The document discusses the principles of surgical oncology for treating cancer in companion animals. It covers the role of surgery in cancer diagnosis, cure, palliation and as an adjunct to other therapies. Key aspects discussed include pre-operative assessment and management of intercurrent disease, cancer cachexia and providing nutritional support, and peri-operative treatment including antibiotics, blood transfusions and managing pain and immunosuppression. Understanding these principles is essential for veterinarians to successfully treat cancers and maximize benefits while minimizing side effects for patients.
Nutrition Implications in Gastric CancerCooper Feild
This document summarizes recent research on gastric cancer, focusing on the role of nutrition during treatment and recovery. It discusses the causes, pathogenesis, diagnosis, and standard treatments of gastric cancer. Gastric cancer is caused by a combination of genetic, environmental, and dietary factors and starts as a local malignancy that can metastasize. Diagnosis involves endoscopy, biopsy, and imaging tests. Standard treatments include surgery to remove parts of or the entire stomach, along with nearby lymph nodes. Research suggests nutrition before, during, and after treatment can help improve outcomes and lower morbidity and mortality from gastric cancer.
- The document summarizes a seminar presentation on the molecular pathophysiology of colorectal cancer.
- Colorectal cancer is one of the most common cancers worldwide and its incidence is rising rapidly in Asia. It is the 4th most common cancer globally and the 2nd leading cause of cancer death.
- The molecular basis of colorectal cancer is complex, with different genetic and epigenetic pathways contributing to tumor development and progression, including chromosomal instability, microsatellite instability, and CpG island methylation. A better understanding of these pathways may help improve prevention and treatment strategies.
1. cancer care.pdf medical surgical nursing 1akoeljames8543
This document provides an overview of cancer principles and concepts in Kenya. It discusses Kenya's health policy goals to address rising non-communicable diseases like cancer. Cancer arises due to uncontrolled cell growth and can spread through the body. Risk factors include genetics, behaviors, age, and environmental exposures. Diagnosis relies on tissue biopsy. Cancer management involves multidisciplinary teams. Prevention strategies include screening and avoiding risk factors. Genetic testing can assess cancer risk in families with predispositions. The cell cycle is important to understand cancer development.
Stomach cancer accounts for 1.3% of new cancers and 1.9% of cancer deaths in the US. Risk factors include H. pylori infection, smoking, and diet low in fruits and vegetables. Symptoms often present at advanced stages and include weight loss, abdominal pain, and nausea. Treatment involves surgery, with chemotherapy and radiation sometimes used adjuvantly or palliatively. Radiation improves local control after surgery and survival outcomes compared to surgery alone. It is also effective for palliation of symptoms from advanced disease.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
Nutrition Implications in Gastric CancerCooper Feild
This document summarizes recent research on gastric cancer, focusing on the role of nutrition during treatment and recovery. It discusses the causes, pathogenesis, diagnosis, and standard treatments of gastric cancer. Gastric cancer is caused by a combination of genetic, environmental, and dietary factors and starts as a local malignancy that can metastasize. Diagnosis involves endoscopy, biopsy, and imaging tests. Standard treatments include surgery to remove parts of or the entire stomach, along with nearby lymph nodes. Research suggests nutrition before, during, and after treatment can help improve outcomes and lower morbidity and mortality from gastric cancer.
- The document summarizes a seminar presentation on the molecular pathophysiology of colorectal cancer.
- Colorectal cancer is one of the most common cancers worldwide and its incidence is rising rapidly in Asia. It is the 4th most common cancer globally and the 2nd leading cause of cancer death.
- The molecular basis of colorectal cancer is complex, with different genetic and epigenetic pathways contributing to tumor development and progression, including chromosomal instability, microsatellite instability, and CpG island methylation. A better understanding of these pathways may help improve prevention and treatment strategies.
1. cancer care.pdf medical surgical nursing 1akoeljames8543
This document provides an overview of cancer principles and concepts in Kenya. It discusses Kenya's health policy goals to address rising non-communicable diseases like cancer. Cancer arises due to uncontrolled cell growth and can spread through the body. Risk factors include genetics, behaviors, age, and environmental exposures. Diagnosis relies on tissue biopsy. Cancer management involves multidisciplinary teams. Prevention strategies include screening and avoiding risk factors. Genetic testing can assess cancer risk in families with predispositions. The cell cycle is important to understand cancer development.
Stomach cancer accounts for 1.3% of new cancers and 1.9% of cancer deaths in the US. Risk factors include H. pylori infection, smoking, and diet low in fruits and vegetables. Symptoms often present at advanced stages and include weight loss, abdominal pain, and nausea. Treatment involves surgery, with chemotherapy and radiation sometimes used adjuvantly or palliatively. Radiation improves local control after surgery and survival outcomes compared to surgery alone. It is also effective for palliation of symptoms from advanced disease.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
This document discusses tumor cell proliferation and immunotherapies for cancers. It covers the cell cycle phases and their implications for cancer therapy. Tumor growth can be altered by immunologic therapies, chemotherapy, hormones, radiation therapy and other factors. Biologic and targeted therapies that inhibit angiogenesis, growth factor receptors, and signaling pathways are described. Immunotherapy strategies including vaccines against HPV have shown success in preventing cervical cancer.
The document discusses the leading causes of death worldwide due to illnesses like heart disease, malignant neoplasms, and cerebrovascular disease. It then covers various risk factors for cancer and heart disease, including smoking and diet. The rest of the document details cancer treatment methods such as staging and surgery, as well as principles of chemotherapy, radiation therapy, hormonal therapy, immunotherapy, and molecularly targeted agents. It provides examples of cancers that may be cured through chemotherapy alone or in combination with other treatments.
The document discusses various approaches to immunotherapy in cancers, including targeted therapies, biologic therapies, angiogenesis inhibitors, and immune-based therapies. It describes cellular processes like the cell cycle and cell kinetics that are relevant for cancer growth. It provides details on specific targeted therapies for pathways like EGFR, HER2/neu, VEGF, and PI3K/Akt/mTOR that are dysregulated in cancers. Immunotherapies like HPV vaccines have been successful in preventing cervical cancers associated with HPV infection. Overall, the document outlines current understandings and therapeutic approaches regarding tumor proliferation and immunotherapies for cancer.
Sitagliptina e proteção em ca diferenciado da tireóide.xRuy Pantoja
This document discusses whether anti-diabetic medications play a specific role in differentiated thyroid cancer compared to other cancer types. It reviews the prevalence of thyroid carcinoma in obese individuals, people with intermediate hyperglycemia, and diabetic patients compared to other cancers. It suggests that the over-expression of dipeptidyl peptidase IV (DPP-IV) in thyroid tumors, which is not seen in other cancer types, may be a potential reason for the unique relationship between thyroid cancer and diabetes.
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in early stage disease. Ongoing studies continue to refine the use of neoadjuvant and adjuvant therapies to further improve outcomes.
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in some trials. Ongoing research focuses on expanding neoadjuvant approaches and personalized treatment.
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in some trials. Ongoing research focuses on expanding neoadjuvant approaches and personalized treatment.
gastriccancer types classified and manageShehinSalim3
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in some trials. Ongoing research focuses on expanding neoadjuvant approaches and personalized treatment.
Background: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasms of the gastrointestinal (GI)
tract, occupying 0.2% of all digestive tract cancer cases. The main affected site is the stomach (50% cases). The vast majority (95%) have a mutation in the Kit gene. Surgery is the treatment of choice, with complete tumor resection with free margins, and no need for lymphadenectomy. Minimal invasive surgery may be an option, mainly for small tumors and patients with localized disease. The emergence of molecular targeted therapy has brought great advances in the treatment of unresectable metastatic tumors, and in cases of recurrence after surgical treatment.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
1. Cancer therapies are becoming more precise and personalized by taking into account a patient's unique genetic profile and molecular alterations in their tumor.
2. Lipid metabolism is altered in cancer to sustain tumor growth and progression. Certain gene expression patterns related to lipid metabolism are biomarkers for colon cancer prognosis and response to treatment.
3. Natural compounds like rosemary extracts show potential for targeting lipid metabolism genes and sensitizing chemoresistant cancer cells, representing personalized nutritional interventions for colon cancer prevention and treatment.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
El 29 de marzo de 2016 celebramos un Simposio Internacional sobre el 'Impacto de las ciencias ómicas en la medicina, nutrición y biotecnología'. Organizado por la Fundación Ramón Areces en colaboración con la Real Academia Nacional de Medicina y BioEuroLatina, abordó cómo un mejor conocimiento del genoma humano está permitiendo notables avances hacia una medicina de precisión.
Integrative Cancer - New theories and Advances in Treatment From Hippocrates ...Sheldon Stein
Professor Serge Jurasunsas' recent paper on Integrative Cancer, From Hippocrates to the Human Genome - posted on his behalf. Discusses testing, protocols and case discussion.
Obesity is now clearly established as a major risk factor for endometrial cancer.
