This document discusses lymphatic mapping and sentinel lymph node biopsy for melanoma and breast cancer patients. It provides background on the importance of assessing lymph node status for staging and determining prognosis. For melanoma patients, sentinel lymph node biopsy is now preferred over elective lymph node dissection for nodal staging due to lower morbidity. Factors determining risk of lymph node metastases are discussed for selecting appropriate patients. Technical aspects of using radiocolloids and vital dyes are reviewed to optimize lymphatic mapping.
Development & structure of prostate By Dr. TatheerSMS_2015
This document appears to be a list of anatomy references authored by Dr. Tatheer Zahra, an assistant professor of anatomy. It includes references from Gray's Anatomy, The Developing Human: Clinically Oriented Embryology, Langman's Embryology, a histology text by Ross, a histology atlas by Junqueira and Carneiro, LAST's Anatomy Regional & Applied, Clinical Anatomy by Regions by Snell, and Clinically Oriented Anatomy by Moore.
This document provides an overview of various imaging modalities used in gastrointestinal surgery at the University of Alexandria, including plain x-rays of the chest, abdomen, and pelvis. It discusses normal anatomy and findings, as well as pathologies seen on barium swallow, barium meal, barium follow through, barium enema, oral cholecystography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), T-tube cholangiography, and intraoperative cholangiography. Examples of findings for conditions like hiatal hernia, gastric and duodenal ulcers, gallstones, biliary strictures, and cholangiocarcin
lymphnodes having metastatis from primary tumors. incidence of metastasis from various tumors to lymph nodes. how to differentiate metastatic lymph node from primary lymph node tumor(lymphoma) overview of TNM staging with example.
Three doctors presented on renal cell carcinoma. Some key points:
- Renal cell carcinoma arises from renal tubular cells and is the most common type of kidney cancer.
- Presentation may include hematuria, loin pain, and palpable abdominal mass. Metastasis can cause cough or bone pain.
- Diagnosis involves imaging like CT scan and lab tests. Surgery is the main treatment but immunotherapy and targeted drugs are also used.
- Prognosis depends on stage - early stage has good prognosis but late stage with metastasis has poorer outlook.
This document discusses ablation as a treatment for renal cell carcinoma (RCC). It provides details on:
- RCC incidence, classification, staging, prognosis, and importance of preserving renal function.
- Minimally invasive ablation techniques for RCC including radiofrequency ablation, cryoablation, and emerging methods like microwave thermotherapy and irreversible electroporation.
- Results from studies show ablation techniques have acceptable short and intermediate-term oncologic outcomes for early-stage RCC with a low risk of complications compared to surgery. Ablation allows for renal function preservation in patients who need it.
The document discusses screening for ovarian cancer. It provides guidelines from BGCS and NICE regarding screening recommendations for average and high-risk women. It summarizes a large study that found annual screening with CA-125 and transvaginal ultrasound (multimodal screening) increased early-stage cancer detection but did not reduce mortality. Therefore, general population screening is not recommended. For high-risk women, screening may be considered after discussing risks and benefits. Recent advances like liquid biopsies and analyzing the MUC16 gene show promise but require more research before implementing.
Development & structure of prostate By Dr. TatheerSMS_2015
This document appears to be a list of anatomy references authored by Dr. Tatheer Zahra, an assistant professor of anatomy. It includes references from Gray's Anatomy, The Developing Human: Clinically Oriented Embryology, Langman's Embryology, a histology text by Ross, a histology atlas by Junqueira and Carneiro, LAST's Anatomy Regional & Applied, Clinical Anatomy by Regions by Snell, and Clinically Oriented Anatomy by Moore.
This document provides an overview of various imaging modalities used in gastrointestinal surgery at the University of Alexandria, including plain x-rays of the chest, abdomen, and pelvis. It discusses normal anatomy and findings, as well as pathologies seen on barium swallow, barium meal, barium follow through, barium enema, oral cholecystography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), T-tube cholangiography, and intraoperative cholangiography. Examples of findings for conditions like hiatal hernia, gastric and duodenal ulcers, gallstones, biliary strictures, and cholangiocarcin
lymphnodes having metastatis from primary tumors. incidence of metastasis from various tumors to lymph nodes. how to differentiate metastatic lymph node from primary lymph node tumor(lymphoma) overview of TNM staging with example.
