Devita, Hellman, and Rosenberg's Cancer

LWBK1006-06 LWW-Govindan-Review November 24, 2011 11:20

Chapter 6•Principles of Surgical Oncology 83

Answer 6.12. The answer is D.

All of the above are the beneficial effects of laparoscopy. This is attributed

to the use of small incisions and lack of retractors holding the incision

open. In addition, exposure to CO 2 contributes to a diminished acute

phase systemic response, which likely leads to decreased inflammation

and pain.

Answer 6.13. The answer is D.

General anesthetics can cause bone marrow depression, alteration of the

phagocytic activity of macrophages, and immunosuppression.

Answer 6.14. The answer is A.

Resection of isolated liver metastasis from colon cancer can be curative;

therefore, he should be referred to a surgeon for possible resection of

the liver lesion. Observation until he is symptomatic and hospice are

inappropriate. Decisions regarding systemic chemotherapy before or after

resection of the lesion should be made after consultation with the surgeon.

Answer 6.15. The answer is C.

This gentleman has an isolated brain metastasis from renal cell carci-

noma. Both sorafenib and interleukin-2 are approved systemic therapies

for metastatic renal cell carcinoma, but surgical resection would be the

most appropriate next step, with the greatest potential for cure. Hospice

would not be appropriate in this setting, as he has a potentially curable

condition.

Answer 6.16. The answer is D.

Fine-needle aspiration involves aspiration of cells through a needle. Core

biopsy uses a special needle through which a core of tissue can be obtained.

Tissue obtained from a core biopsy is usually sufficient for diagnosis of

most types of cancers. For suspected lymphoma, removal of an entire

lymph node (excisional biopsy) is preferred, as it can provide better eval-

uation of the architecture of the lymph node. Incisional biopsies are used

to take a small piece of tissue from a large tumor mass. In this case, the

mass is small enough that it can be removed entirely.

Answer 6.17. The answer is D.

Cryptorchidism is associated with a high incidence of testicular cancer,

which can be prevented by prophylactic orchiopexy. Multiple endocrine

neoplasia types 2 and 3 are associated with high incidence of medullary

cancer of the thyroid, which can be prevented by performing prophylactic

thyroidectomy. Ulcerative colitis is associated with increased risk for colon

cancer, which can be prevented by prophylactic colectomy.