In medium income country like ours , Obesity prevention and lifestyle initiatives should become the responsibility of public health services. Stepwise programmes with realistic time-related goals are required, starting with modification of lifestyle, progressing to pharmacotherapy and ultimately obesity surgery.
The real challenge now is to triage those women at a higher risk and offer them prophylactic measures as COCPs ,DMPA, oral progesterone or Mirena coil.
Standard treatment for endometrial cancer is surgery.
Obesity is associated with numerous disorders which put the patient at increase risk of peri-operative complications that require more detailed pre-operative assessment and more intensive post-operative care.
Thus treatment for endometrial cancer needs to be reassessed in the complex and increasingly common situation of the obese, older women with this disease.
This study analyzed 103 cases of aggressive histologic variants of endometrial carcinoma, including uterine papillary serous carcinoma, uterine clear cell carcinoma, and mixed tumors, treated at a single cancer center between 1984 and 1994. The median age was 67 years. Various treatment approaches were used including surgery alone, surgery with radiation therapy, and surgery with chemotherapy. The study found that lymphvascular space invasion and stage were independent prognostic factors. Radiation therapy significantly reduced pelvic recurrence for Stages I-III. Chemotherapy improved overall survival but not distant relapse rates. Stage Ia cases treated with surgery alone had a low risk of relapse.
Overweight and obesity are associated with worse cancer outcomes and prognosis. Adipose tissue surrounding tumors, called cancer-associated adipocytes, secrete inflammatory molecules like IL-6 that can promote tumor growth, invasion, and metastasis. In obese conditions, adipose tissue develops a pro-inflammatory state characterized by immune cell infiltration and cytokine expression. This inflamed environment may further enhance cancer-associated adipocytes' effects on tumor progression. Targeting inflammation in adipose tissue, such as with IL-6 blocking antibodies, could potentially improve cancer treatment outcomes, especially in obese patients where adipose tissue inflammation is increased.
This document discusses malnutrition in elderly cancer patients and its effects. It finds that about one-third of elderly hospital patients are malnourished, and malnutrition is associated with higher mortality and morbidity. Studies show malnutrition is common in elderly cancer patients, with over 70% having weight loss and over 40% having a low BMI. Malnutrition is an independent negative prognostic factor, reducing survival and quality of life while increasing chemotherapy toxicity and impairing response to treatment. Sarcopenia, or loss of muscle mass, regardless of weight loss has also been identified as a risk factor for chemotherapy toxicity. The oncologist should consider the nutritional status of elderly cancer patients.
Upper GI bleed is a common, scary and life threatening medical condition usually caused by peptic ulcer disease or oesophageal varices. Uncommon causes include neoplasms, aortoenteric fistulas, vascular lesions, Dieulafoy's lesion etc. Patients usually present with hematemesis or melena. GIST is the third most common tumor of stomach and also the most common mesenchymal tumor. GIST may be asymptomatic and discovered incidentally or they may cause nonspecific symptoms like early satiety and fullness. Although major presentation of GIST is upper GI bleed, GIST as a cause of upper GI bleed is very rare. We here present a patient admitted to us with massive upper GI bleed due to gastrointestinal stromal tumor.
This document summarizes a study examining the impact of squamous cell carcinoma of the head and neck (SCCHN) on patient weight status over 5 weeks of radiation therapy treatment. The study found an average weight loss of 3.12% (2.38 kg) over 5 weeks, though the results did not reach statistical significance. Multiple linear regression identified age, gender, and tumor site as explanatory variables for 13.44% of weight change. The document provides background on SCCHN incidence, treatment complications, weight loss studies, and the importance of nutrition for cancer patients. It concludes that SCCHN causes significant nutritional problems and weight loss, which are associated with decreased survival, and identifies a need for additional research on preventing
This document discusses the etiology, staging, and classification of gastric cancer. It covers:
1. Risk factors for gastric cancer including H. pylori infection, diet, genetic factors, and conditions like pernicious anemia.
2. Precancerous lesions like atrophic gastritis and intestinal metaplasia that can develop due to chronic inflammation.
3. Pathological classification systems for gastric cancer including the Lauren classification of intestinal and diffuse types.
4. The Cancer Genome Atlas project identified 4 molecular subtypes of gastric cancer with different genetic profiles and clinical outcomes.
This document discusses tumor cell proliferation and immunotherapy for cancers. It provides details on the cell cycle phases (M, G1, S, G2, G0) and how they relate to tumor growth and response to treatment. It also discusses cell kinetics, the growth fraction, and cancer stem cells. Targeted therapies discussed include those that inhibit angiogenesis by targeting VEGF, as well as EGFR inhibitors. Bevacizumab is highlighted as an anti-angiogenic therapy shown to improve outcomes for ovarian cancer both as a single agent and in combination with other drugs.
This document discusses tumor cell proliferation and immunotherapies for cancers. It covers the cell cycle phases and their implications for cancer therapy. Tumor growth can be altered by immunologic therapies, chemotherapy, hormones, radiation therapy and other factors. Biologic and targeted therapies that inhibit angiogenesis, growth factor receptors, and signaling pathways are described. Immunotherapy strategies including vaccines against HPV have shown success in preventing cervical cancer.
The document discusses the leading causes of death worldwide due to illnesses like heart disease, malignant neoplasms, and cerebrovascular disease. It then covers various risk factors for cancer and heart disease, including smoking and diet. The rest of the document details cancer treatment methods such as staging and surgery, as well as principles of chemotherapy, radiation therapy, hormonal therapy, immunotherapy, and molecularly targeted agents. It provides examples of cancers that may be cured through chemotherapy alone or in combination with other treatments.
The document discusses various approaches to immunotherapy in cancers, including targeted therapies, biologic therapies, angiogenesis inhibitors, and immune-based therapies. It describes cellular processes like the cell cycle and cell kinetics that are relevant for cancer growth. It provides details on specific targeted therapies for pathways like EGFR, HER2/neu, VEGF, and PI3K/Akt/mTOR that are dysregulated in cancers. Immunotherapies like HPV vaccines have been successful in preventing cervical cancers associated with HPV infection. Overall, the document outlines current understandings and therapeutic approaches regarding tumor proliferation and immunotherapies for cancer.
Sitagliptina e proteção em ca diferenciado da tireóide.xRuy Pantoja
This document discusses whether anti-diabetic medications play a specific role in differentiated thyroid cancer compared to other cancer types. It reviews the prevalence of thyroid carcinoma in obese individuals, people with intermediate hyperglycemia, and diabetic patients compared to other cancers. It suggests that the over-expression of dipeptidyl peptidase IV (DPP-IV) in thyroid tumors, which is not seen in other cancer types, may be a potential reason for the unique relationship between thyroid cancer and diabetes.
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in early stage disease. Ongoing studies continue to refine the use of neoadjuvant and adjuvant therapies to further improve outcomes.
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in some trials. Ongoing research focuses on expanding neoadjuvant approaches and personalized treatment.
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in some trials. Ongoing research focuses on expanding neoadjuvant approaches and personalized treatment.
gastriccancer types classified and manageShehinSalim3
Gastric cancer remains the fourth most common cancer worldwide, with high rates in Eastern Asia and South America. While rates have declined significantly in the last century, most patients still present with advanced disease. Surgical resection with D1 or D2 lymphadenectomy offers the only chance for cure, with 5-year survival rates of 20-50% depending on stage. Adjuvant chemoradiation has been shown to improve survival after surgery in some trials. Ongoing research focuses on expanding neoadjuvant approaches and personalized treatment.
Background: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasms of the gastrointestinal (GI)
tract, occupying 0.2% of all digestive tract cancer cases. The main affected site is the stomach (50% cases). The vast majority (95%) have a mutation in the Kit gene. Surgery is the treatment of choice, with complete tumor resection with free margins, and no need for lymphadenectomy. Minimal invasive surgery may be an option, mainly for small tumors and patients with localized disease. The emergence of molecular targeted therapy has brought great advances in the treatment of unresectable metastatic tumors, and in cases of recurrence after surgical treatment.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
1. Cancer therapies are becoming more precise and personalized by taking into account a patient's unique genetic profile and molecular alterations in their tumor.
2. Lipid metabolism is altered in cancer to sustain tumor growth and progression. Certain gene expression patterns related to lipid metabolism are biomarkers for colon cancer prognosis and response to treatment.
3. Natural compounds like rosemary extracts show potential for targeting lipid metabolism genes and sensitizing chemoresistant cancer cells, representing personalized nutritional interventions for colon cancer prevention and treatment.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
El 29 de marzo de 2016 celebramos un Simposio Internacional sobre el 'Impacto de las ciencias ómicas en la medicina, nutrición y biotecnología'. Organizado por la Fundación Ramón Areces en colaboración con la Real Academia Nacional de Medicina y BioEuroLatina, abordó cómo un mejor conocimiento del genoma humano está permitiendo notables avances hacia una medicina de precisión.
Integrative Cancer - New theories and Advances in Treatment From Hippocrates ...Sheldon Stein
Professor Serge Jurasunsas' recent paper on Integrative Cancer, From Hippocrates to the Human Genome - posted on his behalf. Discusses testing, protocols and case discussion.
