Surgical oncology
The surgical management of cancer can be dated back to the Ancient Egyptians in 1600BC, with the papyri offering the first descriptions of a cancer managed surgically. Surgeons are often involved in the initial assessment of patients and require clinical and technical skills to participate as an effective member of a multidisciplinary team (Tables 19.1 and 19.2).
Prevention
The identification of genetic predisposition syndromes allows for the intervention with prophylactic surgical removal to reduce the lifetime risk of cancer. For example: total colectomy in patients with familial adenomatous polyposis; bilateral mastectomy with reconstruction and oophorectomy for BRCA1 and BRCA2 gene mutation carriers; thyroidectomy for patients with multiple endocrine neoplasia to prevent medullary carcinoma of the thyroid.
Evaluation of primary disease
Adequate biopsy of any lump or mass with histological evaluation is required before starting anticancer treatment (Table 19.3). The surgeon must select an appropriate site and biopsy method, and furthermore has the responsibility to communicate the results, prognosis and treatment options effectively to the patient and their family.
Biopsy types
Fine-needle aspiration (FNA) can be performed with a 21G needle and a 20-ml syringe and can easily be repeated if there is inadequate sampling for assessment. This can be performed under image guidance, e.g. for a biopsy of liver, suspicious lymph node or breast lump. The sensitivity and specificity are >90% and false-positive rates are 0-3%. It is unsuitable for accurate diagnosis in lymphoma and inconsistent for cancers of the pancreas, thyroid and soft tissue.
Needle core biopsy
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
