Melanoma in-situ. 5mm resection margin is needed. (only 5 mm). In 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. In FAP, there is a nearly 100 percent risk of colorectal cancer in the absence of treatment for polyposis.
Uncontrolled local recurrence is the main cause of death with retroperitoneal sarcomas.
Radiation therapy generally has not been shown to help low grade completely resected extremity sarcomas.
Flat colorectal polyps: ~25% contain high grade dysplasia.
SLN in colorectal cancer increases the accuracy of lymph node cancer status but often does not change the operation.
Stage III colorectal cancer, all chemotherapy regimens seem to improve outcome. Another related topic: Stage 4 colon cancer.
T2 colorectal lesions have a local recurrence rate of about 22%. With resection you induce a 20% local recurrence rate on a T2 cancer which had a 80% cure rate before resection. Salvage operations for local recurrence are associated with a 40-60% cure rate. Therefore, there is a 20% chance that a T2 patient survival will be reduced by doing a local resection (ie. transanal).
Rectal cancers. Size of an adenocarcinoma after initial preoperative chemotherapy is more predictive than the initial size of the tumor.
More advanced Gallbladder tumors, stage II, should be treated with a completion radical cholecystectomy – partial hepatectomies of the gallbladder bed with hepatoduodenal lymphadenectomy. Stage II: This 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.
Metastasis found in remote lymph nodes in gallbladder cancer portend a poor prognocis.
PET scans doesn’t help distinguish acute or chronic cholecystitis vs. gallbladder cancer.
Endoscopic ultrasound should be used often in evaluating patients with pancreatic cysts.
If a pancreatic cyst wall has any nodularity then it may be malignant or on it’s way.
Pancreatic cancer, the risk of malignancy is lower for side branch intraductal papillary mucinous neoplasm than for main duct IPMNS.
Statistically, patients with pancreatic intraductal papillary mucinous neoplasms have an increased risk of colon and breast cancer.
Jaundice is not an emergency. First understand the root cause before reflexively draining the bile duct.
Parenchymal metastasis from a primary tumor such as lung metasis or liver metastasis, etc – those pts tend to do very poorly with peritoneal chemotherapy.
GIST (Gastro Intestinal Stromal Tumors) – standard therapy is gleevec (IMATINIB). Metastatic disease may have resistance to the drug
For patients with Colon cancer primary with metastasis to the liver with < or = 6 tumors in the liver where R0 resection (resection for cure) can be done, then these patients are reasonable candidates for resection surgery.