Basic principles of surgical
oncology

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

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 )

Needle biopsy
Types of needle biopsies:
Fine needle biopsy (also called fine needle aspiration)
Core needle biopsy (also called core biopsy)

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

•
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.

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

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.

C-Incisional Biopsy
Incisional biopsies are usually done when a needle biopsy is not diagnostic or technically
not feasible.

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.

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.

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..

 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.

 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

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

 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

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

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

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.

•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,

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)