Principles of Surgical Oncology Salah R. Elfaqih.

Principles of Surgical Principles of Surgical OncologyOncology

Salah R. ElfaqihSalah R. Elfaqih

Pathological cell changes

Types of TumorsTypes of Tumors

BenignBenign MalignantMalignant

•CarcinomaCarcinoma

•SarcomaSarcoma

TeratomaTeratoma HamartomaHamartoma

Dermoid Cyst

AngioMyoLipoma

Hamartoma vs TeratomaHamartoma vs Teratoma

Cancer NomenclatureCancer Nomenclature

Types of Malignancies

BenignBenign EncapsulatedEncapsulated No invasionNo invasion No metastasisNo metastasis

MalignantMalignant Non encapsulatedNon encapsulated Usually invadeUsually invade MetastasisMetastasis

Benign vs Malignant Benign vs Malignant

Benign vs Malignant TumorsBenign vs Malignant Tumors

What are the treatment implicationsWhat are the treatment implications

Local excision for benign tumors and radical excision for malignantLocal excision for benign tumors and radical excision for malignant

Normal cell & malignant cellNormal cell & malignant cell

Characteristics of malignant cellsCharacteristics of malignant cells

Uncontrolled growth and loss of contact Uncontrolled growth and loss of contact phenomenan are the main characteristics of phenomenan are the main characteristics of

malignant cellsmalignant cells

Normal versus Malignant CellsNormal versus Malignant Cells

Malignant cell morphologyMalignant cell morphology

Tumor Grading & DifferentiationTumor Grading & Differentiation

GradingGrading: Describes the histologic characteristics of : Describes the histologic characteristics of cancer cells mainly talk about cell layers.cancer cells mainly talk about cell layers.e.g.e.g. grade I, II, III.grade I, II, III.

DifferentiationDifferentiation: Describes the characteristics of : Describes the characteristics of cancer cells in reference to their resemblance to cancer cells in reference to their resemblance to the cell of origin.the cell of origin.e.g.e.g. well differentiated well differentiated

moderately differentiatedmoderately differentiated poorly differentiatedpoorly differentiated anaplastic. anaplastic.

Both describe the histological features of the tumorBoth describe the histological features of the tumor

Tumor Grading & DifferentiationTumor Grading & Differentiation

Tumor grading & tumor differentiation both describe the Tumor grading & tumor differentiation both describe the histological features of the tumor and not the macroscopic histological features of the tumor and not the macroscopic

features , invasion or metastasisfeatures , invasion or metastasis

Tumor DifferentiationTumor Differentiation

Well Moderatee

Poorly Anaplstic

Local Effects of Tumours

Why malignant cells are Why malignant cells are dangerousdangerous

Spread of Malignant tumours

Spread of Malignant TumoursSpread of Malignant Tumours

Spread of Malignant TumorSpread of Malignant Tumor

Local invasion : Local invasion : •within the organwithin the organ

•adjacent organsadjacent organs

Metastasis :Metastasis :•Lymphatic : Regional & Lymphatic : Regional &

distant lymph nodes.distant lymph nodes.

•Haematogenous e.g. liver, Haematogenous e.g. liver, lung, bones.lung, bones.

•Transcoelomic e.g Transcoelomic e.g peritoneal & pleural cavity.peritoneal & pleural cavity.

• Implantation e.g. needle Implantation e.g. needle tracks, wounds. tracks, wounds.

Local InvasionLocal Invasion

Distant MetastasisDistant Metastasis

STAGING OF MALIGNANT TUMORSSTAGING OF MALIGNANT TUMORS

Staging describes the primary tumor, its relation Staging describes the primary tumor, its relation with the organ of origin ,adjacent and distant organswith the organ of origin ,adjacent and distant organs

Staging of Malignant TumorsStaging of Malignant Tumors

TNM ClassificationTNM Classification

Classical:Classical: e.g. e.g. stage stage I, II, III, IVI, II, III, IVTNMTNM:e.g:e.gT1, No, MoT1, No, MoT – T – TumorTumor : : T1,2,3, TT1,2,3, Tisis, T, Taa, T, TbbN – N – NodeNode : : N0, 1, 2, 3N0, 1, 2, 3M – M – MetastasisMetastasis::M0,1,2,3M0,1,2,3

Types of Tumor StagingTypes of Tumor Staging

Why Do We Stage Malignant Tumors?Why Do We Stage Malignant Tumors?

