Principles of surgical oncology

Published on 09/04/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 09/04/2015

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2 Principles of surgical oncology

Diagnosis and staging

Diagnosis

Histological diagnosis is obtained from tumour tissue by fine needle aspiration cytology, core biopsy, incisional biopsy and excisional biopsy. Choosing the right technique is based on the location of tumour, anticipated type of the tumour and reliability of the method to make a definite diagnosis.

Fine needle aspiration (FNA) yields quick result and shows cellular characteristics but not architecture. FNA serves as good screening tool prior to more definitive diagnostic methods. FNA is useful for diagnosis of enlarged lymph nodes, aspiration of cysts, diagnosis of thyroid nodule and confirmation of recurrent or metastatic disease.

Core biopsy helps to visualize architecture as well as to perform immunohistochemical studies. It is useful in the diagnosis of solid masses such as breast lumps or liver metastases. However, core biopsy should not be used in lymphoma (which requires extensive immunohistochemical stains) or for soft tissue or bone sarcoma.

Incisional biopsy is used when core biopsy is non-diagnostic and excision biopsy is not appropriate. The common indication is a suspected sarcoma needing neoadjuvant treatment or definite resection. Care should be taken when planning incision biopsy to ensure that the site of biopsy is within the area definite surgery and should only be undertaken by surgeons who will undertake the final surgery. A poorly planned incision biopsy can lead to unnecessary morbid surgery.

Excision biopsy involves removal of the entire mass or skin lesion. It is important to make sure that this procedure does not compromise a later wider excision if necessary. The specimen needs to be oriented in three dimensions for the pathologist to determine surgical margins.

Frozen section is occasionally used preoperatively to confirm diagnosis when previous histologic diagnosis is not available (e.g. solitary lung lesions), to decide need for further surgery (e.g. lymph node dissection) and ensure adequate surgical margins.