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

1. Principles of Surgical Oncology
Chea Chan Hooi
Surgeon
Sibu Hospital

2. Content
• Definition
• Introduction
• Epidemiology
• Multidisciplinary effort
• Classification
– Role
– Intent
– Timing
• Q&A

3. Definition
• The application of surgery in the management
of cancer patients

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

8. Multidisciplinary effort

9. Roles
• Diagnostic
• Staging
• Prognosticate
• Curative
• Restorative
• Palliative
• Prophylactic

10. Diagnostic
• Biopsy
– FNAC
– Core needle
– Surgery
• Excision
• Incision
• Mode of surgery
– Open
– Laparoscopic

13. 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

14. • 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

19. Prognosticate
• Correlates with staging

20. 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

21. 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

22. 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

23. 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

24. 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

25. TQ!
Q&A?