Oncological Surgery

Oncological Surgery Indian Medical PG Question 1: Indication for sentinel node biopsy is:

• A. Palpable axillary lymph node
• B. Metastasis
• C. Mass > 5 cm
• D. Non-palpable axillary lymph node (Correct Answer)

Oncological Surgery Explanation: ***Non-palpable axillary lymph node*** - **Sentinel lymph node biopsy (SLNB)** is indicated when there is no clinical evidence of axillary lymph node involvement, meaning the nodes are **non-palpable**. - Its purpose is to identify micrometastases that would not be detectable by physical examination, staging the cancer more accurately and guiding further treatment. *Palpable axillary lymph node* - A **palpable axillary lymph node** suggests macroscopic nodal involvement, usually requiring a fine needle aspiration (FNA) or core needle biopsy for diagnosis. - If positive, these patients typically proceed directly to **axillary lymph node dissection (ALND)** rather than SLNB. *Mass > 5 cm* - The size of the primary tumor (e.g., > 5 cm) is a factor in staging but does not, in itself, preclude or indicate SLNB. - While larger tumors have a higher risk of nodal involvement, the decision for SLNB still hinges on the clinical status of the axilla (palpable vs. non-palpable nodes). *Metastasis* - If **distant metastasis** is confirmed, the focus shifts to palliative care and systemic treatment, making a regional staging procedure like SLNB less relevant or unnecessary. - SLNB is used for staging early-stage cancer to detect regional spread, not when widespread disease is already established.

Oncological Surgery Indian Medical PG Question 2: The most important prognostic factor in carcinoma of the breast is

• A. Size of tumour
• B. Skin involvement
• C. Axillary gland involvement (Correct Answer)
• D. Involvement of muscles

Oncological Surgery Explanation: ***Axillary gland involvement*** - The presence and number of involved **axillary lymph nodes** are the single most significant factor in determining prognosis and guiding adjuvant therapy in breast cancer. - Lymphatic spread to the axillary nodes indicates a higher likelihood of distant metastasis, directly impacting survival rates. *Size of tumour* - While **tumor size** is an important prognostic factor and is part of the TNM staging system (T for tumor size), it is less significant than nodal status. - A small tumor with nodal involvement has a worse prognosis than a larger tumor without nodal involvement. *Skin involvement* - **Skin involvement** (T4b in TNM staging) indicates locally advanced disease and is a poor prognostic sign, but it is not as universally important as axillary nodal status in predicting overall survival. - It often reflects aggressive local tumor growth rather than systemic spread as directly as nodal metastasis. *Involvement of muscles* - **Muscle involvement** (specifically the pectoralis major muscle, T4a in TNM staging) signifies locally advanced disease and is associated with a poor prognosis. - Similar to skin involvement, it suggests extensive local spread but is not as strong a predictor of distant metastasis and overall survival as axillary nodal involvement.

Oncological Surgery Indian Medical PG Question 3: What is the documented mortality rate for healthy liver donors undergoing donor hepatectomy?

• A. Mortality for donor is 0.6 to 0.8 %
• B. Mortality for donor is 0.5 %
• C. Mortality for donor is 0.2 to 0.4 % (Correct Answer)
• D. Mortality for donor is 1%

Oncological Surgery Explanation: ***Correct: Mortality for donor is 0.2 to 0.4%*** - Studies indicate that the **mortality rate** for healthy liver donors undergoing **donor hepatectomy** is very low, typically ranging from **0.2% to 0.4%**. - This rate reflects the extensive **pre-operative screening** and careful surgical techniques used to ensure donor safety. - Current data from major transplant centers worldwide support this range as the most accurate representation of donor risk. *Incorrect: Mortality for donor is 0.6 to 0.8%* - This range is **higher** than the generally accepted and documented mortality rates for healthy liver donors. - While complications can occur, fatal outcomes are rare, making this percentage an **overestimation** of actual risk. *Incorrect: Mortality for donor is 0.5%* - This mortality rate is also **higher** than the current reported rates for living liver donation in well-established centers. - Continuous advancements in surgical safety and donor selection have driven the mortality rate **below 0.5%** in most high-volume centers. *Incorrect: Mortality for donor is 1%* - A 1% mortality rate for healthy liver donors would be considered **unacceptably high** given the current standards of care. - This percentage severely **overestimates** the actual risks associated with living related liver donation and does not reflect modern surgical outcomes.

