4. Surgical oncology ; introduction
Surgery is the treatment of choice for most localized,
solid neoplasms.
Surgery has recognized limits in its application.
Surgery is increasingly combined with other
treatment modalities.
5. Timeline of landmark developments in
breast cancer surgery.
Nature Reviews Clinical Oncology 12, 115–124 (2015) doi:10.1038/nr
clinonc.2014.191
6. Timeline of landmark developments in
minimally invasive surgery
Nature Reviews Clinical Oncology 12, 115–124 (2015) doi:10.1038/nr
clinonc.2014.191
7. Role of the Surgical Oncologist
Consultant
Special training or
skills
Tumor board
Organizer and
Leader
Cancer programs
Cancer committee
Tumor registry
Oncology section
Educator
Cancer conferences
Teaching programs
Researcher
Clinical protocols
20. The Genomic Era: The Changing Roles of
the Surgeon
More recently the new biomolecular targeted
treatments: Her 2 inhibitors for MBC, imatinib for
GIST, BRAF inhibitors for melanoma, EGFR TKIs for
NSCLC
Neoadjuvant treatments are currently being used for
downstaging. (CT and RT, as well as HT) are shown
to decrease the extent of the solid tumors, rendering
operable, without excising the affected organ.
21. Early detection of cancer has
contributed significantly to the
advance of surgical oncology, as it was
shown to affect both the treatment
strategy toward minimal intervention
and organ saving techniques, and the
prognosis.
22.
23. Roles of Surgeon in Management of
Cancer Patients
Prevention
Diagnosis
Definitive treatment
Palliation
Rehabilitation
25. Sugery That can Prevent Cancer
Underlying
condition
cryptochidism
polyposis coli
familial colon cancer
ulcerative colitis
MEN type II, III
familial breast cancer
familial ovarian cancer
Prophylactic
surgery
Orchiopexy
Colectomy
Colectomy
Colectomy
Thyroidectomy
Mastectomy
Oophorectomy
26. Role of Surgeon in Management of
Cancer Patients
Prevention
Diagnosis
Definitive treatment
Palliation
Rehabilitation
27. Diagnosis of Cancer
Acquisition of tissue for histologic
diagnosis
Staging of patients
29. Needle biopsy ; advantages
Simplest method
Inexpensive
Causes minimal disturbance of the
surrounding tissue
30. Needle biopsy ; disadvantages
Danger of implanting tumor cells in a needle
tract
Not representative of the total tumor
The needle misses the lesion
31. Needle biopsy ; types
Fine needle aspiration biopsy
Large bore needle biopsy ;
Vim Silverman needle
Tru cut needle
32. Principles of the performance of all
surgical biopsies
Needle tract or scar should be removed as part of
subsquent definitive surgical procedure
33. Principles of the performance of all
surgical biopsies
Do not contaminate new tissue plane
during the biopsy
34. Principles of the performance of all
surgical biopsies
Choice of biopsy technique should be
selected carefully in order to obtain
an adequate tissue sample for the
needs of the pathologist
35. Diagnosis of Cancer
Acquisition of tissue for histologic
diagnosis
Staging of patients
36. TNM Classification System
Describes the anatomic extent of disease
based on assessment of three components
T Primary tumor size and extent
N Regional lymph node involvement
M Distant metastasis absent or present
37. TNM Classification System
Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1,T2 Increasing size or local extension
T3,T4 Increasing extent of primary tumor
38. TNM Classification System
Regional lymph nodes (N)
NX Regional lymph nodes cannot be
assessed
N0 No regional lymph node metastasis
N1,N2,N3 Increasing involvement of regional
lymph nodes
39. TNM Classification System
Distant metastasis (M)
MX Presence of distant metastasis cannot be
assessed
M0 No distant metastasis
M1 Distant metastasis (may be further
specified
according to size of occurrence)
40. Role of Surgeon in Management of
Cancer Patients
Prevention
Diagnosis
Treatment
Palliation
Rehabilitation
41. Considerations in choosing
therapy
Disease and results obtained from each type of
therapy
Patient’s general conditions and co-existing
disease
Patient’s life situation and psychological makeup
42. American Society of Anesthesiologists
Physical Status Classification
CLASS DESCRIPTION
Ⅰ Healthy patient
Ⅱ Mild systemic disease, no functional limitation
Ⅲ Severe systemic disease, definite functional
limitation
Ⅳ Sever systemic disease that is a constant threat
to life
Ⅴ Moribund patient unlikely to survive 24 hours
with or without operation
From Miller RD: Principles and Practice of Anesthesia,
2nd ed. New York, Churchill Livingstone, 1986, with
Permission.