Obesity is now clearly established as a major risk factor for endometrial cancer.
In medium income country like ours , Obesity prevention and lifestyle initiatives should become the responsibility of public health services. Stepwise programmes with realistic time-related goals are required, starting with modification of lifestyle, progressing to pharmacotherapy and ultimately obesity surgery.
The real challenge now is to triage those women at a higher risk and offer them prophylactic measures as COCPs ,DMPA, oral progesterone or Mirena coil.
Standard treatment for endometrial cancer is surgery.
Obesity is associated with numerous disorders which put the patient at increase risk of peri-operative complications that require more detailed pre-operative assessment and more intensive post-operative care.
Thus treatment for endometrial cancer needs to be reassessed in the complex and increasingly common situation of the obese, older women with this disease.
This study analyzed 103 cases of aggressive histologic variants of endometrial carcinoma, including uterine papillary serous carcinoma, uterine clear cell carcinoma, and mixed tumors, treated at a single cancer center between 1984 and 1994. The median age was 67 years. Various treatment approaches were used including surgery alone, surgery with radiation therapy, and surgery with chemotherapy. The study found that lymphvascular space invasion and stage were independent prognostic factors. Radiation therapy significantly reduced pelvic recurrence for Stages I-III. Chemotherapy improved overall survival but not distant relapse rates. Stage Ia cases treated with surgery alone had a low risk of relapse.
Overweight and obesity are associated with worse cancer outcomes and prognosis. Adipose tissue surrounding tumors, called cancer-associated adipocytes, secrete inflammatory molecules like IL-6 that can promote tumor growth, invasion, and metastasis. In obese conditions, adipose tissue develops a pro-inflammatory state characterized by immune cell infiltration and cytokine expression. This inflamed environment may further enhance cancer-associated adipocytes' effects on tumor progression. Targeting inflammation in adipose tissue, such as with IL-6 blocking antibodies, could potentially improve cancer treatment outcomes, especially in obese patients where adipose tissue inflammation is increased.
This document discusses malnutrition in elderly cancer patients and its effects. It finds that about one-third of elderly hospital patients are malnourished, and malnutrition is associated with higher mortality and morbidity. Studies show malnutrition is common in elderly cancer patients, with over 70% having weight loss and over 40% having a low BMI. Malnutrition is an independent negative prognostic factor, reducing survival and quality of life while increasing chemotherapy toxicity and impairing response to treatment. Sarcopenia, or loss of muscle mass, regardless of weight loss has also been identified as a risk factor for chemotherapy toxicity. The oncologist should consider the nutritional status of elderly cancer patients.
Upper GI bleed is a common, scary and life threatening medical condition usually caused by peptic ulcer disease or oesophageal varices. Uncommon causes include neoplasms, aortoenteric fistulas, vascular lesions, Dieulafoy's lesion etc. Patients usually present with hematemesis or melena. GIST is the third most common tumor of stomach and also the most common mesenchymal tumor. GIST may be asymptomatic and discovered incidentally or they may cause nonspecific symptoms like early satiety and fullness. Although major presentation of GIST is upper GI bleed, GIST as a cause of upper GI bleed is very rare. We here present a patient admitted to us with massive upper GI bleed due to gastrointestinal stromal tumor.
This document summarizes a study examining the impact of squamous cell carcinoma of the head and neck (SCCHN) on patient weight status over 5 weeks of radiation therapy treatment. The study found an average weight loss of 3.12% (2.38 kg) over 5 weeks, though the results did not reach statistical significance. Multiple linear regression identified age, gender, and tumor site as explanatory variables for 13.44% of weight change. The document provides background on SCCHN incidence, treatment complications, weight loss studies, and the importance of nutrition for cancer patients. It concludes that SCCHN causes significant nutritional problems and weight loss, which are associated with decreased survival, and identifies a need for additional research on preventing
This document discusses the etiology, staging, and classification of gastric cancer. It covers:
1. Risk factors for gastric cancer including H. pylori infection, diet, genetic factors, and conditions like pernicious anemia.
2. Precancerous lesions like atrophic gastritis and intestinal metaplasia that can develop due to chronic inflammation.
3. Pathological classification systems for gastric cancer including the Lauren classification of intestinal and diffuse types.
4. The Cancer Genome Atlas project identified 4 molecular subtypes of gastric cancer with different genetic profiles and clinical outcomes.
This document discusses tumor cell proliferation and immunotherapy for cancers. It provides details on the cell cycle phases (M, G1, S, G2, G0) and how they relate to tumor growth and response to treatment. It also discusses cell kinetics, the growth fraction, and cancer stem cells. Targeted therapies discussed include those that inhibit angiogenesis by targeting VEGF, as well as EGFR inhibitors. Bevacizumab is highlighted as an anti-angiogenic therapy shown to improve outcomes for ovarian cancer both as a single agent and in combination with other drugs.
Similar to 1997+AVP+surgical+oncology+review.pdf (20)
This document discusses portal hypertension and its causes, effects, diagnosis, and treatment. It begins by describing portal vein anatomy and how portal pressure is normally measured. The main causes of portal hypertension are then outlined as being pre-hepatic (portal vein obstruction), intra-hepatic (liver disease), or post-hepatic (hepatic vein issues). Key sequelae include portosystemic collaterals, splenomegaly, gastrointestinal congestion, bleeding varices, and ascites. Investigations focus on liver function tests, detecting varices, and assessing severity using the Child-Pugh classification. Treatment involves resuscitation, preventing encephalopathy, and procedures like sclerotherapy, banding, drugs,
The document discusses portal hypertension, including:
- Anatomy of the portal vein and causes of increased portal pressure.
- Cirrhosis of the liver is a leading cause of portal hypertension due to obstruction of blood flow through the liver.
- Consequences of portal hypertension include splenomegaly, variceal bleeding, and ascites.
- Investigations involve assessing liver function and imaging tests to identify varices.
- Treatment depends on severity but may include band ligation, sclerotherapy, drugs, or shunt surgery to reduce portal pressure.
This document discusses liver abscesses, including pyogenic and amoebic types. Pyogenic abscesses are usually caused by bacteria spreading from other infected organs to the liver via blood vessels. They present with fever, abdominal pain, and hepatomegaly. Diagnosis involves blood tests, imaging, and aspirating pus for culture. Treatment is antibiotics and sometimes drainage. Amoebic abscesses are caused by Entamoeba histolytica infection spreading from the intestine to the liver. They contain anchovy sauce pus and mainly involve the right liver lobe. Diagnosis involves imaging, serology, and aspirating pus. Treatment is metronidazole and sometimes drainage. Both types can lead to complications
This document provides information on pancreatic cancer including incidence, risk factors, clinical presentation, staging, investigations, surgery, palliation and controversies in management. Some key points are:
- Pancreatic cancer incidence is highest in American Blacks at 11-13 per 100,000 people and 80% of cases occur in those over age 60.
- Only 20% of pancreatic cancers are operable for cure and the 5-year survival is less than 5% due to late presentation and aggressive biology.
- CT scan is the gold standard for staging to assess operability. Surgical resection through pancreaticoduodenectomy or distal pancreatectomy offers the only chance for cure but is only possible in 20-30% of
This document discusses cysts, ulcers, sinuses, and fistulas. It defines each term and provides examples. For cysts, it describes types like congenital cysts that occur during development and acquired cysts caused by infections or tumors. Complications and investigations for cysts are outlined. For ulcers, it defines them as breaks in epithelial surfaces and describes clinical examination and management. Sinuses are defined as tracts lined with granulation tissue, and examples of pathological sinuses are given. Fistulas are tracks between epithelial surfaces. The classification and features of sinuses are also summarized.
This document discusses the clinical approach to a patient presenting with abdominal pain. It covers the anatomical basis of abdominal pain, types of pain, history and physical examination findings, differential diagnosis, and special considerations. The key points are that abdominal pain can have many underlying causes, a thorough history and physical exam are important to localize and characterize the pain, and laboratory and imaging studies may be needed to make a diagnosis.
This document provides an overview of the anatomy of the large intestine, including its dimensions, blood supply, lymphatic drainage, peritoneal relations, and positions of the appendix. Key sections include descriptions of the divisions of the large intestine (cecum, ascending colon, transverse colon, descending colon, and sigmoid colon), relationships with surrounding structures like the mesentery and peritoneum, common vascular variations, and lymphatic drainage pathways. References are provided for additional information.
This document discusses cholecystitis, or inflammation of the gallbladder. It begins by describing the anatomy of the hepatobiliary system and gallbladder. It then explains the types of cholecystitis, including acute calculous cholecystitis caused by gallstones blocking the cystic duct. Clinical features include right upper quadrant pain. Diagnosis involves ultrasound and blood tests. Treatment ranges from antibiotics and fluids for mild cases to early laparoscopic cholecystectomy for moderate or severe cases. Complications include gangrenous or perforated cholecystitis if not treated promptly.