Three doctors presented on renal cell carcinoma. Some key points:
- Renal cell carcinoma arises from renal tubular cells and is the most common type of kidney cancer.
- Presentation may include hematuria, loin pain, and palpable abdominal mass. Metastasis can cause cough or bone pain.
- Diagnosis involves imaging like CT scan and lab tests. Surgery is the main treatment but immunotherapy and targeted drugs are also used.
- Prognosis depends on stage - early stage has good prognosis but late stage with metastasis has poorer outlook.
This document discusses ablation as a treatment for renal cell carcinoma (RCC). It provides details on:
- RCC incidence, classification, staging, prognosis, and importance of preserving renal function.
- Minimally invasive ablation techniques for RCC including radiofrequency ablation, cryoablation, and emerging methods like microwave thermotherapy and irreversible electroporation.
- Results from studies show ablation techniques have acceptable short and intermediate-term oncologic outcomes for early-stage RCC with a low risk of complications compared to surgery. Ablation allows for renal function preservation in patients who need it.
The document discusses screening for ovarian cancer. It provides guidelines from BGCS and NICE regarding screening recommendations for average and high-risk women. It summarizes a large study that found annual screening with CA-125 and transvaginal ultrasound (multimodal screening) increased early-stage cancer detection but did not reduce mortality. Therefore, general population screening is not recommended. For high-risk women, screening may be considered after discussing risks and benefits. Recent advances like liquid biopsies and analyzing the MUC16 gene show promise but require more research before implementing.
This document discusses urinary bladder tumors. It begins by covering the anatomy and histology of the bladder. It then describes the WHO classification of bladder tumors, which includes urothelial, squamous, glandular, urachal, mullerian, and mesenchymal tumors, among others. Non-invasive urothelial lesions like carcinoma in situ, papillomas, and non-invasive papillary carcinomas are summarized. Invasive urothelial carcinoma is also covered, noting the range of architectural patterns and cell types seen microscopically. Variants with divergent differentiation like squamous or glandular are also common. The document provides an overview of bladder tumor pathology.
The document summarizes the anatomy of the venous system in the lower limb. It describes the three main components: deep veins, superficial veins, and perforating veins. The major superficial veins are the long and short saphenous veins. The long saphenous vein runs from the foot up the leg and thigh, draining into the femoral vein. It has numerous tributaries along its path. The short saphenous vein drains the back of the calf and popliteal fossa, joining the popliteal vein. Perforating veins connect the superficial and deep systems to allow for bidirectional flow of blood.
Transitional cell carcinoma (TCC) originates from the transitional epithelium of the urinary tract. It most commonly occurs in the urinary bladder but can also arise in the renal pelvis or ureter. Risk factors include increasing age, male gender, smoking, and exposure to chemical carcinogens. Patients typically present with hematuria but may also experience flank or abdominal pain. Imaging plays an important role in diagnosis and staging. Intravenous urography can detect filling defects or masses in the renal pelvis or ureter. Computed tomography and magnetic resonance imaging provide detailed images of tumor location and extent.
A 28-year-old female presented with a large abdominal mass that had been growing over the past 5-6 months. Examination revealed a firm, fixed pelvic mass resembling a 26-week gravid uterus. Imaging studies suggested a malignant ovarian tumor. At surgery, a 25x25cm lobulated mass was found arising from the broad ligament and displacing the uterus, ovaries, and other pelvic structures. The mass was enucleated and found to have a glistening white capsule with surprising lack of vascularity. Histopathology revealed a benign leiomyoma originating from the broad ligament, with a final diagnosis of a true broad ligament fibroid.
Localization of non palpable breast tumor for surgeryGowtham Krishnan
Photoacoustic imaging combines the high optical contrast of photoacoustics with the high resolution of ultrasound. This study aims to evaluate photoacoustic imaging as a method for localizing non-palpable breast tumors during surgery. The study will compare photoacoustic imaging to the current gold standard of wire-guided localization to analyze positive margin rates, re-excision rates, and tumor resection volumes. A sample size of 120 patients is estimated to provide sufficient power to detect differences between the groups. Outcomes will help assess photoacoustic imaging's ability to improve surgeon confidence and reduce logistical burdens compared to standard techniques.
