Surgical Oncology
Core concepts
Understand the biology of cancer, staging systems, and the principles of oncologic resection: negative margins, adequate lymph node sampling, and en bloc resection. Know the role of neoadjuvant and adjuvant therapy, and multidisciplinary tumor boards. Master the evaluation of a breast, colorectal, melanoma, and soft tissue sarcoma patient. Understand sentinel lymph node biopsy, tumor markers, and surveillance. Know the principles of palliative surgery and goals-of-care discussions.
Traps in questions
Questions often test whether to biopsy before resection and the consequences of inadequate margins. Distinguish tumor markers used for monitoring from those used for screening. Another trap is assuming a mass is benign without tissue diagnosis. Watch for questions about the timing of adjuvant therapy and about genetic syndromes such as Lynch syndrome and BRCA mutations.
Worked rule of thumb
For any suspected malignancy, obtain tissue diagnosis before definitive resection unless the procedure is diagnostic and therapeutic in one step. Margins should be planned preoperatively with imaging and multidisciplinary input.
Exam strategy
Use staging to guide treatment. Early-stage disease favors surgery; locally advanced disease often favors neoadjuvant therapy; metastatic disease favors systemic therapy and palliation.