The document discusses sample collection and handling for bacterial culture and antibiotic sensitivity testing in veterinary clinical microbiology. It provides guidance on collecting various sample types like exudates, tissues, blood, urine and swabs from different sites while avoiding contamination. The importance of clinical history and proper transport and storage of samples is emphasized. Different methods for antimicrobial susceptibility testing including disc diffusion, dilution and molecular methods are overviewed. Common sets of drugs used in routine susceptibility testing are also listed.
This document discusses pancreatic cancer, including its incidence, risk factors, clinical presentation, investigations, staging, treatment options, and controversies in management. Some key points:
- Pancreatic cancer has a very poor prognosis with only 20% being operable and a 5-year survival of less than 5%.
- Risk factors include smoking, diet high in fat/low in fiber, diabetes, and certain occupations.
- Presentation is often vague with painless jaundice in 50-60% of cases. CT scan is the gold standard for staging and assessing operability.
- Surgical resection through pancreaticoduodenectomy or distal pancreatectomy offers the only chance of cure but is
This document provides information on obstructive jaundice, including its definition, relevant anatomy, physiology, pathophysiology, causes, clinical presentation, and approach to patients. Obstructive jaundice is caused by cholestasis or obstruction of the biliary tree, leading to conjugated hyperbilirubinemia. The biliary tree has significant anatomical variations that surgeons must be aware of. Clinical features may include jaundice, abdominal pain, weight loss, fever, and more, depending on the underlying cause which can include gallstones, tumors, strictures, or other conditions. A thorough history and physical exam is important to evaluate obstructive jaundice.
- Sutures play an important role in wound healing after surgery. The ideal suture material is sterile, causes minimal tissue injury, is easy to handle, has high tensile strength, and resists infection.
- Suture materials can be absorbable, non-absorbable, natural or synthetic. Common natural sutures include catgut and silk, while synthetic options include Vicryl, PDS, Monocryl, Prolene, and nylon.
- Absorbable sutures provide temporary wound support until healing, while non-absorbable sutures offer longer-term support. Selection depends on factors like tissue type and tension. Proper suture and
Gallbladder disorders include cholelithiasis, acute cholecystitis, and chronic cholecystitis. Cholelithiasis refers to gallstones, which form from bile constituents like cholesterol and pigment in the gallbladder or bile ducts. Risk factors include age, female sex, obesity, family history, and estrogen therapy. Acute cholecystitis is inflammation of the gallbladder due to gallstones obstructing the cystic duct or gallbladder neck. Symptoms include right upper quadrant pain, nausea, and fever. Chronic cholecystitis results from repeated inflammation and infection leading to gallbladder fibrosis. Treatment involves antibiotics, pain management, and cholecystectomy for severe or recurrent cases
Choledocholithiasis refers to stones in the common bile duct. Stones can be primary, formed in the bile duct itself, or secondary, passed from the gallbladder. Clinical features include biliary colic, jaundice, and complications like cholangitis. Investigations include ultrasound, MRCP, CT, and ERCP. Treatment involves ERCP with sphincterotomy and stone extraction, or open exploration during cholecystectomy. For retained stones, techniques like T-tube drainage and flushing or reoperation may be used.
Congenital diaphragmatic hernia is a birth defect caused by a defect in the diaphragm that allows abdominal organs to enter the chest cavity. It occurs in approximately 1 in 2000-5000 births. The majority (85%) occur on the left side. Prenatal ultrasound can detect CDH by visualizing organs in the chest cavity. After birth, affected infants experience respiratory distress. Treatment involves surgery to return organs to the abdomen and repair the diaphragmatic defect. Even with treatment, CDH carries a high risk of complications and mortality.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
1997+AVP+surgical+oncology+review.pdf
1. CLINICAL
REVIEW
The Principlesof SurgicalOncology
JuliusM.Liptak
Department
ofCompanion
Animal
Medicine
andSurgery
TheUniversity
of Queensland 4072
INTRODUCTION
Cancer is one of the major causesof death in cats and
dogs (Ogilvie, 1995:Withrow, 1996a).Successfulcancer
treatment requires a positive and dedicated attitude by
both the owner and veterinarian but this approach should
also be realistic. The treatment of cancer requires
knowledge of tumour behaviour,surgicaltechniques,and
adjunctive therapies such as chemotherapy and
radiotherapy.
The role of surgery in oncology is multifactorial and
includes diagnosis with various biopsy techniques,
curative with completeexcision of the tumour, palliative
when the type or severity of tumour prevents curative
surgery, adjunctive or cytoreductive surgery to facilitate
the effectiveness of other therapies such as cryosurgery,
chemotherapy and radiotherapy, and the resection of
metastaticdisease.
DIAGNOSIS
Many cancerpatientsare old and henceit is important to
assesstheir health (Soderstrom & Gilson, 1995). The
following tests should be considered on an individual
basis: haematology, biochemistry, electrocardiogram,
radiography, computed tomography scans, nuclear
medicine, and magnetic resonance imaging (Straw,
r99s).
Radiography always requires a minimum of two views
for proper assessmentof the size and extent of the
tumour. Thoracic radiographs require four views to
ensure the best opportunity of detecting metastatic
disease. These projections are right and left laterals,
dorsoventraland ventrodorsal(Straw, 1995). Secondary
nodules are usually identifiable if their diameter is
greaterthan lOmm or if their cross-sectional
diameteris
lessthan that of a major pulmonary vessel(Straw, 1995).
The two lateral views are requiredas atelectasisand
increased
perfusionoccursin the dependant
lung fields
which resultsin poorerdefinition of metastatic
nodules
(Straw, 1995). The non-dependant
lung fields have
increased
ventilationand, combinedwith the greater
lesion-to-film magnification,make diagnosisof
metastaticpulmonary noduleseasier (StraW 1995).
Metastasis
may still exist despitethe failure to detect
pulmonary
nodules.
ParaneoplasticSyndromes
Cancer
canalterthemetabolism
andfunctionof all body
partsattheprimarytumoursite,metastatic
disease
siteor
distantto the actualtumour(Ruslander
& Page,1995).
Thesearecalledparaneoplastic
syndromes.
Theyarenot
relatedto tumour size, metastasis
or tissueof origin
(Ruslander
& Page,1995).The causeof paraneoplastic
syndromes
is unknownbut hypothesised
to resultfrom
tumour cell productionof biochemicalsincluding
polypeptides,
hormones,
hormone-likesubstances
and
toxins (Gilson & Stone, 1990b; Gorman, 1990;
Ruslander & Page, I995). The incidence of
paraneoplastic
syndromes
is unknownbutaffectsl5Voto
20Va
of htmanpatients,
notincludingcachexia,
andupto
75Voof patientswith untreatable
cancers(Gilson &
Stone, 1990b).Paraneoplastic
syndromesoccur most
frequentlywith endocrine
and haematological
tumours
(Gorman,1990).Paraneoplastic
syndromes
havebeen
reviewed in the veterinary literature (Dyer, 1992;
Forrester& Fallin, 1992;Forrester& Relford, 1992;
Rogers,
1992;
Ruslander
& Page,
1995;
Ogilvie,1996).
INTRODUCTIONTO SURGERY
The surgicalremovalof localisedtumourscuresmore
human and animal cancersthan any other mode of
therapybutit is only partof a multidisciplinaryapproach
involving tumour biology, chemotherapy,
radiotherapy
Oncology is a field in veterinary medicine which is demanding more
attention from both veterinarians and their clients. An understanding of the
principlesof oncology andits treatmentis essentialfor a successful
outcome.
The role of the veterinary surgeon in treating cancersin companion animals
is reviewed.(Liptak, J.M. (1997). Aust. Vet.Practit. 27:114)
2. PRINCIPLES
OF SURGICALONCOLOGY
andothertreatment
modalities
(Gilson& Stone.1990a:
Birchard, 1995; Soderstrom& Gilson, 1995) A
knowledge
of theseprinciplesshouldbe acquired
by all
oncologistsand oncological surgeons.The goal of
therapyis to maximisethebenefitsof treatment
andcure
rateswhile minimisingtheside-effects
(Gilson& Stone,
1990a).The advantages
of surgery are that it is
non-carcinogenic
andlessimmunosuppressive
compared
to chemotherapyand radiotherapy(Gilson & Stone,
1990a;Soderstrom
& Gilson,1995).The disadvantages
include the morbidity and mortality associatedwith
procedure,
decreased
functionanddisfigurement
(Gilson
& Stone,1990a).
Important
questions
tobeasked
priorto
planningoncologicalsurgeryare(Withrow,1996c):
1.WhatamI treating?
2.Do thebiopsyresults
fit theclinicalsituation?
3.Whatis theknownbiolosicalbehaviour
of thecancer?
4. Is a curepossible?
5. What is the propersurgicalapproach
(intralesional,
marginal,
wideor radical)?
6. Whataremy alternatives
to treatment?
7.Whataretheexpectations
andattitudeof theownerand
arethese
reasonable?
There are five different surgical goals with cancer:
prevention,
diagnosis,
cure,palliation,andcombination
therapy(Withrow,1996c).
