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Principles of surgical oncology

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Presentation encompasses basic oncological principles adhered to in managing surgical patients with cancers

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Principles of surgical oncology

  1. 1. Principles of Surgical Oncology Chea Chan Hooi Surgeon Sibu Hospital
  2. 2. Content • Definition • Introduction • Epidemiology • Multidisciplinary effort • Classification – Role – Intent – Timing • Q&A
  3. 3. Definition • The application of surgery in the management of cancer patients
  4. 4. Introduction • Increasing incidence of cancer worldwide • Better patient outcomes in highly-specialised cancer centers • Various treatment modalities nowadays • Various surgical techniques • Multidisciplinary, multifactorial management
  5. 5. Multidisciplinary effort
  6. 6. Roles • Diagnostic • Staging • Prognosticate • Curative • Restorative • Palliative • Prophylactic
  7. 7. Diagnostic • Biopsy – FNAC – Core needle – Surgery • Excision • Incision • Mode of surgery – Open – Laparoscopic
  8. 8. Staging • Determine the extent of tumour invasion, either local or distant • Broadly classified into early, locally-advanced and metastatic • Assists in determining optimal managing strategies • Directly correlates with prognosis • Examples – TNM staging system – Duke staging sytem
  9. 9. • Examples of surgical staging – Staging laparoscopy for locally advanced GI malignancy – Axillary surgery for breast carcinoma • Sentinel lymph node biopsy • Axillary sampling Level 1 • Axillary dissection Level 2 • Axillary clearance Level 3
  10. 10. Prognosticate • Correlates with staging
  11. 11. Curative • Total excision of all tumour cells (in reality almost impossible) • Adequacy of resection – Margin • R0 Microscopically negative • R1 Microscopically involved • R2 Grossly involved – LN • Preserve restorative options as much as possible
  12. 12. Palliative • To overcome some symptom-producing consequence of the tumour in a patient deemed incurable • Limited to patients whom are relatively fit with expected survival > 6 weeks • Either resect or by-pass
  13. 13. Restorative • To return the organ or system to its original/anatomic/functional state as much as possible • Example – Reconstruction post maxillofacial tumour resections – Various methods of reconstruction post gastrectomy – Closure of covering ileostomy post ULAR – Breast reconstruction post mastectomy
  14. 14. Intent • Curative – To achieve clearance of all cancer cells, hence cure • Palliative – To reduce, control or minimise cancer cells with the aim to reduce rate of cancer growth, thus prolonging meaningful patient survival
  15. 15. Timing • Neoadjuvant – Surgical resection after other treatment modality had been initiated – Reduce the bulk of large tumour (down-staging) • To improve likelihood of successful resection (R0) • To allow less destructive surgeries – AKA “sandwich therapy” in UGI carcinoma management • Adjuvant – Surgical resection prior to other treatment modalities
  16. 16. TQ! Q&A?

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