Oncological Surgery Indian Medical PG Question 4: Which statement is incorrect about the pathology of the bone tumor?

• A. Tumor has distinct margin
• B. Tumor arises from epiphyseal to metaphyseal region
• C. Eccentric lesion
• D. Chemotherapy is the treatment of choice for all bone tumors. (Correct Answer)

Oncological Surgery Explanation: ***Tumor has distinct margin*** - A **distinct margin** often indicates a benign tumor, while malignant tumors typically show **infiltrative margins**. - In bone tumors, particularly malignant ones, the lack of clear demarcation is a key pathological feature. *Chemotherapy is the treatment of choice* - While chemotherapy may be used for certain **malignant bone tumors**, it is not the first-line treatment for most bone tumors [1]. - The primary treatment is often **surgical excision**, especially for localized lesions [1]. *Tumor arise from epiphyseal to metaphyseal region* - While some tumors can originate in these areas, many actually arise from the **diaphyseal** region in bone tumors like osteosarcoma. - This option misrepresents the common locations where various tumors develop, as osteochondromas tend to develop near the epiphyses of limb bones [2]. *Eccentric lesion* - Many bone tumors do indeed present as **eccentric lesions**, especially benign ones like **osteochondromas**. - However, this feature does not apply universally, as some malignant tumors can also be **central or infiltrative** in nature. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 673-674. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 672-673.

Oncological Surgery Indian Medical PG Question 5: Which of the following statements are correct regarding iron deficiency? 1. More common in older age group 2. More common in females of reproductive age 3. Associated with heavy menstrual bleeding 4. Commonly caused by chronic blood loss Select the correct answer using the code given below.

• A. 1, 2 and 3
• B. 1, 2 and 4 (Correct Answer)
• C. 2, 3 and 4
• D. 1, 3 and 4

Oncological Surgery Explanation: ***1, 2 and 4*** * **Iron deficiency** is indeed more common in **older age groups**, often due to decreased dietary intake, malabsorption, or chronic diseases [1], [3]. * It is also frequently observed in **females of reproductive age**, primarily due to physiological iron loss through menstruation [2]. * **Chronic blood loss** from various sources, such as gastrointestinal bleeding [1] or heavy menstruation [2], is a very common cause of iron deficiency [3]. *1, 2 and 3* * While iron deficiency is common in older age groups and females of reproductive age, the statement that it is *only* associated with heavy menstrual bleeding isn't comprehensive enough, as chronic blood loss is a broader and more common cause [1]. * Though heavy menstrual bleeding is a significant cause of iron deficiency in women, this option omits chronic blood loss as a more general and equally important cause. *2, 3 and 4* * This option incorrectly implies that iron deficiency is *not* more common in older age groups, which is a known demographic at risk [3]. * While **heavy menstrual bleeding** and **chronic blood loss** are major causes, excluding the increased prevalence in older populations makes this option incomplete. *1, 3 and 4* * This option inaccurately suggests that iron deficiency is *not* more common in females of reproductive age, which is a key demographic for iron deficiency due to menstrual blood loss [2]. * It correctly identifies chronic blood loss and heavy menstrual bleeding as causes but misses a significant demographic for prevalence.

Oncological Surgery Flashcard 1 of 5

Question: 50% of patients with _____ metastases can be sucessfully treated with resection of the hepatoblastoma

Answer: pulmonary

Oncological Surgery Flashcard 2 of 5

Question: The D1 gastrectomy involves the removal of lymph node stations _____

Answer: 1-6

Oncological Surgery Flashcard 3 of 5

Question: The D1 gastrectomy involves the removal of lymph node stations _____

Answer: 1-6

Oncological Surgery Flashcard 4 of 5

Question: Gastric carcinoma may spread and involve the _____ node, also known as Virchow's node

Answer: left supraclavicular

Oncological Surgery Flashcard 5 of 5

Question: _____ cell carcinomas of the lung usually do not respond well to chemotherapy and are thus treated upfront with surgical resection

Answer: Non-small