Pre-operativeAssessment
The pre-operative
management
of the oncological
surgical patient should include an assessment
of
intercurrent
disease
whichmayberelated
(e.g.,vomiting
and dehydrationwith a gastro-intestinal
tumour) or
unrelated
(e.g.,renalor hepatic
disease)
to theneoplastic
process(Gilson& Stone,1990b).Intercurrent
disease
increasesthe morbidity and mortality associated
with
surgery,can limit the extent of surgery and alter
post-operativemanagementbut it should not be a
contraindication
to surgicaltherapyasits recognitionand
management
will reducephysiological
stresses
(Gilson
& Stone,1990b;
Soderstrom
& Gilson,1995).
Theriskof
haemorrhage
is a serious
complication
with bothbiopsy
and surgery, and hence blood coagulationtests and
correctionof any haemostatic
abnormalities
shouldbe
performedprior to surgicalintervention
(Straw,1995).
Chemotherapy,
radiotherapyand/or surgery can be
altered,incorporatedor eliminatedon the basis of
intercurrentdisease(Gilson & Stone, 1990b).For
example,nephrotoxic
chemotherapeutic
agentssuchas
cisplatinshouldnotbeusedin animals
with renalfailure
and limb amputationshouldnot be performedif other
joints are affected by degenerative
joint disease.
Paraneoplastic
syndromes
should
betreated
or controlled
prior to surgery to minimise surgical morbidity and
mortality.
Cancer Cachexia& Nutritional Support
Cancer cachexia,a form of malnutrition due to
competition between the host and the tumour for
nutrients,
resultsin a numberof nutritionalimbalances,
cancause
immunesystem
failure,inhibitwoundhealing,
andincrease
morbidity associated
with surgeryandother
treatment alternatives(McCaw, 1989; Gilson & Stone,
1990b;Ogilvie, 1993;Ogilvie &Vail, 1996).The most
significantnutritional imbalancesinclude disturbances
in
carbohydrate,protein and lipid metabolism.
The tumour metabolisesglucosefor energyby anaerobic
glycolysis which forms lactate as an end product. The
hostusesenergyto convertlactateto glucosethrough the
Cori cycle resulting in a net energy gain for the tumour
and lossfor the host (Holyroyde & Reichard,1981).This
is exacerbatedby diets high in simple carbohydratesand
intravenousfluids containing either glucose or lactate,
suchaslactatedRinger's solution,astheseincreaseblood
lactateconcentrations(Ogilvie, 1993).
Cancercausesdecreased
body muscle massand skeletal
protein synthesis, negative nitrogen balance, and a
concurrent increasein skeletalprotein breakdown, liver
protein synthesis, and whole-body protein synthesis
(Langstein, 1991). Tumours preferentially use amino
acids via gluconeogenesisat the expense of the host
(Kurzer & Meguid, 1986). Amino acids are also
important in the treatment of tumours. Arginine
stimulates lymphocyte blastogenesis and decreases
tumour growth and metastatic rate in some rodents
( T a c h i b a n ae t a l . , 1 9 8 5 ) . G l y c i n e r e d u c e s
cisplatin-inducednephrotoxicity (Heyman et al., l99l).
Fat loss accounts for the majority of weight loss in
animals with cancer cachexia. Abnormalities in lipid
metabolisminclude decreasedlipogenesisand increased
lipolysis (Ogilvie, 1993). Some tumour cells have
difficulty in utilising lipids as an energy source hence
enabling the host to continue oxidising fats for energy
(Ogilvie, 1993). Researchhas demonstratedthat high
amounts of specific types of fat, such as omega-3 fatty
acid, can improve nitrogen intake and balance,in vitro
lymphocyte mitogenesis, and wound healing time
(Tisdaleet al., l99l).
The most effective method of treating cancer cachexia is
through the elimination of the primary tumour, although
the alterations in carbohydrate, protein and lipid
metabolism can continue after the animal is tumour free,
but it can be managedwith enteral or parenteral nutrition
such as nasogastric,pharyngostomy, oesophagostomy,
gastrotomy or jejunostomy feeding tubes (Gilson &
Stone, 1990b).Nutritional support should be considered
when anorexia is present for greater than five days, there
is greater than a l0%a acute loss of body weight, the
existenceof a diseaseor tumour which interferes with
oral feeding for greater than three days, and laboratory
results indicating hypoalbuminaemia, lymphopaenia
and/oranaemia(Gilson & Stone,1990b).Total parenteral
nutrition is effective but technically demanding and
expensive(Gilson & Stone,1990b).
Peri-operative Treatment
Prophylactic antibiotics should be used with cancer
surgeryas infection is likely due to immunosuppression
resulting from anaesthesia,surgery, chemotherapy,
radiotherapy, neoplastic disease, malnutrition,
splenectomy, and/or intercurrent disease (Gilson &
Stone,1990b).
Blood or blood basedproducts are often requried to treat
the anaemia of chronic diseasepresent with tumours,
3. PRINCIPLES
OF SURGICALONCOLOGY
chemotherapy
andradiotherapy,
malnutrition,andblood
lossor myelophthisis
(Gilson& Stone,1990b).Blood
transfusionscan cause marked immunosuppression
through prostaglandinE-mediatedsuppression
of
macrophage
and lymphocytefunction and increasedT
suppressor
cell activity(Gilson& Stone,1990b).
Blood
transfusions
decrease
five yearsurvivalratesby 26Voin
human cancer surgery but are still indicatedwhen
required(Gilson& Stone,1990b).
Tumour-associated
pain is presentin l5%oof
non-metastatic
tumours,33Va
of earlymetastatic
tumours
and60Vo
to 90Vo
of advanced
metastatic
tumours(Gilson
& Stone,1990b).Sixty two percentto 78Voof pain is
tumour-relateddue either to mechanicalor chemical
stimulationof nociceptors(Gilson & Stone, 1990b).
Nineteenpercentto 25Voof pain is dueto thetreatment
regimes
(Gilson& Stone,1990b).
Paincanbecontrolled
through the administration of narcotic agents,
non-steroidal
anti-inflammatories,
andlocalanaesthesia.
PREVENTATIVESURGERY
Forms of preventative surgery include early
ovariohysterectomy,
to reducetheincidence
of cancers
of
theovary,uterusandmammaryglands;andcastration
to
prevent sertoli cell tumours in cryptorchid dogs and
perianaladenomas
(Gilson& Stone,1990a;
Soderstrom
& Gilson.1995).
DIAGNOSTICSURGERY_ BIOPSY
The ideal biopsy techniqueshould safely and simply
provide an adequatesample of tissue that will
consistentlyprovide an accuratediagnosis(Soderstrom
& Gilson,1995).Thereareseveral
methods
to obtaina
biopsy,including fine needleaspirate,
needlebiopsy,
surface-bitinginstrument,incisionalbiopsy, and
excisional
biopsy(Withrow,1996b).
Improper
useor the
useof faultybiopsyinstruments
maydamage
thebiopsy
sampleand henceshouldbe avoided.
Forceps,
suction
andotherhandlingmethodsmayalsodamage
thebiopsy
sample
(Withrow,1996b).
All biopsiesshouldbe submittedfor histopathological
examinationby a trained veterinarypathologist
(Withrow,1996b).Medicolegal
concerns
dictatethatall
biopsy samplesbe submittedfor pathologyand,if the
ownerdoesnot wantto submitthebiopsy,thenatleastit
should be stored in formalin (Straw, 1995). The
histologicaltype andgradeof tumour areimportantfor
assessing
surgical
technique,
hence
mostbiopsies
should
be performedprior to surgery(Withrow,1996b).Biopsy
resultsshouldbe discussed
with thepathologist
asthey
should
fit theclinicalfindings(Straw,
1995).
If theresults
do notfit theclinicalfindings,thenrequest
resectioning,
special
stains
for possible
tumourtypes(suchastoluidine
blue for mast cells, or a secondopinion from another
pathologist(Straw, 1995).A pre-operative
biopsy is
recommendedif the tumour type will affect the
treatment,the extent of treatment,or the owner's
willingnessto proceedwith treatment(Powerset al.,
1995;Withrow1996b).
Fine NeedleAspiration
Fine needleaspiration(FNA) is an inaccuratebiopsy
method but should differentiate betweenbenign and
malignant
tumours(Clinkenbeard
& Cowell,1994).It is
an acceptable
methodfor the diagnosisof round cell
tumours such as mast cell tumour, lymphoma and
histiocytoma(Clinkenbeard& Cowell, 1994).All skin
tumours should have FNA performed as one study
showed that 74Voof skin tumours were diagnosed
correctlywith FNA cytology (Clinkenbeard& Cowell,
1994). Other collection methods for cytological
evaluationinclude transtracheal
washesand
bronchoalveolar
lavage.Histopathologicalconfirmation
followingexcision
is stillrequired.