Laparoscopy is a minimally invasive surgical technique that allows visualization of the abdominal organs through small incisions. It has many applications in gynecological endoscopy including diagnostic laparoscopy to investigate causes of infertility, ovarian cysts, ectopic pregnancy, and endometriosis. Key steps in the laparoscopy procedure are pneumoperitoneum creation, trocar insertion, visualization of organs, and completion with gas evacuation. It provides diagnostic and therapeutic benefits over laparotomy with less pain and faster recovery.
1) Breast cancer is a major global health problem, with most cases occurring in developing countries. Ghanaian studies show that patients often present with advanced-stage disease and experience poor outcomes.
2) Early breast cancer is defined as stage 0, 1, or 2 based on tumor size and lymph node involvement. Treatment involves surgery such as breast-conserving therapy or mastectomy, followed by radiation and/or systemic therapies based on tumor biomarkers.
3) Ductal carcinoma in situ (DCIS) is a non-invasive proliferation of malignant cells within breast ducts. Diagnosis is often from mammography screening, and management involves surgery such as lumpectomy plus radiation therapy based on prognostic factors.
This document discusses bladder cancer. Some key points:
1. Bladder cancer is the most common tumor of the urinary tract and the second most common cause of cancer death.
2. Bladder cancer presents at a muscle-invasive stage in 20-40% of cases.
3. Diagnosis involves cystoscopy, urine cytology, imaging like CT/MRI, and biopsy.
4. Treatment depends on stage - non-muscle invasive cancers receive transurethral resection and intravesical therapy while muscle-invasive cancers require radical cystectomy and urinary diversion.
Contrast-enhanced ultrasound (CEUS) uses microbubble contrast agents and ultrasound to improve visualization of blood flow and vascularity within liver lesions. CEUS can help characterize focal liver lesions and determine whether further testing is needed when findings from CT/MRI are inconclusive. The document discusses the principles and agents used in CEUS, its accuracy in evaluating liver lesions compared to unenhanced ultrasound, advantages like lack of ionizing radiation, and limitations like dependency on operator skill. Examples of enhancement patterns seen in common liver lesions like hemangioma and hepatocellular carcinoma on CEUS imaging are provided.
updated overview in management of ovarian cancerSajan Thapa
The document provides information on epithelial ovarian cancer including its epidemiology, classification, risk factors, diagnosis, staging, and management. It discusses that epithelial ovarian cancer is the 12th most common cancer in Bangladesh. The standard treatment involves surgical staging and debulking followed by platinum-based chemotherapy, with the goal of optimal cytoreduction to 1cm or less residual disease. Additional treatments discussed include targeted therapies like bevacizumab and PARP inhibitors for certain patients.
The document summarizes information about male breast cancer. Some key points:
1) Male breast cancer is considered a rare or "orphan" disease that affects about 1 in 1000 men annually in the US, with estimated new cases of 2,140 and deaths of 450 in 2011.
2) The causes of male breast cancer include gene mutations like BRCA2 and PTEN, as well as factors like estrogen exposure.
3) Male breast cancer has some similarities to female breast cancer, especially the luminal/hormone receptor positive subtype, but the incidence peaks about 10 years later in men at age 75 compared to age 61 in women.
4) Treatment options are generally the same as for
Laparoscopic ovarian surgery can be used to manage most ovarian abnormalities. Key steps in laparoscopic ovarian cystectomy include aspirating cyst contents, stripping the cyst capsule from the ovarian cortex, and extracting the capsule. It is important to avoid injury to nearby structures like the ureter and completely remove the cyst to evaluate for early carcinoma. Outcomes are better when the ovary can be preserved through cystectomy rather than full oophorectomy. Teratomas require especially careful removal of all contents to prevent chemical peritonitis.
