
- margins: outside the pseudocapsule--> microscopic disease usually left behind
- ideal way to treat benign cancers
-
What is wide excisional surgery?
- margins: rim of lateral and deep margins around the tumor--> usually no local disease left behind
- ideal for malignant cancer tumors
-
What is radical surgery?
- margins: structure or compartment removed (limb amputation, organ removed)--> no local disease left behind
- altered cosmesis
-
When you remove a mass from a patients, ALWAYS...
- submit for histopathology (diagnosis, margins, grading)
- don't leave this decision up to the owner.... JUST SUBMIT IT (build it into your surgery cost)
-
What ways are mammary tumors approached? (5)
- regional or radical mastectomy (cats- ALWAYS radical mastectomy)
- mammectomy
- lumpectomy
- may also want to remove regional lymph nodes
- mammary tumors have 50% chance of being malignant in dogs; almost always malignant in cats
-
Inflammatory mammary carcinomas are managed by...
NOT SURGERY CANDIDATES; managed medically.
-
What are ways to approach oral cancer?
- [based on how much bone we are removing]
- mandibulectomy, maxillectomy (rim excision, rostral, segmental, caudal, total unilateral)
-
Oral neoplasia surgical dose is based upon... (4)
tumor type, location, extent of local disease, metastasis [dogs do wonderful after oral surgery, cats are much harder to manage]
-
Benign cutaneous lesions are treated with ___________.
marginal excision
-
Cutaneous mast cell tumors need what margins?
- wider lateral margins with higher grade of tumor
- 1 fascial plane deep
-
Soft tissue sarcomas margins are...
- 3cm lateralÂ
- 1-2 fascial planes deep
-
Vaccine-associated fibrosarcomas in cats margins are...
- 3-5cm lateral margins
- 2-3 fascial planes deep
- [very extensive surgery]
-
GI tumors usually require __________ margins.
wide (6cm lateral margins on either side)
-
Lung neoplasia treated by surgery is usually...
primary lung tumors only (we don't remove lung mets)
-
What are indications for lymph node removal? (3)
metastasis, inconclusive FNA results, part of a radical surgery
-
What are indications for benign tumor removal? (6)
- discomfort
- mechanical obstruction
- infection
- cosmesis
- location
- rapid growth
-
What elective procedures can prevent cancer? (3)
- spay: decreased mammary cancer if spayed young
- castration: decreased testicular cancer, perianal adenoma
- cryptorchid castration: crypts have higher risk of cancer
|
|
