Surgical Oncology and Multidisciplinary Management
Core concepts
Understand the multidisciplinary team (MDT) model: surgeons, medical and radiation oncologists, radiologists, pathologists, specialist nurses, and palliative care. Know surgical principles: oncologic resection with negative margins (R0), en bloc resection, lymph node dissection vs sentinel node biopsy, and staging laparoscopy where relevant. Recognise the role of neoadjuvant vs adjuvant therapy (downstaging, organ preservation, micrometastasis control) and conversion surgery in initially unresectable disease. Understand breast-conserving surgery + radiotherapy, sentinel node biopsy, axillary dissection indications, and colorectal liver metastasectomy criteria. Know HIPEC/cytoreduction, isolated limb perfusion, and metastasectomy for oligometastatic disease. Understand reconstruction, functional outcomes, and shared decision-making. Recognise surgical emergencies (obstruction, perforation, bleeding, pathological fracture) and the role of palliative surgery.
Traps
Questions test whether adjuvant therapy is indicated after R0 resection based on stage/risk, and whether neoadjuvant is preferred (e.g., rectal cancer, locally advanced breast, oesophageal). Distinguish sentinel node biopsy from complete axillary dissection indications. Do not assume surgery is always first - many tumours are treated with systemic therapy first. Watch for margin status implications on re-excision.
Worked example / rule of thumb
A 4 cm HER2-positive breast cancer with clinically node-negative axilla: neoadjuvant chemotherapy + anti-HER2, then surgery with sentinel node biopsy, then adjuvant radiotherapy ± further systemic therapy. Rule of thumb: neoadjuvant when downstaging enables surgery or organ preservation; adjuvant when micrometastasis control is the goal after R0.