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PRINCIPLES OF THE

SURGICAL
MANAGEMENT OF
CANCER
BIOLOGY OF CANCER IS
DEPENDENT ON
Increased Cell proliferation
Decreased programmed cell death
Combination of the two
Adenoma-carcinoma progression
Invasion and metastases.

SCREENING
A test for use in screening must
be sensitive
be specific
be acceptable
detect cancer at a stage when cure is
possible
be a reasonable cost
EXAMPLES OF CANCER TYPES THAT
ARE OF COULD BE THE SUBJECT OF
SCREENING PROGRAMMES
CANCER SCREENING TEST
Breast Mammography
Cervix Smear Cytology
Colon Faecal Occult blood test
+colonoscopy
Prostate Prostate-specific Antigen
PATIENTSS CANCER JOURNEY
Asymptomatic phase
Symptoms
Consultation with GP
Histological/cytological confirmation
Investigation
Referral to cancer specialist/centre
Staging
Surgery
Adjuvant theraphy
Palliative care
Follow up
Cure
SYMPTOMS THAT SHOULD
INITIATE INVESTIGATION
Weight loss
Rectal Bleeding/melena
Haemoptysis/persistent Cough
Haematuria
Breast lump
Dysphagia/Dyspepsia
Persistent Headache
INVESTIGATION FOR THE
DIAGNOSIS OF CANCER
Blood test Haematology FBC
Biochemistry LFT
Tumour markers
Cytology Sputum
Urine
Endoscopic brushings
Radiology Plain Xrays CXR
Contrast enhanced Barium Enema
Ultrasound
CT
MRI
Endoscopy Upper GI Endoscopy
Colonoscopy
ERCP
Histology Fine needle aspiration, e.g. breast and thyroid cancer
Radiologically guided FNA
Endoscopic Biopsy
Excision biopsy
Excision biopsy e.g. lymph node
Operative Examination under anaesthetic and biopsy
Diagnostic laparoscopy and biopsy
PURPOSE OF STAGING
Define the extent of disease
Assess likely prognosis
Allow the development of a
treatment plan
TNM STAGING
T- extent of primary Tumour
N- presence of distant metastases in
regional lymph Nodes
M- presence of distant Metastases
PRINCIPLES OF SURGERY FOR
CANCER
Multidisciplinary team approach
Accurate pre/post operative adjuvant
theraphy
Enbloc Radical Surgery
Appropriate pre/postoperative
adjuvant theraphy
Good communication with patients
and relatives
Audit of results.
PRINCIPLES OF
SURGICAL
MANAGEMENT OF
CANCER
Clinical Scenarios
1) A 69 year old male ,who suffered from Rectal
Bleeding for 3 months, was found to have a
fixed irregular mass ,on the anterior rectal wall
on rectal examination .The liver was enlarged
but not palpably irregular.

How would you confirm your provisional
diagnosis?
Which investigations should be done to determine
the stage of the disease?
What would you discuss with the patient at first
consultation?
2) A 33 year old female, who has one son ,presents with a
painless lump in the right breast, which she noticed when
washing. On examining her you confirm the presence of a
lump,3cm in diameter but no nodes are palpable either in
the axilla nor the Supraclavicular region.

She asks you whether she will have to have her breast
removed. How will you deal with this question?
How will you determine if the tumour has metastasised to
bone?
Assuming that the lump proves to be malignant,which
types of theraphy in addition to surgery,are available to
treat her?
What effect will surgery and adjuvant tharaphies have upon
her fertility and her marital life?
Does her disease have any implications for her two sisters?


3) A 50 year old headmaster ,with a history of weight loss,
tiredness and a poor appetite is found on gastroscopy to
have an irregular ulcer in the antral region of the stomach.
It proves to be a malignant ulcer.

If surgery is advised, how should the patient be treated
pre-operatively to optimise his medical condition?
Where do the regional lymph nodes of the stomach lie ?
What is meant by enbloc resection of the lymph nodes
field?
What findings in investigation would make surgery
inadvisable or futile?

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