This document discusses the diagnosis and staging of prostate cancer. It begins by covering risk factors for prostate cancer like increasing age and ethnicity. It then discusses methods for diagnosing prostate cancer which include a digital rectal exam, PSA testing, prostate biopsy, and various imaging tests. Imaging tests covered include transrectal ultrasound, MRI, CT, bone scan, and PET which can help determine if the cancer has spread. Factors that increase the need for bone scans are outlined. The document provides details on how each diagnostic and imaging test is performed and what they can indicate regarding prostate cancer detection and staging.
This document provides an overview of ureteric injury in obstetrics and gynecological surgery. It discusses the anatomy of the pelvic ureter and risk factors for injury. Common sites of injury include at the pelvic brim and broad ligament. Injuries may be intraoperative such as crushing or transection, or postoperative like kinking. Prevention strategies include careful dissection and visualization of the ureter. Management depends on the timing, location and extent of injury, and may involve primary repair, ureteroureterostomy, or autotransplantation of the kidney. Stenting is often used to support healing after repair.
Current Diagnosis And Management Of Prostate Cancerfondas vakalis
1) Prostate cancer risk factors include increasing age, family history, and lifestyle factors like smoking and high fat diets.
2) Screening methods include digital rectal exam and PSA testing, though screening recommendations vary.
3) Treatment options depend on cancer severity and include watchful waiting, surgery, radiation, hormone therapy, and cryotherapy. Long-term side effects can include incontinence and impotence.
The document discusses intravenous urography (IVU), including its definition, history, indications, contraindications, technique, and what to look for in the images. Some key points:
- IVU involves injecting contrast media intravenously and imaging the urinary tract, allowing visualization of the kidneys, ureters, and bladder.
- It was introduced in 1929 but use has declined with the rise of CT, ultrasound and MRI. However, it remains useful for visualizing the pelvicalyceal system.
- The procedure involves obtaining baseline images, injecting contrast, then timed imaging as the contrast passes through the urinary system, sometimes using compression. Findings are assessed for
- Microinvasive breast cancer (MIBC) has a low but measurable risk of lymph node metastasis. Several studies found positive lymph nodes in 3.7-7.5% of MIBC patients who underwent sentinel lymph node biopsy (SLNB).
- Factors like lymphatic invasion and positive estrogen receptor status predict higher risk of lymph node metastases in MIBC. However, routine SLNB is not warranted for all MIBC patients. Careful selection based on risk factors is needed to avoid overtreatment.
- Studies of patients with DCIS found lymph node micrometastases in 21-34% of those undergoing SLNB for high-risk features like palpable mass or suspicious imaging. However, the clinical significance
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
This document discusses urinary bladder tumors. It begins by covering the anatomy and histology of the bladder. It then describes the WHO classification of bladder tumors, which includes urothelial, squamous, glandular, urachal, mullerian, and mesenchymal tumors, among others. Non-invasive urothelial lesions like carcinoma in situ, papillomas, and non-invasive papillary carcinomas are summarized. Invasive urothelial carcinoma is also covered, noting the range of architectural patterns and cell types seen microscopically. Variants with divergent differentiation like squamous or glandular are also common. The document provides an overview of bladder tumor pathology.
The document summarizes the anatomy of the venous system in the lower limb. It describes the three main components: deep veins, superficial veins, and perforating veins. The major superficial veins are the long and short saphenous veins. The long saphenous vein runs from the foot up the leg and thigh, draining into the femoral vein. It has numerous tributaries along its path. The short saphenous vein drains the back of the calf and popliteal fossa, joining the popliteal vein. Perforating veins connect the superficial and deep systems to allow for bidirectional flow of blood.
Transitional cell carcinoma (TCC) originates from the transitional epithelium of the urinary tract. It most commonly occurs in the urinary bladder but can also arise in the renal pelvis or ureter. Risk factors include increasing age, male gender, smoking, and exposure to chemical carcinogens. Patients typically present with hematuria but may also experience flank or abdominal pain. Imaging plays an important role in diagnosis and staging. Intravenous urography can detect filling defects or masses in the renal pelvis or ureter. Computed tomography and magnetic resonance imaging provide detailed images of tumor location and extent.
