Surgical Oncology – Cancer

• 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.