43. Eastern Cooperative Oncology Group
Performance Scale and Corresponding
ECOG-PS
GRADE
DESCRIPTION KARNOFSKY
RATING
0 Fully active, able to carry on all predisease
activities without restriction
100
1 Restricted in physically strenuous activity,
but ambulatory and able to carry out work
of a light or sedentary nature
80-90
2 Ambulatory and capable of all self-care, but
unable to carry out any work activities; up
and about more than 50% of waking hours
60-70
3 Capable of only limited self- care; confined
to bed of chair 50% or more of waking
hours
40-50
4 Completely disabled; cannot carry on any
self-totally confined to bed or chair
≤30
44. Major Challenges Confronting the
Surgical Oncologist I
Accurate identification of patients who can be
cured by local treatment alone
45. Major Challenges Confronting the
Surgical Oncologist II
Development and selection of local
treatments that provide the best balance between
local cure and the impact of treatment morbidity on the
quality of life
46. Major Challenges Confronting the
Surgical Oncologist III
Development and application of
adjuvant treatments that can improve
the control of local and distant
invasive and metastatic disease
47. Cancer surgery ; principles
Enucleation or incomplete excision of tumor mass is
never indicated as a therapeutic measure
Prevention of tumor cell implantation during
surgery
Prevention of vascular dissemination at
surgery
48. Types of cancer operations
Local resection
Radical local resection
Radical resection with en bloc excision of
lymphatics
Extensive surgical procedures
49. Adequate margin of Resection
• A complete margin of normal tissue around the
primary lesion
• Frozen sections used to evaluate tissue
margins in instances of doubt
• Complete removal of involved regional lymph
nodes
• Resection of involved adjacent organ
• En bloc resection of biopsy tracts and tumor
sinuses
50. Roles of Surgery in the Treatment of
Cancer
Definitive surgical treatment for primary cancer
Surgery for reduce the bulk of residual disease
Surgical resection of metastatic disease with
curative intention
Surgery for treatment of oncologic emergencies
51. Surgery for residual disease
In selected cancers, surgical resection
of bulk disease may lead to
improvement in the ability to control
residual gross disease that has not been resected
52. Surgery for metastatic disease
Resection of pulmonary metastasis in
patients with soft tissue and bony sarcomas
Resection of pulmonary metastasis in
patients with colon cancer
Resection of hepatic metastasis in patients with colorectal
cancer
53. Surgery for oncologic emergencies
exsanguinating hemorrhage
perforation
drainage of abscess
impending destruction of vital organs
54. Role of Surgeon in Management of
Cancer Patients
Prevention
Diagnosis
Definitive treatment
Palliation
Rehabilitation
55. Surgery for Palliation
To improve the quality of life
Examples ; relief of intestinal obstruction,
removal of mass causing pain
56. Role of Surgeon in Management of
Cancer Patients
Prevention
Diagnosis
Definitive treatment
Palliation
Rehabilitation
57. THE CANCER SURGEON
AS A CARE PROVIDER
Brings surgical skill and compassionate care to
patients
Leads screening, prevention, and risk assessment
programs
Facilitates molecular characterization of tumor and
surrogate tissues
Coordinates mu1tidisciplinary clinical care teams
58. THE CANCER SURGEON
AS A RESEARCHER
Facilitates laboratory research
Coordinates epidemiologic studies
Conducts clinical trials research
Develops novel approaches to education
59. THE CANCER SURGEON
AS A TEACHER
Ensures excellence in surgical care
Leads a multidisciplinary team to implement
integrate oncology training