A 28-year-old female presented with a large abdominal mass that had been growing over the past 5-6 months. Examination revealed a firm, fixed pelvic mass resembling a 26-week gravid uterus. Imaging studies suggested a malignant ovarian tumor. At surgery, a 25x25cm lobulated mass was found arising from the broad ligament and displacing the uterus, ovaries, and other pelvic structures. The mass was enucleated and found to have a glistening white capsule with surprising lack of vascularity. Histopathology revealed a benign leiomyoma originating from the broad ligament, with a final diagnosis of a true broad ligament fibroid.
Localization of non palpable breast tumor for surgeryGowtham Krishnan
Photoacoustic imaging combines the high optical contrast of photoacoustics with the high resolution of ultrasound. This study aims to evaluate photoacoustic imaging as a method for localizing non-palpable breast tumors during surgery. The study will compare photoacoustic imaging to the current gold standard of wire-guided localization to analyze positive margin rates, re-excision rates, and tumor resection volumes. A sample size of 120 patients is estimated to provide sufficient power to detect differences between the groups. Outcomes will help assess photoacoustic imaging's ability to improve surgeon confidence and reduce logistical burdens compared to standard techniques.
Laparoscopy is a minimally invasive surgical technique that allows visualization of the abdominal organs through small incisions. It has many applications in gynecological endoscopy including diagnostic laparoscopy to investigate causes of infertility, ovarian cysts, ectopic pregnancy, and endometriosis. Key steps in the laparoscopy procedure are pneumoperitoneum creation, trocar insertion, visualization of organs, and completion with gas evacuation. It provides diagnostic and therapeutic benefits over laparotomy with less pain and faster recovery.
1) Breast cancer is a major global health problem, with most cases occurring in developing countries. Ghanaian studies show that patients often present with advanced-stage disease and experience poor outcomes.
2) Early breast cancer is defined as stage 0, 1, or 2 based on tumor size and lymph node involvement. Treatment involves surgery such as breast-conserving therapy or mastectomy, followed by radiation and/or systemic therapies based on tumor biomarkers.
3) Ductal carcinoma in situ (DCIS) is a non-invasive proliferation of malignant cells within breast ducts. Diagnosis is often from mammography screening, and management involves surgery such as lumpectomy plus radiation therapy based on prognostic factors.
This document discusses bladder cancer. Some key points:
1. Bladder cancer is the most common tumor of the urinary tract and the second most common cause of cancer death.
2. Bladder cancer presents at a muscle-invasive stage in 20-40% of cases.
3. Diagnosis involves cystoscopy, urine cytology, imaging like CT/MRI, and biopsy.
4. Treatment depends on stage - non-muscle invasive cancers receive transurethral resection and intravesical therapy while muscle-invasive cancers require radical cystectomy and urinary diversion.
Contrast-enhanced ultrasound (CEUS) uses microbubble contrast agents and ultrasound to improve visualization of blood flow and vascularity within liver lesions. CEUS can help characterize focal liver lesions and determine whether further testing is needed when findings from CT/MRI are inconclusive. The document discusses the principles and agents used in CEUS, its accuracy in evaluating liver lesions compared to unenhanced ultrasound, advantages like lack of ionizing radiation, and limitations like dependency on operator skill. Examples of enhancement patterns seen in common liver lesions like hemangioma and hepatocellular carcinoma on CEUS imaging are provided.
updated overview in management of ovarian cancerSajan Thapa
The document provides information on epithelial ovarian cancer including its epidemiology, classification, risk factors, diagnosis, staging, and management. It discusses that epithelial ovarian cancer is the 12th most common cancer in Bangladesh. The standard treatment involves surgical staging and debulking followed by platinum-based chemotherapy, with the goal of optimal cytoreduction to 1cm or less residual disease. Additional treatments discussed include targeted therapies like bevacizumab and PARP inhibitors for certain patients.
The document summarizes information about male breast cancer. Some key points:
1) Male breast cancer is considered a rare or "orphan" disease that affects about 1 in 1000 men annually in the US, with estimated new cases of 2,140 and deaths of 450 in 2011.
2) The causes of male breast cancer include gene mutations like BRCA2 and PTEN, as well as factors like estrogen exposure.
