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7/27/2019 Kuliah Bedah Oncology

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Introduction to

SURGICAL ONCOLOGY


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ONCOLOGY

MULTIDISCIPLINARY FIELD OF

MEDICINE

Oncology ORCHESTRA


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Oncology Orchestra

General Physician

Radiology Specialist

Pathology Specialist

General Surgeon

Surgical Oncologist

Medical Oncologist

Radiotherapy Oncologist

Oncologic Nursing Specialist

Palliative Medicine

Medical Rehabilitation

Nutrition specialist

Psychologist etc..


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3 Factors

Tumour Factors

Patients Factors Doctor & Hospital Factors


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Tumour Factors

Clinical diagnosis

Microscopic diagnosis

Lymphatic metastase Hematogenic metastase


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Patient Factors

Physical General Status

Psychological Status

Socioeconomic Factors


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Doctor & Hospital factors

Competence of Doctors

Supporting Facilities


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Tumors

Clinical dx

Microscopic dx

Treatment Planning Curative treatment or non curative

Palliative treatment

Temporary or definitive


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Microscopic

Tumor type

Carcinoma, Sarcoma, Blastoma

(embryonal), Lymphoreticular

Histopathological grading

Extent of the disease to surounding tissue


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Microscopic Factors

Differentiation degree

Well, moderate, poorly differentiated

Undifferentiated With/without surrounding tumor invasion

Lymph node mets, is there any invasive

lymphnode capsule Distant metastase


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Grade of malignancy

Pleomorphic changes of the cell

Grade of differentiation

The number of mitosis Cells necrosis


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Natural History of Cancer

Dysplasia

Carcinoma (malignancy in situ)

Invasive type/ Infiltrating type

Local extension

Spreading lymphatic or haematogenic

Special: Basal cell carcinoma

Locally destruction


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TNM staging

Tumor

Node (Lymph node)

Metastase

To indicate treatment planning

To indicate prognosis

To facilitate evaluation and exchange oftreatment result


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SPREAD

Lymphatic spread

Extranodal growth

Haematogenic spread


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Tumor

The extent of primary tumor

T 0 : no evidence of primary tumour

Tis : insitu

T 1-4 (a, b, c) : increasing size T1 microscopic


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Lymph node

The absence or presence and

extent of regional lymph nodemetastase

N 0 : no evidence of regional lymph nodeinvolvement

N 1-3 : increasing involvement number

mobility/ fixation

connection to one another


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Metastase

The absence or presence of distant

metastase

Distant Metastase Haematogenic metastase

Lymph node metastses beyond the

regional lymph node area


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Clinical and Pathological

cTxNxMx (Clinical TNM)

pTxNxMx (Pathological)

Postoperative microscopic examination ofresected tissue

Exp: preop cT2N0M0 become pT2N2M0

Implications for treatment planning


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The Basic

No Cancer treatment may start before

there is microscopic evidence of a

malignant disesase

Plays a significant role in oncology

Cytology: FNAB/FNAC Exfoliative cytologyHistolgy: Thick needle biopsy/ core needle

biopsy, incisional biopsy, excisional biopsy


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Depends on the site and siize of tumour

The pathological information that is

needed for treatment planning

Bite punch biopsy


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FNAB FNAC

Easy, simple, quick

Hardly any complications

Disadvantages Histologic characteristics like invasive

growth are misssing

A possible false-negative result Bone?


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A NEGATIVE RESULT MEANS:

NO TUMOUR CELLS ARE FOUND IN

THE SAMPLE

THIS DOES NOT MEAN THAT THIS

EXCLUDES A MALIGNANT TUMOUR

THE SAMPLE TOO SMALL TAKEN FROM ADJACENT TISSUE


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WHEM THERE IS CLINICAL

SUSPICION OF MALIGNANT

TUMOUR

SHOULD BE REPEATED OR ANOTHERBIOPSY METHOD


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TUMOUR SPILL IN BIOPSY

CONTAMINATION OF THE

SURROUNDING TISSUES WITH

TUMOUR CELLS

WHICH IN TURN CAN CAUSE

RECURRENT TUMOURS


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IN THE IMMEDIATE SURROUNDING OF

THE INVASIVE PROCEDURES

IN CAVITIES

SPONTANEOUSLY

IATROGENIC


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Contaminated instrument

Must be replaced

From several lesions Use clean instrument for each new biopsy

May be One of the tumour malignant the

others are not


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Local anesthesia

Field block

Field wise at a distance around the lesion

NOT TO INFILTRATE UNDER OR IN THE

LESION

LOCAL NERVE BLOCK OR GENERAL

ANESTHESIA FNAC no need

Thick or Core biopsy only the skin area


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Treatment

Treatment Planning

WATCHFUL WAITING

Curative treatment or non curativePalliative treatment

Temporary or definitive

Locoregional treatment Systemic treatment


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Tumour type

Biological behavioour

Localization and the extent The Age and the general conditions


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Locoregional Treatment

Surgery

Radiation Therapy

Whether or not combined with cancer drug

treatment (aduvant treatment)

Curation can be obtained whom the the tumour is

restricted to the primary locoregional area and inthe whom locoregional lymph nodes do not

show extranodal growth


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SYSTEMIC

DISEASE


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Neoadjuvant treatment

Cancer drug treatment Radiation Therapy

Hormonal therapy

Immunotherapy Spesific Receptors therapy


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SURGERYThe most dramatic but not the only

Most tumours cancer surgery is usually

more extensive than non-oncological

surgery

Tumor characteristics

Biological behaviour

Possibilities of radiation therapy,

chemotherapy, hormonal therapy,

immunotherapy


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EVERY ONCOLOGICAL

SURGICAL TREATMENT

WITH CURATIVE INTENT IS AIMED TO

COMPLETE REMOVAL OF THETUMOUR AND POSSIBLY PRESENT

LYMPH NODE METASTASES


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Enucleation (only in selected cases)

Tissue destructive methods

Isolated regional perfusion Excision of haematogenic metastases


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Follow up

IN ONCOLOGY FOLLOW UP IS ANIMPORTANT PART OF PATIENTMANAGEMENT

FOR SEVERAL TUMOURS FOLLOW UP ISALSO IMPORTANT IN THE ERALYDETECTION OF A SECOND PRIMARYTUMOUR

IN THE CASE OF LOCAL OR DISTANTRECURRENCES, TREATMENT WITHCURATIVE INTENT CAN STILL BE OFFEREDTO SEVERAL PATIENTS


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THANK YOU

TO SERVE AND TO PROTECT

PROTECT YOURSELF BY PROTECT

YOUR PATIENTs

PRIMUM NON NOCERE

Learn to communicate with patients and

their family

Learn to teach patients and their family

Balanced informations

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