Surgical Oncology
Core Concepts
Focus on the principles of oncologic surgery: en bloc resection, margins, lymphadenectomy, and multidisciplinary care. Understand staging and management of common cancers (colorectal, gastric, melanoma, sarcoma). Key concepts: sentinel lymph node biopsy for melanoma, neoadjuvant therapy for rectal cancer, and the role of cytoreductive surgery in peritoneal carcinomatosis. Also, know the indications for metastasectomy (e.g., colorectal liver metastases).
Traps in Questions
A common trap is the management of melanoma: wide local excision with margins based on Breslow thickness (0.5–1 cm for thin, 2 cm for thick). Another trap is the use of adjuvant therapy in stage II colon cancer – only considered in high-risk features. For gastric cancer, D2 lymphadenectomy is standard in fit patients. Also, beware of the “sarcoma” question: grade and size determine prognosis; surgery is mainstay, and radiation for high-grade.
Worked Example
A 50-year-old man with a 2.5 mm Breslow melanoma on the back. What is the appropriate surgical margin? Answer: 2 cm wide local excision, plus sentinel lymph node biopsy.
Rule of Thumb
In colorectal liver metastases, resect if feasible with clear margins and adequate future liver remnant, regardless of number, as long as R0 achievable.