3) Male breast cancer has some similarities to female breast cancer, especially the luminal/hormone receptor positive subtype, but the incidence peaks about 10 years later in men at age 75 compared to age 61 in women.
4) Treatment options are generally the same as for
Laparoscopic ovarian surgery can be used to manage most ovarian abnormalities. Key steps in laparoscopic ovarian cystectomy include aspirating cyst contents, stripping the cyst capsule from the ovarian cortex, and extracting the capsule. It is important to avoid injury to nearby structures like the ureter and completely remove the cyst to evaluate for early carcinoma. Outcomes are better when the ovary can be preserved through cystectomy rather than full oophorectomy. Teratomas require especially careful removal of all contents to prevent chemical peritonitis.
This document discusses the diagnosis and staging of prostate cancer. It begins by covering risk factors for prostate cancer like increasing age and ethnicity. It then discusses methods for diagnosing prostate cancer which include a digital rectal exam, PSA testing, prostate biopsy, and various imaging tests. Imaging tests covered include transrectal ultrasound, MRI, CT, bone scan, and PET which can help determine if the cancer has spread. Factors that increase the need for bone scans are outlined. The document provides details on how each diagnostic and imaging test is performed and what they can indicate regarding prostate cancer detection and staging.
This document provides an overview of ureteric injury in obstetrics and gynecological surgery. It discusses the anatomy of the pelvic ureter and risk factors for injury. Common sites of injury include at the pelvic brim and broad ligament. Injuries may be intraoperative such as crushing or transection, or postoperative like kinking. Prevention strategies include careful dissection and visualization of the ureter. Management depends on the timing, location and extent of injury, and may involve primary repair, ureteroureterostomy, or autotransplantation of the kidney. Stenting is often used to support healing after repair.
Current Diagnosis And Management Of Prostate Cancerfondas vakalis
1) Prostate cancer risk factors include increasing age, family history, and lifestyle factors like smoking and high fat diets.
2) Screening methods include digital rectal exam and PSA testing, though screening recommendations vary.
3) Treatment options depend on cancer severity and include watchful waiting, surgery, radiation, hormone therapy, and cryotherapy. Long-term side effects can include incontinence and impotence.
The document discusses intravenous urography (IVU), including its definition, history, indications, contraindications, technique, and what to look for in the images. Some key points:
- IVU involves injecting contrast media intravenously and imaging the urinary tract, allowing visualization of the kidneys, ureters, and bladder.
- It was introduced in 1929 but use has declined with the rise of CT, ultrasound and MRI. However, it remains useful for visualizing the pelvicalyceal system.
- The procedure involves obtaining baseline images, injecting contrast, then timed imaging as the contrast passes through the urinary system, sometimes using compression. Findings are assessed for
- Microinvasive breast cancer (MIBC) has a low but measurable risk of lymph node metastasis. Several studies found positive lymph nodes in 3.7-7.5% of MIBC patients who underwent sentinel lymph node biopsy (SLNB).
- Factors like lymphatic invasion and positive estrogen receptor status predict higher risk of lymph node metastases in MIBC. However, routine SLNB is not warranted for all MIBC patients. Careful selection based on risk factors is needed to avoid overtreatment.
- Studies of patients with DCIS found lymph node micrometastases in 21-34% of those undergoing SLNB for high-risk features like palpable mass or suspicious imaging. However, the clinical significance
This document summarizes information about sentinel lymph node biopsy for breast cancer. It discusses the history and technique of sentinel lymph node biopsy. It describes that the sentinel lymph node is the first lymph node to receive drainage from the primary tumor site, usually in the axilla. The document outlines the procedure for sentinel lymph node biopsy and evaluating biopsy specimens. It discusses studies that have shown sentinel lymph node biopsy is an accurate method for staging breast cancer and that completion axillary lymph node dissection may not be needed in all cases with limited sentinel lymph node involvement.
This document discusses neck dissection procedures for treating cervical lymph node metastases. It begins by outlining factors that influence the incidence of neck metastases from various head and neck cancers. These include the size and characteristics of the primary tumor. It then discusses staging of neck cancer and limitations of current staging systems. The indications for neck dissection are described as either therapeutic for palpable disease or elective for occult metastases. Comprehensive neck dissections remove lymph nodes from levels I-VI, while selective dissections remove only nodes at specific levels predicted to contain metastases from the primary site.
