Surgical Oncology
Biology and staging
Carcinogenesis involves oncogenes, tumour suppressor genes (TP53, APC, BRCA), DNA repair defects and angiogenesis. Invasion and metastasis require basement membrane breakdown, vascular access and immune evasion. Grade describes differentiation; stage describes spread. TNM is the universal language: T (size or invasion), N (nodes), M (metastasis). Staging determines treatment and prognosis; grade influences biology and adjuvant therapy. Always record margin status (R0, R1, R2) and lymphovascular invasion.
Multidisciplinary management
MDT discussion is standard for breast, colorectal, lung, upper gastrointestinal and sarcoma cases. Neoadjuvant therapy downstages locally advanced disease and tests biology; adjuvant therapy treats micrometastases. Sentinel node biopsy avoids unnecessary lymphadenectomy. Common solid tumours have predictable spread: breast to axilla and bone, colorectal to liver, prostate to bone, melanoma to regional nodes and then any organ. Tumour markers (CEA, CA19-9, AFP, PSA) are for monitoring, not screening or diagnosis.
Palliative care
Palliative care is symptom control, not just end-of-life care. Follow the WHO analgesic ladder, treat constipation and nausea prophylactically with opioids, and address psychological and social needs. Recognise oncological emergencies: spinal cord compression (dexamethasone and urgent imaging), superior vena cava obstruction, hypercalcaemia, tumour lysis syndrome and febrile neutropenia.
Rule of thumb
A rising tumour marker with a normal scan is not proof of recurrence; re-image and discuss at MDT. Never call a mass benign on imaging alone - tissue is the issue.