{"id":77,"date":"2013-10-20T01:20:50","date_gmt":"2013-10-20T01:20:50","guid":{"rendered":"http:\/\/www.modestosurgery.com\/surgeryblog\/?p=77"},"modified":"2013-10-20T02:13:19","modified_gmt":"2013-10-20T02:13:19","slug":"oncology-surgery-highlights-notes","status":"publish","type":"post","link":"http:\/\/www.modestosurgery.com\/surgeryblog\/oncology-surgery-highlights-notes\/","title":{"rendered":"Oncology Surgery Highlights &#8211; Notes"},"content":{"rendered":"<h2>Surgical Oncology &#8211; Cancer<\/h2>\n<ul>\n<li>Melanoma in-situ. \u00a05mm resection margin is needed. \u00a0(only 5 mm). \u00a0In Situ = outer layer of the skin only (epidermis only)<\/li>\n<li>Currently Melanoma SLN positive mandates lymphadenectomy in melanoma.<\/li>\n<li>Patients with Familial Adenomatous Polyposis and Desmoids, ~10% of the tumors will have a very rapid and aggressive course. \u00a0In FAP, there is\u00a0a nearly 100 percent risk of colorectal cancer in the absence of treatment for polyposis.<\/li>\n<li>Uncontrolled local recurrence is the main cause of death with retroperitoneal sarcomas.<\/li>\n<li>Radiation therapy generally has not been shown to help low grade completely resected extremity sarcomas.<\/li>\n<li>Flat colorectal polyps: \u00a0~25% contain high grade dysplasia.<\/li>\n<li>SLN in colorectal cancer increases the accuracy of lymph node cancer status but often does not change the operation.<\/li>\n<li>Stage III colorectal cancer, all chemotherapy regimens seem to improve outcome. Another related topic: \u00a0<a href=\"http:\/\/www.surgerytoday.com\/education\/what-is-stage-4-colon-cancer\/\">Stage 4 colon cancer.<\/a><\/li>\n<li>T2 colorectal lesions have a local recurrence rate of about 22%. \u00a0With resection you induce a 20% local recurrence rate on a T2 cancer which had a 80% cure rate before resection. \u00a0Salvage operations for local recurrence are associated with a 40-60% cure rate. \u00a0Therefore, there is a 20% chance that a T2 patient survival will be reduced by doing a local resection (ie. transanal).<\/li>\n<li>Rectal cancers. \u00a0Size of an adenocarcinoma after initial preoperative chemotherapy is more predictive than the initial size of the tumor.<\/li>\n<li>More advanced Gallbladder tumors, stage II, should be treated with a completion radical cholecystectomy &#8211; partial hepatectomies of the gallbladder bed with hepatoduodenal lymphadenectomy. \u00a0Stage II: \u00a0This means that cancer has grown through the muscle layer of the gallbladder wall and into the connective tissue underneath. It has not spread outside the gallbladder. Stage 2 in the TNM stages is the same as T2, N0, M0.<\/li>\n<li>Metastasis found in remote lymph nodes in gallbladder cancer portend a poor prognocis.<\/li>\n<li>PET scans doesn&#8217;t help distinguish acute or chronic cholecystitis vs. gallbladder cancer.<\/li>\n<li>Endoscopic ultrasound should be used often in evaluating patients with pancreatic cysts.<\/li>\n<li>If a pancreatic cyst wall has any nodularity then it may be malignant or on it&#8217;s way.<\/li>\n<li>Pancreatic cancer, the risk of malignancy is lower for side branch intraductal papillary mucinous neoplasm than for main duct IPMNS.<\/li>\n<li>Statistically, patients with pancreatic intraductal papillary mucinous neoplasms have an increased risk of colon and <a title=\"Breast Cancer Modesto Blog\" href=\"http:\/\/www.breastguide.com\/breastcancerblog\/\">breast cancer<\/a>.<\/li>\n<li>Jaundice is not an emergency. \u00a0First understand the root cause before reflexively draining the bile duct.<\/li>\n<li>Parenchymal metastasis from a primary tumor such as lung metasis or liver metastasis, etc &#8211; those pts tend to do very poorly with peritoneal chemotherapy.<\/li>\n<li>GIST (Gastro Intestinal Stromal Tumors) &#8211; standard therapy is gleevec (IMATINIB). \u00a0Metastatic disease may have resistance to the drug<\/li>\n<li>For patients with Colon cancer primary with metastasis to the liver with &lt; or = 6 tumors in the liver where \u00a0R0 resection (resection for cure) can be done, then these patients are reasonable candidates for resection surgery.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Surgical Oncology &#8211; Cancer Melanoma in-situ. \u00a05mm resection margin is needed. \u00a0(only 5 mm). \u00a0In Situ = outer layer of the skin only (epidermis only) Currently Melanoma SLN positive mandates lymphadenectomy in melanoma. Patients with Familial Adenomatous Polyposis and Desmoids, ~10% of the tumors will have a very rapid and aggressive course. \u00a0In FAP, there &hellip; <a href=\"http:\/\/www.modestosurgery.com\/surgeryblog\/oncology-surgery-highlights-notes\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Oncology Surgery Highlights &#8211; Notes<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,117,9,61],"tags":[139,147,145,131,138,260,122,129,140,127,124,123,128,134,258,149,150,119,146,133,143,118,136,142,141,148,137,126,135,151,125,132,121,144,120,130],"class_list":["post-77","post","type-post","status-publish","format-standard","hentry","category-cancer","category-colon-cancer","category-gist","category-pearls","tag-acute-cholecystitis","tag-bile-duct","tag-breast-cancer","tag-chemotherapy","tag-chronic-cholecystitis","tag-colon-cancer","tag-desmoids","tag-dysplasia","tag-endoscopic-ultrasound","tag-extremity-sarcomas","tag-familial-adenomatous-polyposis","tag-fap","tag-flat-colorectal-polyps","tag-gallbladder-cancer","tag-gist","tag-gleevac","tag-gleevec","tag-in-situ","tag-jaundice","tag-local-resection","tag-malignancy","tag-melanoma","tag-metastasis","tag-nodularity","tag-pancreatic-cysts","tag-parenchymal-metastasis","tag-pet-scans","tag-radiation-therapy","tag-radical-cholecystectomy","tag-resistence-to-gleevec","tag-retroperitoneal-sarcoma","tag-salvage-operations","tag-sentinel-lymph-node","tag-side-branch-ipmns","tag-sln","tag-stage-iii-colorectal-cancer"],"_links":{"self":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts\/77","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/comments?post=77"}],"version-history":[{"count":4,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts\/77\/revisions"}],"predecessor-version":[{"id":81,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts\/77\/revisions\/81"}],"wp:attachment":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/media?parent=77"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/categories?post=77"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/tags?post=77"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}