Oncological Surgery — MCQs

Q: Treatment of squamous cell carcinoma of the anal canal not involving the deeper structures includes

Chemoradiation. ***Chemoradiation*** - **Chemoradiation** is the gold standard for treating **squamous cell carcinoma of the anal canal** that does not involve deeper structures, aiming for organ preservation. - This combined modality achieves high rates of tumor control and anus preservation, avoiding the need for a permanent colostomy. *Abdominoperineal resection* - **Abdominoperineal resection (APR)** is a more invasive surgical procedure involving the removal of the rectum and anus, resulting in a **permanent colostomy**. - It is typically reserved for **recurrent disease**, treatment failures, or large, deeply invasive tumors that cannot be managed with chemoradiation. *Wide local excision with radiotherapy* - While **wide local excision** can be used for very superficial or small, well-differentiated tumors, adding **radiotherapy alone** is generally insufficient for squamous cell carcinoma of the anal canal. - The combination of chemotherapy with radiation significantly improves treatment outcomes by increasing radiosensitization and targeting microscopic disease. *Wide local excision with chemoradiation* - **Wide local excision** followed by **chemoradiation** is generally not the primary approach for most anal canal SCCs not involving deeper structures. - The standard treatment is definitive chemoradiation alone, reserving surgery for biopsy or salvage.

Q: The most common tumor in the posterior mediastinum is:

Schwannoma. ***Schwannoma*** - **Schwannomas** are **neurogenic tumors** that arise from the **nerve sheaths** and are the most common type of tumor found in the **posterior mediastinum**. - They account for about **20% of all mediastinal tumors** and usually present as a solitary, well-defined mass. *Lymphoma* - Lymphomas are more commonly found in the **anterior** or **middle mediastinum**, often presenting as multiple enlarged lymph nodes. - While they can occur in the posterior mediastinum, they are **not the most common primary tumor type** in this location. *Teratoma* - **Teratomas** are **germ cell tumors** and are predominantly found in the **anterior mediastinum**. - They contain tissue from all three germ layers and can be benign or malignant, often presenting with calcifications or fat. *Bronchogenic cyst* - **Bronchogenic cysts** are **congenital cysts** derived from abnormal budding of the tracheobronchial tree, usually located in the **middle mediastinum** or intraparenchymally. - While they can occasionally be found in the posterior mediastinum, they are developmental anomalies rather than primary tumor types and are less common than neurogenic tumors.

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Principles of Surgical Oncology

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Cancer Staging

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Surgical Margins in Cancer Surgery

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Sentinel Lymph Node Concepts

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Neoadjuvant and Adjuvant Therapy

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Metastasectomy

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Cytoreductive Surgery

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Hyperthermic Intraperitoneal Chemotherapy

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Palliative Surgical Procedures

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Minimally Invasive Approaches in Cancer Surgery

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Follow-up and Surveillance

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Hereditary Cancer Syndromes

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