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What is Cancer? Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems. Surgical Oncology: A glimpse of the past Ancient History of Surgery for Cancer Treatment 1600 BC 400 BC First recorded description of the surgical treatment of cancer (in Egypt) Hippocratesdescribes the stages of cancer and advises against surgery for terminal disease; he coins the terms carcinoma(crab-leg tumor) and sarcoma (fleshy tumor) Galenidentifies cancer as a systemic disease (primary and metastasis)
200 AD
Historical Eras of Surgery to Treat Cancer Before 1850 1850-1950 1950-1960 960-1980 1980-2000 2000-present Early heroic attempts to resect cancer Development of standard surgical resection techniques Development of extended radical surgical procedures Exploration of combined-modality treatment Multimodality therapy improves organ preservation and survival Surgical practice incorporates improved understanding of the molecular basis of tumor biology
Roles for Surgery Diagnosis of Cancer Treatment of Cancer Resection of primary tumor Cytoreductive surgery Metastatic disease Palliation Reconstruction
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SURGERY IN CANCER MANAGEMENT DIAGNOSIS OF CANCER Biopsy An examination of tissue removed from a living body in order to determine the presence or extent of a disease. Origin: 19th century French from Greek bios (life) and opsis (sight) Types of Biopsy Needle Biopsy - Fine Needle - Core Needle Open Surgical Biopsy - Incision Biopsy - Excision Biopsy NEEDLE BIOPSY 1. Fine Needle Aspiration Biopsy A cytologic technique in which cells are aspirated from a tumor using a needle and syringe with the application of negative pressure. Aspirated tissue consists of disaggregated cells rather than intact tissues Other related terms: o Fine needle cytology o Fine needle biopsy o Needle aspiration biopsy o Aspiration biopsy o Aspiration cytology
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Office procedure Hemorrhage Wide sampling Ease of interpretation Ability to invasion Cost Rapid diagnosis
detect No + +++
HOW WILL YOU BIOPSY NON-PALPABLE LESIONS? Image-guided biopsy for non-palpable lesions of the breast Stereotactic guidance Ultrasound guidance Magnetic resonance imaging guidance Needle localization biopsy A. Stereotactic Guidance Uses the principle of parallax to determine the lesion position in 3-D space
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2. Vacuum-assisted biopsy device (Mammotome Stereotactic or ultrasound guidance) once and rotated while in the breast to obtain samples from different areas of the lesion. sample notch and transported tothe collection chamber -assisted breast biopsy system, the probe is positioned at the lesion. It vacuums, cuts, and removes tissue samples, which are passed through the probes hollow chamber into a collection tray. This allows for multiple samples to be collected whole only one incision into the breast is made. Mammographic Needle Localization Biopsy Specimen Mammography
Not all tumors need to be biopsied prior to surgical removal Parotid neoplasms Tumors of the head of the pancreas or periampullary area causing obstructive jaundice Liver tumors Retroperitoneal tumors **Biopsy may be omitted in situations whereby the histopath result will not change the decision to operate and surgically remove a tumor Biopsy is mandatory to establish the presence of malignancy in
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TREATMENT OF CANCER 1. process. Removal of primary tumor provideslocal and regional control of the malignant
Local tumor itself with margin of normal tissue Regional draining lymph nodes BREAST CANCER Modified Radical Mastectomy vs. Lumpectomy
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there will be less recurrence and improved survival. surgery there is a chance for an early recurrence. TREATMENT OF CANCER 2. Cytoreductive Surgery In some instances, the extensive local spread of cancer precludes the removal of all gross disease by surgery. The partial surgical resection of bulk disease in the treatment of selected cancers improves the ability of other treatment modalities to control residual gross disease that has not been resected.
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of metastatic disease that can be resected without major morbidityshould undergo resection of that metastatic cancer 4. Oncologic Emergencies
5. Palliation resection often is required for the relief of pain or functional abnormalities. an improve the quality of life for cancer patients. ocedures to relieve mechanical problems, such as intestinal obstruction, or the removal of masses that are causing severe pain or disfigurement 6. Reconstruction and Rehabilitation ects can substantially improve function and cosmetic appearance en can be restored by surgical approaches. uscle transposition to restore muscular function that has been damaged by previous surgery or radiation therapy
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Sources: Poston, G., Beauchamp, D., & Ruers, T. (2007). Textbook of Surgical Oncology. India: Replica Press Pvt Ltd. Cancer Staging - National Cancer Institute. (n.d.). Retrieved April 17, 2013, from National Cancer Institute: http://www.cancer.gov/cancertopics/factsheet/detection/staging Langhorne, M., Fulton, J., & Otto, S. (2011). Oncology NUrsing. Elsevier Inc. What Is Cancer? - National Cancer Institute. (n.d.). Retrieved April 18, 2013, from National Cancer Institute: National Cancer Institute What You Need To Know About™ Cancer - National Cancer Institute. (n.d.). Retrieved April 16, 2013, from National Cancer Institute: http://www.cancer.gov/cancertopics/wyntk/cancer/page8
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