Principles of surgical oncology

2 Principles of surgical oncology





Diagnosis and staging



Diagnosis


Histological diagnosis is obtained from tumour tissue by fine needle aspiration cytology, core biopsy, incisional biopsy and excisional biopsy. Choosing the right technique is based on the location of tumour, anticipated type of the tumour and reliability of the method to make a definite diagnosis.


Fine needle aspiration (FNA) yields quick result and shows cellular characteristics but not architecture. FNA serves as good screening tool prior to more definitive diagnostic methods. FNA is useful for diagnosis of enlarged lymph nodes, aspiration of cysts, diagnosis of thyroid nodule and confirmation of recurrent or metastatic disease.


Core biopsy helps to visualize architecture as well as to perform immunohistochemical studies. It is useful in the diagnosis of solid masses such as breast lumps or liver metastases. However, core biopsy should not be used in lymphoma (which requires extensive immunohistochemical stains) or for soft tissue or bone sarcoma.


Incisional biopsy is used when core biopsy is non-diagnostic and excision biopsy is not appropriate. The common indication is a suspected sarcoma needing neoadjuvant treatment or definite resection. Care should be taken when planning incision biopsy to ensure that the site of biopsy is within the area definite surgery and should only be undertaken by surgeons who will undertake the final surgery. A poorly planned incision biopsy can lead to unnecessary morbid surgery.


Excision biopsy involves removal of the entire mass or skin lesion. It is important to make sure that this procedure does not compromise a later wider excision if necessary. The specimen needs to be oriented in three dimensions for the pathologist to determine surgical margins.


Frozen section is occasionally used preoperatively to confirm diagnosis when previous histologic diagnosis is not available (e.g. solitary lung lesions), to decide need for further surgery (e.g. lymph node dissection) and ensure adequate surgical margins.




Curative surgery


Surgery plays a significant role in curative treatment of cancer. For many cancers surgery is the primary modality of treatment. A decision regarding curative surgery is made after careful consideration of various patient and tumour related characteristics at a multidisciplinary meeting with surgeons, oncologists, radiologists and pathologists. At this meeting staging and diagnosis will be reviewed along with information concerning the patient. Patient-related factors which influence the choice of curative surgery include age, performance status and co-morbidities. Tumour-related factors include chances of long-term benefit and potential surgical risks and complications.


Jun 18, 2016 | Posted by in ONCOLOGY | Comments Off on Principles of surgical oncology

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