S E L E C T I V E A X I L L A R Y D I S S E C T I O N I NAnil Haripriya
This document discusses selective axillary dissection in carcinoma of the breast. It notes that tumor size and axillary lymph node status are important prognostic factors, and that axillary lymph node dissection is an important staging procedure. However, total axillary dissection can cause morbidity. The concept of sentinel node biopsy is explored as a way to select patients who need full axillary dissection versus those who do not by examining the first lymph node(s) that receive metastatic cells from the primary tumor. Studies demonstrating the predictive value and accuracy of sentinel node biopsy in determining axillary node status are summarized.
This document discusses nasopharyngeal carcinoma (NPC), including its epidemiology, pathogenesis, clinical presentation, diagnosis, staging, treatment with radiotherapy and chemotherapy, and areas of ongoing research. NPC arises from the epithelial lining of the nasopharynx and is more common in certain racial groups. Diagnosis involves clinical examination, imaging such as CT/MRI, and biopsy. Treatment of locally advanced NPC involves concurrent chemoradiotherapy, with some studies exploring additional benefit from induction or adjuvant chemotherapy. Ongoing areas of research include optimizing staging criteria and determining which patients benefit most from additional chemotherapy.
This document discusses gynecologic cancers and the importance of lymphadenectomy in staging and treatment. It notes that endometrial, ovarian, and cervical cancers represent 95% of gynecologic cancers and collectively rank fourth among women's cancers. Comprehensive lymphadenectomy is important for accurate staging of early and advanced cancers of the ovary, endometrium, and cervix. While lymphadenectomy improves survival for some cancer types and stages, overtreatment should be avoided for low risk early stage cancers that have high cure rates with surgery alone.
This document discusses several types of rare head and neck tumors, including extramedullary plasmacytomas, nasopharyngeal angiofibroma, non-lentiginous melanoma, and extracranial meningiomas. It provides details on the epidemiology, clinical presentation, diagnosis, treatment options including radiation therapy techniques, and outcomes for each of these tumor types.
The document discusses the surgical management of primary tumors, regional lymph nodes, and distant metastases. It covers topics like radical vs conservative surgery, lymphadenectomy, sentinel lymph node biopsy, and criteria for resection of distant metastases. It also discusses the use of chemotherapy, including neoadjuvant chemotherapy and response evaluation criteria.
This document reviews rare types of breast cancer. It summarizes information on 16 epithelial subtypes classified by the World Health Organization, including histopathology descriptions and clinical parameters. While rare cancers cannot be studied through large randomized trials, this review aims to provide clinicians an understanding to help determine optimal treatment approaches. It discusses cancers such as tubular carcinoma and mucinous carcinoma, which typically have a good prognosis and are often estrogen receptor positive with low lymph node involvement.
Lymphadenectomy plays an important role in the surgical management of urologic malignancies, providing both diagnostic and therapeutic benefits. While minimally invasive techniques allow for less invasive lymphadenectomy, they require advanced surgical skills and may not duplicate the extent of lymph node dissection achieved with open surgery. The literature demonstrates laparoscopic lymphadenectomy can be performed for conditions like penile cancer and testicular cancer, though long-term outcomes compared to open surgery are still being evaluated. The role and extent of lymphadenectomy, particularly when using minimally invasive techniques, remains an area of ongoing study and debate.
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
Vulvar cancer accounts for 4% of cancers of the female reproductive organs. Risk factors include advanced age, cigarette smoking, HPV infection, and preinvasive lesions. The majority are squamous cell carcinomas. Treatment involves radical vulvectomy and inguinofemoral lymphadenectomy for early-stage disease. Adjuvant radiation is recommended for lymph node-positive or high-risk disease. Locally advanced tumors are treated with preoperative chemoradiation to allow for organ-preserving surgery if possible. Unresectable disease receives definitive chemoradiation.
