- •Common Diagnostic Techniques
- •Core Needle Biopsy
- •Common Diagnostic Techniques
- •Curability of Solid Neoplasms
- •Requirements for Wide Resection
- •CLINICAL MANAGEMENT
- •TNM Sınıflandırması
- •The Preoperative Conference
- •Preoperative Preperation of the Patient
- •CONDUCT OF OPERATION
- •Conduct of operation
- •Cunduct of operation
- •Operation
PRINCIPLES OF SURGICALAL
ONCOLOGY
Surgical oncology is the specific applicationation ofof surgical principles to the oncologic settingting
In many cases the surgeon assumes responsibility for orchestrating the overallrall management of the cancer patient’s careare
The surgical oncologist must be knowledgeableledgeable about all of the available surgical and adjuvantadjuvant therapies for a particular cancer
The role of surgery in cancerncer treatment
Operation may be required for;
Biopsy
Staging
Resection for cure
Palliation
Prophylaxis
Tumor and treatment-related complicationslications
Common Diagnostic Techniquesniques
Fine-Needle aspiration (FNA)
Rapid, minimally invasive
Palpabl superficial tumors
Deeper, nonpalpable lessions (CT or US guideduided))
Cytologic examination of the stained smearar
Useful for enlarged lymph nodes, breast lumpslumps,, thyroid masses and lung nodules.
False (+) rare, sampling errors lead to falsealse ((--)) Inadequate for grading and invasion
Core Needle Biopsy
Utilizes a needle that cuts a sliver of tissueissue forfor analysis
Provides more histologic information thanhan FNAFNA because it allows the pathologist to seee thethe histologic architecture of the sample ratherather thanthan just the cellular characteristics
Used for prostate, breast, and liver massesasses
CT or US guided for deeper and nonpalpablalpabl lesions
Common Diagnostic Techniquesniques
Excisional biopsy is defined as the surgical removalemoval ofof anan entire gross lesion
Incisional biopsy involves sampling a representativentative partion of a suspicious lesion
Biopsy Principles
The positioning of the needle tract or scar should bebe suchsuch thatthat ifif further surgery is required, the biopsy site will be includedincluded inin thethe excised specimen
Hemostasis
Orientation of the pathologic specimen (breast)
If radiation therapy is anticipated, radiopaque clipss shouldshould bebe placed
INVASIVE DIAGNOSTICC
MODALITES
Lymph Node Biopsy
Lymphoma Î Exsicional biopsy
Carcinoma Î FNA, Core biopsy, incisionall
Head and Neck adenopathy Î FNA or corere biopsybiopsy
Biopsy of a tissue-based mass
Mass in the airodigestive tract Îtissue fromom periphery of the lesion
Breast mass Î FNA or core biopsy, excisionalional biopsybiopsy
Mass in the trunk or extremities Î Core (FNA?)(FNA?)
BIOLOGIC BASIS FOR CANCERNCER
SURGERY
Curability of Solid Neoplasms
Micrometastases may occur very early in thethe coursecourse of some cancers
Desease-free intervals of 5 or 10 years afterter treatment of most solid cancers are associatediated withwith so few clinical recurrences that it is safe too assumeassume the patient will never be bothered by thatt tumortumor again
Cure is defined in terms of the tumor-free intervalinterval forfor the spesific cancer associated with a negligibleligible chance of recurrence
Curability of solid Neoplasmss (II)(II)
The risk of microfocal, regional orr distantdistant dissemination generally increases withwith thethe advancing clinical and pathologic stagestage ofof disease
Later the disseminated phase is reachedreached,, better the prognosis