NeedleBiopsy
Needlebiopsiesare atraumatic,easyto use,relatively
inexpensive,versatile,and long-lasting(Withrow,
1996b).Tumoursarepoorly innervatedandhencelocal
anaesthesia
is not requiredbut the overlying skin will
needto be anaesthetised
anda smallstabincisionmade
for theinsertion
of thebiopsyneedle(Withrow,1996b).
Multiple specimens
shouldbe obtainedto ensurea
representative
samplefor histopathological
examination
(Withrow,1996b).
Caremustbetakenwhenhandling
the
tissueand removing it from the needle.Removethe
samplewith a scalpel
blade,hypodermic
needleor fine
toothedforceps(Withrow,1996b).Needlebiopsiesare
moreaccurate
thanFNAs but not asreliably accurate
as
incisional or excisionalbiopsies(Clinkenbeard&
Cowell,1994).
Complications
arerarebutincludefistula
formation,haemorrhage,
spread
of infection,andtumour
seeding
(Withrow,1995).
Incisional Biopsy
Incisional biopsy is recommended
in preferenceto
needlebiopsy for soft or friable tumours, peripheral
lymph nodes, and highly inflammed and necrotic
tumours (Withrow, 1996b).Incisional biopsy is
performedusing a scalpelbladeto obtain a wedgeof
tissue.The biopsy shouldincludea junction between
normaland abnormaltissue.However,somesurgeons
believe that this may disrupt and extend the tumour
margins as the peripheral tumour is where greatest
cellular activity occurs (Gilson & Stone, 1990a;
Birchard. 1994: Withrow. 1995: Withrow. 1996b).
Normaltissue
should
notbeincluded
if thattissue
will be
involved in subsequentreconstructiveprocedures
following definitive treatment (Withrow, 1996b).
Electrocauteryand other tissue damaging techniques
should be avoided as they will disrupt tumour
architecture
(Withrow,1996b).
Incisionalbiopsyshould
not be performedin areasof ulceration,necrosis,or
inflammation(Withrow,1996b).Multiple samplesare
preferredas a singlesamplemay not be representative
(Withrow,1996b).Carefulhaemostasis
and asepsis
is
required while performing incisional biopsies,dead
spaceshouldbe reduced,
andtheuseof drainsavoided
(Withrow, 1996b).The incisional biopsy should be
performedby the surgeonso definitive surgerycan be
plannedtoremovethebiopsytractwith thetumourasthe
biopsyprocedure
canseed
normaltissueandbea source
of local tumour recurrence
(Gilson & Stone,1990a;
Soderstrom& Gilson, 1995; Straw, 1995: Withrow,
1996b).
For adequate
fixation,thebiopsyshouldbe less
than one centimetrethick and placedin I0Vobuffered
formalin at oneparttissueto 10partsfixative (Gilson&
Stone,1990a;
Powers,
1996;Withrow,1996b).
4. PRINCIPLES
OF SURGICALONCOLOGY
ExcisionalBiopsy
The role of excisionalbiopsy is controversial.
Some
oncologistsbelieve that excisional biopsy is more
frequentlyperformedthanis indicatedbut someauthors
regardit asthepreferredmethodof biopsyasthebiopsy
procedure
maybe curativeaswell asdiagnostic
(Gilson
& Stone, 1990a; Withrow, 1996b).A complete
pre-operative
work-up, including eitherFNA or needle
biopsy,will provideknowledgeof thelikely tumourand
betterplanningfor curativesurgery.
For example,a mast
cell tumour can be diagnosedby FNA, but if an
excisionalbiopsy is performedwithout this knowledge
thenthetumourwill beincompletelyexcisedresultingin
anunnecessary
risk to thepatientandtheneedfor further
andmoreextensivesurgery.
The first surgeryis thebest
chancefor cureandthis shouldnot be compromised
by
inadequate
planning(Mann& Pace,
1993;Soderstrom
&
Gilson,1995;Straw,1995).Excisional
biopsyshouldbe
performedwhen the treatmentwould not be alteredby
knowledgeof the tumour type suchassplenectomy
for
splenic
masses
(Withrow,1996b).
STAGINGOF TUMOURS
The locationand extentof tumourscan be classified
accordingto the World Health Organisation
clinical
stagingsystemfor tumoursin domesticanimals(Table
l). Theclassfication
involves
local(T),regional(N) and
distant(M) disease
(Gilson& Stone,1990a;
Soderstrom
& Gilson, 1995).Stagingis an aid to the planningof
treatment,
establishing
a prognosis,
evaluating
results,
investigatingtumoursand assistingin the exchangeof
informationbetweenveterinarians
(Powerset al., 1995).
Tumour stagingshouldbe done in a standardised
and
reproducablemanner.The minimum stagingrequired
prior to surgeryshould include preoperative
biopsy,
thoracicradiographyand FNAs of the regionallymph
nodes(Soderstrom
& Gilson,1995).Othermethodsof
stagingtumours include laboratorytests,ultrasound,
computed
tomography,
magnetic
resonance
imaging,
and
nuclearscintigraphy
(Powers
etaI.,1995;Soderstrom
&
Gilson,1995).
CURATIVE SURGERY
Curative surgery involves completeexcision of the
tumour.The first surgeryis the bestchancefor a cure.
Benignandmalignanttumourswill recurif excisionis
incomplete.Tumoursrecurring after intial surgeryare
oftenmorelocally invasivedueto alteredvascularityand
local immune responses
and the destructionof normal
tissueplanesin the initial surgerywill makesubsequent
surgeries
more difficult (Soderstrom
& Gilson, 1995).
Surgical
planning
depends
onknowledge
of tumourtype,
grade,stage,
andexpected
behaviour
(Gilson,& Stone,
1990a).
If mass
biopsyor staging
hasnotbeencompleted
then surgery should be planned with all possible
considerations
including intraoperative
cytology or
frozensectionhistopathology
(Gilson& Stone,1990a;
Rogersetal., 1996).
Preparation
General anaesthesia
is usually required although
neoplasms
in appropriatelocationscan be amenableto
regionalblocksor epidurals.
Localanesthesia
shouldbe
avoidedasit candistorttumourarchitecture,
increase
the
difficulty of microscopicinterpretation,and potentiate
T1
T3
PRIMARYTUMOUR
Noevidence
of neoplasia
Tumour
< 1cmin diameter
andnotinvasive
Tumour1-3cmin diameter
or locallyinvasive
Tumour> 3cmin diameter
or evidence
of
ulceration
or locallyinvasive
NODE
N0 Noevidence
of nodalinvolvement
N1 Nodefirmandenlarged
N2 Nodefirm,enlarged
andfixedto surrounding
tissue
N3 Nodalinvolvement
beyondregional
lymphnodes
It'ETASTASIS
M0 Noevidence
of metastasis
M1 Metastasis
to oneorgansystem
M2 Metastasis
to morethanoneorgansystem
TABLEI: WorldHealthOrganisation's
TNMclassification
oftumours
indomestic
animals.
World
HealthOrganisation,
Geneva,
1980.
metastasis
(Soderstrom
& Gilson, 1995).The patient
shouldbe prepared
with a widely clippedareato allow
for anextension
of incisions
if required
(Gilson& Stone,
1990a).Asepticpreparation
is especiallyimportantas
cancerpatients
areimmunosuppressed
andhencemore
susceptible
to infections.Gentle skin preparationis
requiredasvigorousscrubbingcanresultin tumourcell
exfoliation (Gilson & Stone. 1990a:Soderstrom&
Gilson,1995).
SurgicalTechnique
Following skin and subcutaneous
skin incisions,
protectivedrapesshould be placed on skin edgesto
prevent tumour seeding(Gilson & Stone, 1990a;
Soderstrom
& Gilson, 1995).Normal tissuemust be
protectedfrom tumour cells, hence determinationof
tumourstageandmarginsbeforesurgeryminimisesthe
amountof normaltissueexposedand the disruptionof
tumour margins(Soderstrom
& Gilson, 1995).If an
exploratoryabdominalor thoracic surgeryis being
performed,thentheentirecavity shouldbe examinedto
determinethe extent of the tumour (Gilson & Stone,
1990a;
Soderstrom
& Gilson,1995).
Tumoursare consideredan infective nidus and hence
careful handling is requiredto preventexfoliation of
tumour cells and local recurrence(Gilson & Stone,
1990a;Birchard, 1995; Soderstrom
& Gilson, 1995;
Withrow, 1996c).Five-yearsurvivalratein humanswith
colonic cancer improved l00Vo with careful
intra-operative
handling(Gilson& Stone,1990a).The
tumour is isolatedwith a laparotomyspongeand, if
required,
manipulated
with staysutures.
Thesecanalso
actasmarkers
toorientate
thepathologist
(Mann&Pace,
1993; Birchard, 1995). All vascularand lymphatic
vessels
shouldbe ligatedasearlyaspossible
to prevent
therelease
of tumouremboliintotheciruclation
(Gilson
& Stone,1990a;Straw,1995;Soderstrom
& Gilson,
1995;Withrow,1996c).
