Surgical principle of Management of Tumors M.A.Kubtan, MD – FRCS 1 st Lecture 1M.A.Kubtan

 Cancer is a disease of cells and that the disease progressed as a result of abnormal proliferation.  The importance of chromosomal abnormalities in cancer cells, the structure of DNA.  It has not escaped our notice that the specific pairing we have postulated immediately suggests a possible copying mechanism for the genetic material’. M.A.Kubtan2

 They have no respect for the rights of other cells.  They violate the democratic principles of normal cellular organization.  Their proliferation is uncontrolled;  Their ability to spread is unbounded.  Their inexorable, relentless progress destroys first the tissue and then the host.  Loss of function in a tumors suppressor gene will contribute to malignant transformation. M.A.Kubtan3

 Cancer cells will be able to evade apoptosis, which means that the wrong cells can be in the wrong places at the wrong times.  The ability of a tumors to form blood vessels is termed angiogenic competence and is key feature of malignant transformation.  Cancer cells acquire the ability to breach the basement membrane and thus gain direct access to blood and lymph vessels. M.A.Kubtan4

 Precise diagnosis is crucial to the choice of correct therapy.  Role of surgery.  Surgically treated malignant disease. M.A.Kubtan5

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For most solid tumors, surgery remains the definitive treatment and the only realistic hope of cure.  Diagnosis and Staging.  Removal of primary disease.  Removal of metastatic disease.  Palliation.  Prevention.  Reconstruction. M.A.Kubtan7

Occasionally, a surgical procedure is required to make the diagnosis.  with malignant ascites where laparoscopy has an important role in obtaining tissue for diagnosis.  Laparoscopy is also widely used for the staging of intra-abdominal malignancy, particularly esophageal and gastric cancer.  Laparoscopic ultrasound is a particularly useful adjunct for the diagnosis of intrahepatic metastases. M.A.Kubtan8

 Orchidectomy where a patient is suspected of having testicular cancer.  lymph node biopsy in a patient with lymphoma.  Sentinel node biopsy in melanoma and breast cancer.  A radiolabelled colloid is injected into or around the primary tumor, and the regional lymph node tumor is then scanned with a gamma camera that will pinpoint the lymph node nearest to the tumor. This lymph node can then be removed for histological diagnosis. M.A.Kubtan9

Consist of laparatomy : Liver Biopsy, Small Bowel Biopsy, Splenectomy. This practice is now largely redundant for Lymphoma. M.A.Kubtan10

It is important,, to appreciate that high-quality, meticulous surgery taking care not to disrupt the primary tumor at the time of excision is of the utmost importance M.A.Kubtan11

 in obtaining a cure in localized disease and preventing local recurrence.  Radical surgery for cancer involves removal of the primary tumor.  Removal of as much of the surrounding tissue and lymph node drainage.  Ensure local control.  Prevent spread of the tumor through the lymphatic's.  Although the principle of local control is still extremely important, it is now recognized that ultraradical surgery probably has little effect on the development of metastatic disease. M.A.Kubtan12

 In certain circumstances, surgery for metastatic disease may be appropriate.  This is particularly true for liver metastases arising from colorectal cancer.  With multiple liver metastases, it may still be possible to take a surgical approach by using in situ ablation with cryotherapy or radiofrequency energy.  Another situation where surgery may be of value is pulmonary resection for isolated lung metastases, particularly from renal cell carcinoma. M.A.Kubtan13