Principles of surgery

From Oncology for Medical Students
Ideal oncology curriculum > Principles of surgery

Objective 5.2

At graduation, the student should be able to:

a) describe the aims of surgical treatment of cancers and the general principles of common procedures
b) demonstrate an understanding of the range of surgical options and the ways these are affected by the integration into multi-modality care
c) recognise clinical indications for surgery of common cancers
d) evaluate the outcomes of surgery, including efficacy, short and long-term side-effects, financial costs and quality of life.
e) describe the general and specific pre-operative factors that influence surgical decision making
f) discuss the effect surgery may have on body image, including the role of reconstructive surgery
g) recognise the common complications of cancer surgery and understand their management
h) discuss interactions with other modalities of therapy, both pre and post-operatively.

Prerequisite knowledge

  • Principles of pre-operative assessment
  • Principles of post-operative management including pain control
  • General complications of anaesthesia and surgery eg. deep venous thrombosis, lymphoedema, pneumonia

Representative questions that suggest the required depth of knowledge

1. Your patient is a fit 65-year-old man with prostate cancer. You are discussing radical (not nerve sparing) prostatectomy as a treatment. What probability would you quote him of these significant side effects occurring after surgery?

Impotence occurs:

(a) < 5%

(b) 20%

(c) 50%

(d) 80%

Answer: (d)

2. A common management of early breast cancer is wide excision. What are the aims of this treatment?

Essential in answer:

  • Adequate pathological margin around invasive and intraductal cancer
  • Breast conservation
  • Good cosmetic outcome

3. Radiation treatment to the breast after wide excision of cancer reduces the local recurrence rate at five years to:

(a) 0

(b) 5-10%

(c) 10-20%

(d) 40%

Answer: (b)

4. Discuss why different surgeons may have different local recurrence rates after surgical resection of rectal cancer.

Essential in answer:

  • Experience
  • Training
  • Number of cases per year
  • Type of cases referred

5. What are the long-term effects of lymph-node dissection for melanoma of the leg?

Essential in answer:

  • Lymphoedema
  • Infection risk