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الخاصة السورية الجامعةالبشري الطب كلية

الجراحة قسم

Surgical principle of Management of TumorsM.A.Kubtan , MD – FRCS

1st Lecture

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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’.

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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.

Cancer cells are psychopaths

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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.

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Precise diagnosis is crucial to the choice of correct therapy .

Role of surgery . Surgically treated malignant disease .

Diagnosis and classification

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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.

Principles of cancer surgery

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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.

Diagnosis and staging

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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.

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Consist of laparatomy : Liver Biopsy , Small Bowel Biopsy , Splenectomy .

This practice is now largely redundant for Lymphoma .

staging laparotomy

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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

Removal of primary disease

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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 .

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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.

Removal of metastatic disease