New PDF release: Clinical Scenarios in Surgical Oncology

By Vijay P. Khatri MD FACS

ISBN-10: 0781754666

ISBN-13: 9780781754668

This detailed case-based evaluate of surgical oncology bargains very good guidance for oral board examinations, which emphasize either normal wisdom and case administration. The publication offers ninety one instances established to mirror the surgeon's decision-making method. every one case starts off with a sufferer presentation and imaging stories or pathology effects and proceeds via a chain of determination points—differential analysis, requests for added assessments, analysis, surgical method, dialogue of capability pitfalls, and follow-up. situations are grouped through organ approach and every part ends with a therapy set of rules summarizing the choice issues. approximately four hundred radiologic pictures and different appropriate illustrations accompany the text.

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Example text

3 PET Scan Report The PET scan demonstrated the presenting neck metastasis clearly. No primary site was identified, no hot spot was seen in the nasopharynx, and there was no evidence of any systemic disease. Diagnosis The diagnosis is metastatic SCC from an unknown primary site, with the tumor staged as Tx N2a M0 (stage III). Recommendation The patient is seen and assessed in a multidisciplinary clinic, and is offered surgical treatment in the form of a comprehensive right neck dissection, to be followed by adjuvant radiotherapy to the neck.

Biopsies should be taken from any suspicious areas. In the absence of any other abnormality, tonsillectomy should be performed. Discussion FNA biopsy is the most appropriate investigation of the neck mass, providing there is no specific contraindication. A diagnosis can be obtained in more than 90% of patients; therefore, open lymph–node biopsy is usually not necessary and is not recommended. If, however, FNA does not provide a diagnosis, current opinion is that an open biopsy can be performed without compromising the long-term outcome.

Discussion FNA biopsy is the most appropriate investigation of the neck mass, providing there is no specific contraindication. A diagnosis can be obtained in more than 90% of patients; therefore, open lymph–node biopsy is usually not necessary and is not recommended. If, however, FNA does not provide a diagnosis, current opinion is that an open biopsy can be performed without compromising the long-term outcome. A thorough history and physical examination, combined with imaging and examination under anesthesia, will uncover a primary site in approximately 50% of patients presenting with a putative unknown primary.

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Clinical Scenarios in Surgical Oncology by Vijay P. Khatri MD FACS


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