This is especially
importantfor
5. PRINCIPLES
OF SURGICALONCOLOGY
tumourswith good arterial and venoussupply suchas
splenic tumours,retainedtesticlesand lung tumours
(Straw,1995).If a malignanttumouris openedduring
resection,
then it is no betterthan a large biopsy.If
tumour marginsare disrupted,then electrocoagulate
or
fulgurate the exposed surface and change gloves,
instrumentsand drapes (Gilson & Stone, 1990a;
Soderstrom
& Gilson,1995).
Tumourdissection
shouldhaveat leastonetissueplane
betweenthe massand the excision (Withrow, I996c).
Tumourand adhesions
shouldbe removeden bloc as
adhesionsmay be related to local tumour invasion
(Soderstrom
& Gilson, 1995).Lavageshouldnot be
performed in cavities as it is difficult to recoverbut
lavage of wound surfacesis acceptableas it washes
exfoliated cells away but the effect of dilution is
unknown(Gilson& Stone,
1990a;Birchard,
1995;Straw,
1995;Withrow, 1996c).Lavageshouldnot replacethe
needfor gentletissue
handling(Straw,1995).
Scalpelbladesshouldbe usedasthey aretheoretically
the smoothestand least traumatic of all the cutting
instruments
especially
on skinandholloworgans
(Gilson
& Stone,1990a;
Soderstrom
& Gilson,1995).
Theproper
useof thescalpel
will reduce
tissue
traumaandpreserve
vascular
supplybut scissors
areusefulto separate
fascial
planesand for the use in body cavitieswherescalpels
may be either impracticalor hazardous
(Soderstrom&
Gilson,'1995).Electrosurgery
is good for oral and
vascular
neoplasms
withgoodhaemostasis
anddecreased
risk of tumourseeding
but thermalnecrosiscanresultin
delayedhealing,decreased
resistance
to infection,and
distortion and damageof biopsy samplesdue to
polarisation
of mitotic figures(Gilson& Stone,1990a;
Soderstrom
& Gilson, 1995;Powers,1996;Withrow,
1996b).Other techniquesinclude laser surgeryand
cryosurgery
(Withrow,1996b).
Gloves,drapes
andinstruments
shouldbe changed
after
excision
of thetumour(Gilson& Stone,
1990a:'
Birchard,
1995).If radiationis planned,thendrains,tissueflaps,
and grafts should be placed to minimise the field of
radiation
(Straw,1995).
If chemotherapy
isplanned,
then
the use of non-absorbable
suturematerialsshouldbe
considereddue to delayedhealing especiallyif an
intestinal
anastomosis
hasbeenperformed.
Margins for Tirmour Excision
The aggressiveness
of surgeryis categorised
as
intracapsular,
marginal,
wide andradical(Soderstrom
&
Gilson, 1995;Straw,1995;Withrow,1996c).
The most
commonmistake
in oncological
surgery
isto usetoolow
alevelofaggressvieness
in surgery.
Intracapsular
surgery
is defined as debulking with macroscopictumour
remainingandis only indicated
for benigndisease
such
asdrainingof an abscess
(Soderstrom
& Gilson,1995).
Marginalsurgeryis the excisionof the tumouroutside
the pseudocapsule
with microscopic
tumourremaining
(Soderstrom
& Gilson,1995;Withrow,
1996c).
Marginal
excisionsare indicatedfor benign tumours such as
lipomas.
Widesurgery
is complete
excision
withmargins
free of tumour cells (Soderstrom
& Gilson, 1995;
Withrow, 1996c).Radicalsurgeryis completeexcision
involving the removal of a body part such as limb
amputationor mastectomy(Soderstrom& Gilson, 1995;
Withrow, 1996c).
The margins of excision should be determined on the
basisof tumour type, aggressiveness
(especiallymastcell
tumours and soft tissue sarcomas),anatomic location,
and the barrier providedby surroundingtissue(Gilson &
Stone,1990a;Soderstrom& Gilson, 1995;Straw, 1995).
Margins are three dimensional and hence are lateral,
medial and deep (Birchard, 1995; Withrow, 1996c).
Cartilage, tendons, ligaments, fascia, and other
collagen-dense, vascular-poor tissue are resistant to
neoplastic invasion (Straw, 1995). Fat, subcutaenous
tissue,muscle, and parenchymaltissue are not resistant
(Straw,1995).Muscle fasciashouldbe removedwith the
tumour. The margins of excision should be greater if the
tumour is invasive,recurrent,or inflamed (Straw, 1995).
Tumours should never be shelled out as malignant
tumours are often surrounded by a pseudocapsule of
compressed, viable neoplastic cells and not healthy,
reactive host cells (Soderstrom& Gilson, 1995; Straw,
1995;Withrow, 1996c).
The excised mass should always be submitted for
pathology to evaluate the tumour and margins. The
pathology report should include margin evaluation,
mitotic index, vascular or lymphatic invasion, and the
grade of tumour (Soderstrom& Gilson, 1995).Marking
the tumour margins with sutures or a dye is
recommendedto assistin orientating the pathologist or
the margins can be submitted separately (Mann & Pace,
1993; Birchard, 1994; Seitz et al., 1995; Withrow,
1996b). A recent study identified alcian blue as the
preferred dye but Indian Ink in acetoneand commercially
available marking kits were acceptable (Seitz et al.,
1995). Ink should not be used when hormone receptor
assaysare anticipated asfalse results are common (Mann
& Pace,1993).Pathologistsdo not often examineall the
margins and hence clean margins should not always be
interpretedas complete removal (Mann & Pace, 1993).
Further surgeryis required if the neoplasticcells extend
to the margins of excised tissue as the excision in
incomplete.
Closure
Primary wound closure is preferred if possible but, as
Straw (1995) quotesWithrow saying,
"It
is betterto leave
a wound partly open with no cancer than to close the
wound with residual cancer". The aggressivenessof
surgeryshouldnot be compromisedby the easeof wound
closure (Withrow, 1996c). Wounds can be closed with
simple reconstructive techniques, skin grafts or
secondary intention healing. The most useful
reconstructive surgery techniques are the advancement
flap, transposition flap, and axial pattern flaps such asthe
caudal superficial epigastric and the thoracodorsal flaps.
A knowledge of these techniques prior to major
reconstructive surgery will reduce patient morbidity and
decrease the risk of compromising the margins of
excision(Soderstrom& Gilson, 1995).
The Lymph Nodes
The regional lymph node is vital to the host's immune
response but studies have not been conducted to
determinethe effectsof lymph node resection(Gilson &
Stone, 1990a). The current recommendations are to
6. PRINCIPLES
OF SURGICAL
ONCOLOGY
resecttheregionallymph nodeif firm, fixed, nodularor
if thereis histological
evidence
of tumourcells(Gilson&
Stone,1990a;
Soderstrom
& Gilson,1995;Straw,1995;
Withrow, 1996c). Firm lymph nodes may indicate
hyperplasiasecondaryto tumour antigen stimulation,
haemorrhage,or infection within the tumour (Straw,
1995).Most reactivenodesare enlargedbut soft and
non-painful while neoplasticnodesare enlarged,firm
and painful. FNA of regionallymph nodesshouldbe
performedprior to surgery(Straw,1995;Rogerset al.,
1996;Withrow,1996c).
Epithelialtumours(carcinomas)
are more likely to metastasise
to regionallymph nodes
than sarcomas(Straw, 1995; Rogerset al., 1996;
Withrow, 1996c).Enlargedlymph nodesin critical areas
(hilar, retropharyngealand mesenteric)should not be
removed
butbiopsied
asremoval
will becomplicated
and
furtheradjuvanttherapycanbeconsidered
onthebasisof
thebiopsyresults
(Straw,1995;Withrow,
1996c).
PALLIATIVE SURGERY
Palliativesurgeryis designedto improvethe quality of
life wherethetypeor extentof disease
prevents
curative
surgery (Soderstrom& Gilson, 1995; Straw, 1995).
Examples of palliative surgery include removal of
ulceratedmammary adenocarcinoma
in a patient with
asymptomatic
pulmonarymetastasis,
splenectomy
for
haemangiosarcoma,
limb amputationfor osteosarcoma,
and gastrojejunostomy
for duodenalobstruction.
The
patientgainshouldalwaysoutweigh
thepotential
riskof
surgery(Gilson& Stone,1990a;
Soderstrom
& Gilson,
1995;Straw,1995;Withrow,1996c).
Heroicsurgery
may
not be indicated and the questionwe have to ask
ourselves
is whendo we giveup?
CYTOREDUCTIVESURGERY
Cytoreductivesurgeryis the incompleteremoval of a
tumourwhichis rarelyanacceptable
or indicatedform of
sole therapyas tumoursthat are incompletelyexcised
will usuallyrecurin a shortperiodof time(Straw,1995;
Withrow,1996c).It is a practicalconsideration
prior to
cryosurgery and may increase the efficacy of
chemotherapyor radiotherapy(Straw, 1995;Withrow,
1996c).
Combination therapy involves decreasingthe tumour
load with cytoreductivesurgeryand using adjuvant
therapies such as chemotherapy,radiotherapy,
hyperthermia,or immunotherapy(Withrow, 1996c).
