الجامعة السورية الخاصة
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الجامعة السورية الخاصة كلية الطب البشري قسم الجراحة. Surgical principle of Management of Tumors M.A.Kubtan , MD – FRCS 1 st Lecture . هذه المحاضرة صوتية. للإستماع إلى المحاضرة ينصح بوضع سماعة الأذن ليكون الصوت واضحاً .

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2178377

الجامعة السورية الخاصةكلية الطب البشريقسم الجراحة

Surgical principle of Management of Tumors

M.A.Kubtan , MD – FRCS

1st Lecture

M.A.K


2178377
هذه المحاضرة صوتية

  • للإستماع إلى المحاضرة ينصح بوضع سماعة الأذن ليكون الصوت واضحاً .

  • يجب الضغط على الزر الأيسر للماوس فوق صورة مكبر الصوت لسماع الشرح الخاص بالسلايد المعروض على الشاشة في الجزء الأول من المحاضرة .

  • يتم الاستماع للمحاضرة ( الجزء الثاني ) اتوماتيكياً بمجرد ظهور السلايد .

M.A.Kubtan


Tumors
Tumors

A new growth or neoplasm has been defined as a :

  • Mass of cells .

  • Tissues .

  • Organ .

    Grows at the expense of the organism without at the same time subserving any useful purpose .

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Cancer cells are psychopaths
Cancer cells are psychopaths

  • 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 ( عنيد ), relentless ( لا هوادة فيه) progress destroys first the tissue and then the host.

  • Loss of function in a tumors suppressor gene will contribute to malignant transformation.

M.A.Kubtan


Continue
continue

  • Cancer cells will be able to evade apoptosis ( (موت الخلايا المبرمج , 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.

M.A.Kubtan


A mass of cells
A Mass of Cells

  • A neoplasm is composed of living cells derived from normal cells of the body .

  • Proliferated cells is the disease .

  • Neoplasia cells continue proliferating without limit , Liver proliferation on demand ( Hyperplasia ) .

  • Neoplasm grows at the expense of the organism and without reference to the needs of the body , Lipoma .

  • In highly malignant tumors the cells revert to primitive form and subserve no purpose except multiplication .

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Continue1
Continue

  • Less malignant tumors retain a certain amount of differentiation but their secretory activity serves no useful purpose .

  • Alimentary canal will secret mucin .

  • Chondrosarcoma will produce cartilage .

  • Osteosarcoma will produce bone .

  • Endocrine tumors produce hormones with a chemical structure identical with the normal .

    In neither case is there any evidence of benefit to the organism.

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Rate of growth
Rate of Growth

  • Continued growth is seen in grate majority of neoplasm .

  • Usually it may not exceed the rate of growth of the normal cells .

  • The most malignant of neoplasm enlarges less rapidly than most innocent of tumors ,

    ( the normal fetus ) or normal tissues ( bone marrow or the Intestinal epithelium ) .

    Role of cytotoxic drugs

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The size of tumor
The size of tumor

  • Governed by the rate of cell division .

  • In normal tissues there is a continuous wastage of cells .

  • In neoplasm unless the surface is ulcerated the derivative cells remain in place an contribute to the bulk of the tumor .

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The doubling effect
The Doubling effect

  • Assuming a tumor will originate from a single cell and it divide at regular intervals , it will take approximately 30 doubling to produce a tumor of 1cm diameter .

  • The doubling time is believed to be of : 10 – 25 days for fast growing tumor such as some types of Sarcoma .

  • In slow-growing tumors the doubling time in the order of 100 days .

  • In between cancers of the Breast and Alimentary tract .

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If these assumptions are accurate it is clear that many tumors must have been in existence for a long time even several years before reaching a size to be detected

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M.A.Kubtan tumors must have been in existence for a long time even several years before reaching a size to be detected


Classification of tumors
Classification of Tumors tumors must have been in existence for a long time even several years before reaching a size to be detected

  • Simple Tumors .

  • Malignant Tumors .