Soft tissue sarcomas account for less than 1% of malignant tumors but around 40% of patients die from the disease. While most soft tissue sarcomas have no clear cause, some risk factors include genetic predispositions, prior radiation therapy, and chemical exposure. A recent study found that over 50% of soft tissue sarcoma patients have a germline genetic variant contributing to tumor development. Diagnosis involves biopsy or imaging like CT or MRI. Treatment depends on location and grade, with surgery to remove the tumor with margins. High-risk cases may also receive radiation therapy or chemotherapy.
This document discusses the concept of field cancerization in oral cancers. It begins by providing background on oral cancer incidence and common sites of occurrence. It then defines field cancerization as the development of cancer in multifocal areas of precancerous changes due to exposure to carcinogens. The document discusses the monoclonal and polyclonal theories of how multiple lesions arise and reviews the concepts of field defects and field effects. It notes that field cancerization can help explain high rates of secondary primary tumors and tumor recurrence. Therapeutic implications and markers for determining field cancerization are also summarized.
CLOC2019: Evaluación y tratamiento adyuvante del melanomaMauricio Lema
1. Studies show that sentinel lymph node biopsy prolongs disease-free survival and melanoma-specific survival compared to nodal observation for intermediate thickness melanomas, while completion lymph node dissection provides no survival benefit over observation alone for sentinel node positive melanomas.
2. Positron emission tomography scanning upstages 17-22% of clinically stage III melanomas by detecting occult metastases.
3. The 8th edition of the American Joint Committee on Cancer staging manual provides improved prognostic stratification of stage III melanoma patients based on the number and size of metastatic lymph nodes.
The document discusses the role of sentinel lymph node biopsy in digestive cancers. It covers the history and techniques of sentinel lymph node mapping in stomach, colon, esophagus, liver and pancreas cancers. For stomach cancer, sentinel lymph node mapping shows potential to alter management of early-stage cancers and select patients for limited surgery. However, its accuracy decreases with increasing T stage. For colon cancer, sentinel lymph node mapping can upstage tumors and identify aberrant drainage but false negatives remain a issue. Further studies are still needed to establish standardized procedures and assess outcomes before it can significantly change treatment.
The document discusses lymph node metastasis in head and neck squamous cell carcinoma (HNSCC). It covers topics such as:
1) The most common sites of lymph node metastasis in HNSCC are levels II and III, with less frequent involvement of levels I and IV-VI.
2) Factors that influence lymph node metastasis include primary tumor characteristics, lymphangiogenesis induced by VEGF-C/D signaling, and the genetic makeup of the tumor which regulates genes involved in invasion and migration.
3) Once tumor cells reach lymph nodes, they can proliferate, remain dormant, or enter circulation to spread hematogenously to distant sites. The presence of lymph node metastases is associated with worse
A presentation created by Dr. Henry N. Ho, Medical Director, Head and Neck Program, Florida Hospital Cancer Institute, discussing everything you need to know about head and neck melanoma.
This document summarizes the key differences between primary and secondary angiosarcoma (AS) of the breast. Primary AS typically affects younger women (median age 40) and presents as masses within the breast parenchyma, while secondary AS affects older women (median age 67-71) and develops in irradiated breast skin and subcutaneous tissue 7-10 years after radiation therapy. Both forms have a poor prognosis. Surgical management often involves mastectomy but optimal margins are unclear. Adjuvant chemotherapy and radiation have shown mixed results, and larger randomized trials are needed to determine their effectiveness for AS of the breast.
manejo quirurgico del cancer oral, generalidadesssuser0db058
1) Management of oral cavity squamous cell carcinoma (OSCC) involves a multidisciplinary team approach, with surgery as the primary treatment for nonmetastatic OSCC and less invasive surgery preferred for early-stage disease.
2) For patients at high risk of recurrence, adjuvant radiation therapy or chemoradiation is often used. Systemic therapy may also be used in neoadjuvant or palliative settings.
3) Sentinel lymph node biopsy shows promise as a less invasive alternative to elective neck dissection for staging early-stage OSCC, with studies finding high negative predictive values and reduced morbidity compared to neck dissection.
Similar to Acs0306 Lymphatic Mapping And Sentinel Lymph Node Biopsy (20)
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.