To decide the treatmentTo decide the treatment To plan the treatmentTo plan the treatment To assess the prognosisTo assess the prognosis

Whenever you deal with malignant Whenever you deal with malignant tumor, always remember that tumor, always remember that there is primary tumor & there there is primary tumor & there

may be secondaries. may be secondaries.

Presentation of Malignant TumorsPresentation of Malignant Tumors

AsymptomaticAsymptomatic Symptoms related to the primarySymptoms related to the primary Symptoms related to the secondariesSymptoms related to the secondaries Incidental findingIncidental finding Weight loss and Cachaxia are late Weight loss and Cachaxia are late

manifestations of most malignant manifestations of most malignant

tumors except GI and Lung cancertumors except GI and Lung cancer

Presentation of Malignant TumorsPresentation of Malignant Tumors

Investigation of Malignant TumorsInvestigation of Malignant Tumors

Investigate for the primaryInvestigate for the primary• Depends on the siteDepends on the site

• Define the histologyDefine the histology

• Define the local extensionDefine the local extension

Investigate for the secondariesInvestigate for the secondaries• Look for metastasisLook for metastasis

• Usually liver, lung and bonesUsually liver, lung and bones

Both will define the diagnosis & stageBoth will define the diagnosis & stage

Investigation of Malignant TumorsInvestigation of Malignant Tumors

Biopsy CytologyBiopsy Cytology

Principles of CytologyPrinciples of Cytology

How we obtain material for histologyHow we obtain material for histology

CytologyCytology : morphology of individual cells. : morphology of individual cells.• Exfoliative (urine,sputum,….)Exfoliative (urine,sputum,….)

• Fluid aspiration (ascitic fluid,pleural fluid)Fluid aspiration (ascitic fluid,pleural fluid)

• Fine needle aspiration (FNA)Fine needle aspiration (FNA)

Biopsy Biopsy : histological (tissue) : histological (tissue) characteristicscharacteristics• Incisional biopsy (open, needle, forceps..)Incisional biopsy (open, needle, forceps..)

• Excisional biopsy Excisional biopsy

CytologyCytology

Cytology : ExamplesCytology : Examples

Tissue BiopsyTissue Biopsy

CT- guided Trucut needle biopsyCT- guided Trucut needle biopsy

Excisional & Incisional BiopsyExcisional & Incisional Biopsy

Tumor MarkersTumor Markers

Substances which if present in the blood Substances which if present in the blood or tissues may indicate malignancy.or tissues may indicate malignancy.

The concept is very importantThe concept is very important There are many tumor markersThere are many tumor markers Most are non-specificMost are non-specific Important in diagnosisImportant in diagnosis Important for screeningImportant for screening Important in follow upImportant in follow up

Tumor Markers-examplesTumor Markers-examples

Tumor Markers in tissuesTumor Markers in tissues

Tumor Markers-non specificTumor Markers-non specific

Tumor Markers-screeningTumor Markers-screening

Tumor Markers-diagnosisTumor Markers-diagnosis

Tumor Markers-follow upTumor Markers-follow up

Tumor Markers-follow upTumor Markers-follow up

Tumor Markers-follow upTumor Markers-follow up

Hormones & CancerHormones & Cancer

Hormones related to tumor growth:Hormones related to tumor growth:

• Usually sex hormones (testosterone,estrogen)Usually sex hormones (testosterone,estrogen)

• They may have a relation to tumor growthThey may have a relation to tumor growth

• Hormone receptorsHormone receptors

• The concept can be used in treatmentThe concept can be used in treatment

Hormones may be produced by tumors:Hormones may be produced by tumors:

• Originally hormone producing organ e.g. adrenalsOriginally hormone producing organ e.g. adrenals

• Originally non hormone producing organ e.g. lungOriginally non hormone producing organ e.g. lung

Testosterone and Prostate CancerTestosterone and Prostate Cancer

Estrogen receptors-breast cancerEstrogen receptors-breast cancer

Estrogen receptors-breast cancerEstrogen receptors-breast cancer