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Continue2
Continue tumors must have been in existence for a long time even several years before reaching a size to be detected

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Simple Tumors

  • Tend to reproduce .

  • The appearance an functional attributes of the cells from which originated .

  • Tend to grow slowly and some times rate of growth slows down .

Malignant Tumors

  • Tend to deviate towards more primitive forms .

  • Shows no limitation of growth .


Continue3
Continue tumors must have been in existence for a long time even several years before reaching a size to be detected

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Simple Tumors

  • Tend to grow by expanding .

  • They may cause pressure atrophy of the surrounding paranchymatous tissues .

  • Thus become encapsulated within a capsule derived from the surrounding Stroma .

Malignant Tumors

  • Extend by Invasion destroying adjacent normal cells and permeating tissue spaces .

  • Ignores contact inhibition .


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الجامعة السورية الخاصة tumors must have been in existence for a long time even several years before reaching a size to be detectedكلية الطب البشريقسم الجراحة

Surgical principle of Management of Tumors

M.A.Kubtan , MD – FRCS

2nd Lecture

M.A.K


Members of the multiprofessional team
Members of the tumors must have been in existence for a long time even several years before reaching a size to be detectedmultiprofessional team

  • Site-specialist surgeon

  • Surgical oncologist

  • Plastic and reconstructive surgeon

  • Clinical oncologist/radiotherapist

  • Medical oncologist

  • Diagnostic radiologist

  • Pathologist

  • Speech therapist

  • Physiotherapist

  • Prosthetist

  • Clinical nurse specialist (rehabilitation, supportive care)

  • Palliative care nurse (symptom control, palliation)

  • Social worker/counsellor

  • Medical secretary/administrator

  • Audit and information coordinator

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Investigation and staging
Investigation and staging tumors must have been in existence for a long time even several years before reaching a size to be detected

  • Staging is the process whereby the extent of disease is mapped out.

  • A change in staging system, or in the techniques used to provide baseline information concerning staging, can produce benefit’s to patients at all stages of the disease.

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M.A.K tumors must have been in existence for a long time even several years before reaching a size to be detected


Principles of cancer surgery
Principles of cancer surgery tumors must have been in existence for a long time even several years before reaching a size to be detected

  • Diagnosis and staging :

    Aspirated fluids .

    FNA .

    Needle Biopsy .

    Surgical Biopsy .

    Excisional Biopsy.

    Lymph node biopsy .

    Sentinel node biopsy (Here, a radiolabelled colloid is injected into or around the primary tumour) .

    Diagnostic Laparoscopy with ultrasound & Biopsy

    Diagnostic Thoracoscopy & Biopsy .

    Diagnostic Cystoscopy & Biopsy .

    Others .

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Removal of primary disease
Removal of primary disease tumors must have been in existence for a long time even several years before reaching a size to be detected

  • Radical surgery for cancer involves removal of the primary tumor .

  • Although the principle of local control is still extremely important, it is now recognized that ultra radical surgery probably has little effect on the development of metastatic disease.

  • Meticulous surgery taking care not to disrupt the primary tumor at the time of excision is of the utmost importance in obtaining a cure in localized disease .

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Removal of metastatic disease
Removal of metastatic disease tumors must have been in existence for a long time even several years before reaching a size to be detected

  • 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.

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Palliation
Palliation tumors must have been in existence for a long time even several years before reaching a size to be detected

  • May increase the patient’s quality of life .

  • have little effect on the ultimate outcome.

  • Other examples include bypass procedures such as an ileotransverse colon anastmosis .

  • Gastrojujenostomy ( Gastric outlet obstruction , Ca head of Pancrease or ampulla

  • Cholecysto jujenostomy ( Ca Head of Pancrease or ampulla ) .

  • Chledocojujenostomy ( Ca Head of Pancrease or ampulla ) .

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Over all management
Over all Management tumors must have been in existence for a long time even several years before reaching a size to be detected

  • Role of Surgery .

  • Role of Chemotherapy .

  • Role of Hormonal Therapy .

  • Role of radiotherapy .

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