Cytoreductive surgery removes drug and radiation
resistanttumour cells,circulatingimmunecomplexes,
and tumour associated
immunosuppressants
(Withrow,
1996c).Expermentally,
surgeryinducescell divisionbut
this is a short-livedphenomenon
(Straw,1995).The
residualcellsaresensitive
to chemotherapy,
radiotherapy,
and immunotherapy(Withrow, 1996c).The principles
andindications
for hyperthermia
(Page,1993),radiation
therapy (Adams, 1991; Gillette & Gillette, 1995;
McEntee,1995;Thrall& Ibbott,1995;LaRue
& Gillette,
1996) and chemotherapy
(Helfand, 1990; Squires&
Gorman, 1990; Read, 1992: McEntee, 1995) are
described
elsewhere.
The timing of adjunctive therapiesis an important
considerationwhen planning curativeor cytoreductive
surgery.Neoadjuvanttherapy, which is administered
NEOADJUVANT
Advantages
Reduction
intumoursizeto facilitate
surgical
resection
Treatment
of metastatic
disease
Determines
tumoursensitivity
to chemotherapy
for
post-operative
treatment
Disadvantages
Riskoffurther
tumourgrowthmakingcomplete
surgical
resection
ditficult
Possible
delayed
woundhealing
INTRAOPERATIVE
Advantages
Directadministration
of chemotherapy
to tumourbed
(intralesional
therapy)
Increased
tumourdruglevelswithoutincreased
systemic
toxicity
Treatment
of microscopic
metastatic
disease
Disadvantages
Decreased
woundhealing
ADJUVANT
Advantages
Chemotherapy
moreetfective
whenmicroscopic
diseasepresent
andcellturnover
rateis higherat
bothprimary
andmetastatic
sites
Woundhealing
is notdelayed
Definitive
surgeryis notdelayed
Disadvantages
Efficacy
of chemotherapy
ditficult
to determine
when
onlymicroscopic
diseaseis present
Decreased
bloodsupplyto tumourwithfibrous
tissueformation
TABLE 2: The advantages and disadvantages of
chemotherapyadministered either as a neoadjuvant (or
prior to surgery), intra-operatively or adjunctively
(following surgery). [McEntee, ] 995l
prior to surgery, has some potential benefits (Tables II
and III) but their disadvantages depend on the agent
being used and its adverseeffects such as bone marrow
suppression(McEntee, 1995). For example, vincristine
has no adverseeffects on wound healing (Cohen et al.,
1975)but wound breaking strengthwas decreased
for up
to 30 days when doxorubicin was administeredto rats
prior to, during and after surgery (Lawrence et al., 1986.
Radiation therapy is indicated prior to surgery as the
vascularsupply of the tumour is not disturbedand hence
tumour cells are better oxygenated and more
radiosensitive.The risk of disseminationof tumour cells
at surgery is reduced and tumour size may be decreased
(Adams, 1991). Radiotherapy should be administered
three weeks prior to surgery to allow the acute side
effects of radiation to subside and to minimise the delay
in wound healing (Adams, 1991;McEntee, 1995).If the
7. PRINCIPLES
OF SURGICALONCOLOGY
PRE.OPERAtrIVE
Advantages
Bloodsupplyto tumouris maintained,
which
decreasesthe riskof radio-resistant
hypoxic
tumour
cells
Smallerradiation
fieldso lessnormalsurrounding
tissueis irradiated
Decreased
riskof disseminating
tumourcellsduring
surgery
Reduction
intumoursizefacilitates
surgical
resection
Dlsadvantages
Delayed
woundhealing
INTRA.OPERANVE
Advantages
Visualisation
of tumourbedandaccurate
delivery
of
radiation
dose
Decreased
exposure
of surrounding
normal
tissueto
irradiation
Abilityto deliverlargertotalradiation
doseto tumour
Disadvantages
Special
facilities
required
Complications
of largertotaldoseincludes
fibrosis
andstricture
of hollowviscera
Delayed
woundhealing
Potentialincreasedriskof lale radiationetfectsand
tumour
induction
POST.OPERANVE
Advantages
Definitive
surgeryis notdelayed
Woundhealingis notdelayed
Stagingof diseasemorecomplete
Dlsadvantages
Largerradiation
fieldrequired
lncreased
riskof disseminating
tumourcellsduring
surgery
Altercdbloodsupply
to tumourwithincreased
radio-resistant
hypoxic
tumourcells
Repopulation
of tumouraftersurgeryandbefore
radiotherapy
TABLE 3: The advantages and disadvantages of
radiotherapy administered either pre-operatively,
intra-operatively or post-operatively (McEntee, I 995).
lag period between radiotherapy and surgery is greater
than three weeks then thereis an increasedrisk of tissue
fibrosis and compromised regional vasculature which
may also affect wound healing (McEntee, 1995).
Adjunctive treatmentis more commonly employed with
chemotherapeuticagents.These should be administered
after the animal has recovered from surgery and wound
healing has advanced to the remodelling stage.
Chemotherapy can be started when the animal is
recovering from anaesthesia
as neoplasticand metastatic
cells are more susceptibleto the effects of
chemotherapeutic
agentsimmediately after surgery
(McEntee,1995). Post-operative
radiotherapyis not
recommended
(McEntee,
1995).
POST.OPERATIVE
MANAGEMENT
Post-operative
management
shouldincludeassessment
of the wound healing process,a return to normal
physiologic function, and checking for tumour
recurrence
andmetastasis
(Gilson& Stone,1990b).
This
may be performed with any of the diagnostic tests
previously mentioned.Re-evaluations
should be
individually assessed
accordingto the tumour type,
grade,
andstage
(Gilson& Stone,1990b).
OTHER INDICATIONSFOR SURGERY
IN VETERINARYONCOLOGY
The five-year survival rate for surgical resectionof
metastatic
disease
is 25Vo
to 65Vo
in humans(Gilson&
Stone,1990a).
Thecriteriafor surgery
includes
absolute
control of the primary tumour, long tumour doubling
time (greaterthan 40 days), late onset of metastatic
disease
(greater
thanoneyear),
thelocation
of metastasis,
and, to a lesserextent,the tumour type, numberof
metastaticnodules,and effectiveness
of adjuvant
treatment
(Gilson& Stone,1990a;
O'Brien et al., 1993:,
Straw,1995).The aim of metastectomy
is to providea
cure and hencerequirescareful patient selectionand
thoroughpreoperativestagingto determinethe extent
and behaviourof the tumour (Soderstrom
& Gilson,
1995).
Palliative
surgery
of metastatic
disease
is possible
buttreatment
shouldnotbeworsethanno treatment.
The
role of surgeryin the treatmentof radiationinjury has
beendescribed
elsewhere
(Dernell& Wheaton,1995a;
Dernell& Wheaton,
1995b).
COMPLICATIONS
The major complicationof oncology is tumour
recurrence(Gilson & Stone, 1990a1,
Kisseberth&
MacEwen, 1996).This can occur due to inadequate
tumourremoval,
microscopic
infiltrationof tumourcells
outsidethe surgicalmargins,
or tumourcell exfoliation
into the surgerysite or circulation.Recurrence
can be
minimisedby reducingtumourcell exfoliationthrough
gentletissuehandlingand wide exposureto prevent
tumourmanipulation
(Soderstrom
& Gilson,1995).
Metastasis
is a majorcauseof mortalityin humanand
animal cancers(Kisseberth& MacEwen, 1996).
Microscopic
or macroscopic
metastases
may be present
at the time of surgery.
The risk of metastasis
can be
predicted
fromtheclinicalstage
andhistological
grade
of
the tumour and its location(Kisseberth
& MacEwen,
1996).
Delayedwoundhealingcanresultfrom chemotherapy,
radiotherapy,
cachexia,
andtumourtype(McCaw,1989).
Wound healing is delayed with chemotherapyand
radiotherapydue to damagedmacrophages,
capillary
endothelialcells, and collagenproducingfibroblasts
(McCaw,1989;Gilson & Stone,1990b).This can be
exacerbatedby malnutrition and intercurrent disease
(McCaw,1989;Gilson& Stone,1990b).
Someof these
complicationsare nevertheless
unavoidable
due to
tumour behaviour,host defences,and physiological
status.
8. PRINCIPLES
OF SURGICAL
ONCOLOGY
CONCLUSION
Surgeryis a primarytool in thediagnosis
andtreatment
of cancerbut is only a part of a multidisciplinary
approachwhich also includes chemotherapy,
radiotherapyand immunotherapy.
The surgeonshould
have a thorough knowledge of tumour type and
behaviourprior to definitive surgery.A FNA or biopsy
shouldbe performedby the surgeonandexaminedby a
qualified veterinary pathologistprior to surgery.The
surgeryshouldbe plannedsothatadequate
marginsare
achievedin three dimensions,
especiallydeep to the
tumour. Other roles of surgeryin oncologyinclude
prevention,
palliation,
cytoreduction,
andmetastectomy.
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