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Basic principles surgical oncology.pptx

  1. Basic principles of surgical oncology
  2. The role of surgery in clinical oncology The role of surgical procedures in diagnosis and proper staging of cancer patients surgery as the main step in treatment of cancer patients cancer prevention and the role of prophylactic surgery
  3. Types of Biopsy 1-procedure Needle biopsies. Surgical (excisional, incisional ) biopsy. 2-site Shave biopsy/punch biopsy. Laparoscopic biopsy.Thoracotomy Endoscopic Bone marrow aspiration and biopsy. ... Liquid biopsy. Image-guided biopsy. ...(CT guided ,ultrasound guided )
  4. Needle biopsy Types of needle biopsies: Fine needle biopsy (also called fine needle aspiration) Core needle biopsy (also called core biopsy)
  5. A-Fine needle aspiration • Thyroid biopsy is a minimally invasive procedure and is often done in the office setting. Patients are awake for the procedure. The process of obtaining a sample of cells and bits of tissue for examination by applying suction through a fine needle
  6. • Lymph node FNA is a very specific and accurate exam, which is reliable in the detection of lymph node metastasis and other causes of lymphadenopathy.
  7. Advantages of FNAC • In systematic reviews and meta-analysis evaluated the accuracy of FNA and CNB in diagnosing thyroid malignancy.The study found a pooled sensitivity of 0.72 (95% CI: 0.69–0.74) and a pooled specificity of 0.99 (95% CI: 0.98– 0.99) for FNA
  8. B-Core-Needle Biopsy Core-needle biopsies can be done percutaneously by palpating a mass or lymph node or by radiologic guidance. Core biopsy material yields tissue architecture, including the diagnosis of malignancy, the tissue of origin of the primary tumor, whether a tumor is noninvasive or invasive, and cell-surface receptors.
  9. C-Incisional Biopsy Incisional biopsies are usually done when a needle biopsy is not diagnostic or technically not feasible.
  10. D-Excisional Biopsy Smaller tumors are often more amenable to excisional biopsy. Excisional biopsy implies the removal of the entire skin lesion or lump. Small, particularly superficial, mobile tumors can be difficult to obtain with an adequate needle biopsy. Small mass or skin lesions on the extremity or trunk that are potentially malignant are often best approached with an excisional biopsy, as it allows definitive diagnosis without risking violation of tissue planes.
  11. Disadvantages of excisional biopsy May result in scar formation , the need for anesthetic, and the potential need for re-excision for margins. It is important to orientate excisional biopsy specimens in three dimensions for the pathologist to determine margins if surgical rescission is needed.
  12. E-Sentinel lymph node biopsy A biopsy of lymph node/s identified This is performed in the operating theatre at the same time as the wide local excision. A cut is made in the lymph node/s area identified by the lymphoscintigram which are marked with the tattoo dot/s. The blue ‘sentinel’ node/s will show up and the radiosensitive probe will confirm that the radioactive lymph node/s are removed and sent to the laboratory..
  13.  F-A liquid biopsy  Much of the early research on liquid biopsies has been in lung, breast and prostate cancers  Definition :simple and non-invasive alternative to surgical biopsies using a simple blood sample.  liquid biopsies consist of isolating tumor-derived entities like circulating tumor cells, circulating tumor DNA, tumor extracellular vesicles, etc., present in the body fluids of patients with cancer, followed by an analysis of genomic and proteomic data contained within them.
  14.  Example A liquid biopsy test that can detect  epidermal growth factor receptor (EGFR ) gene mutations, which occur in 10-35 per cent of patients with non-small cell lung cancer (NSCLC
  15. 2-The major principles of surgical therapy obtain adequate negative margins around the primary tumor, different operative approaches depending on the tumor type and its local involvement with adjacent structures. The risk of local recurrence for all solid malignancies is clearly increased if negative margins are not achieved Therapy
  16.  A-Curative Surgery  Surgery for Primary Cancers  The major objective for surgery is to achieve optimal local control of the lesion.  Local control is defined as the elimination of the neoplastic process in which local tumor recurrence is minimized. Therapy
  17. B-Surgical Resection of Regional Lymph Nodes The regional lymph nodes represent the most prevalent site of metastasis for solid tumors. the involvement of the regional lymph nodes represents an important prognostic factor in the staging of the cancer patient. The removal of the regional lymph nodes is often performed at the time of resection of the primary cancer. Besides staging information, a regional lymphadenectomy provides regional control of the cancer. Therapy
  18. Examples of this are patients with melanoma who have tumor metastatic to lymph nodes. It is well documented that the removal of these regional lymph nodes can result in long-term survival benefit in approximately 20% to 40% of individuals depending upon the extent of nodal involvement. Therapy
  19. Sentinel lymph node mapping SLN mapping refers to intraoperative localization and biopsy of SLNs with specific tracers to assess lymph node metastases. It is widely used in a variety of tumor surgeries for its high sensitivity and high negative predictive value. Complete lymph node dissections of the affected lymph node basin should be performed for positive sentinel lymph nodes.
  20. •3-Cancer Prevention •With the exponential increase in the understanding of inherited genetic mutations and the identification of patients who are predisposed to malignant transformation, surgical therapy has expanded beyond the therapy of established tumors and into the prevention of with the ability to perform genetic screening for relevant mutations, cancer prevention can be implemented before the onset of symptoms or histologic changes.With the decoding of the entire human genome,
  21. Total proctocolectomy Familial adenomatous polypsis coli(FAB) gene mutation Thyroidectomy RET proto-oncogene mutation Prophylactic surgery Bilateral mastectomy (patients with BRCA1 or BRCA2 mutation unilateral breast cancer)