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The Rolle of Surgery

in Oncology
Henry Naland Oncologist Surgeon

Surgery Departement
Medical Faculty Ukrida
University

Malignant Tumors
2

types of malignant Tumors:


Non solid type : Domain of Medical
Oncology
Solid solid type: Domain of Surgical
Oncology

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Modalities of Cancer Treatment

6 Therapy Modalities in treating Cancer


1.Surgery
2.Radiation
3.Chemotherapy
4.Hormontherapy
5.Molecular targeted therapy
6.CAM (Complementary Alternative
Medicine)

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Non solid malignant Tumor

Main treatment modality


Chemotherapy
and Molecular targeted therapy
Supporting treatment modality
Surgery as diagnostic tool or
Life saving surgery
Radiotherapy

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Solid Malignant Tumors


Surgery

Surgery as main dominant treatment modality for solid


malignant tumors
as specially in early stage.
Included Endocrine Tumors ,surgery most as definitive
Treatment
Surgery cures twice as many as total others treatment
modalities as radiotherapy plus chemotherapy plus others
modalities

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Role of surgery in curing Cancer

Diagnosis
Staging
Treating primary tumor
Reconstruction and rehabilitation
Palliative treatment
Treating complication of other Ca treatment
Resection of metastasis
Cytoreductive surgery
Oncologic emergencies
Cancer prevention
Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Surgery disadvantages
Deformity

and mutilation
Cannot prevent distant metastasis
Carefully patients selection are important
to detect pre existing distant metastasis

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Principles of Surgical Oncology


Eradication

of all Tumor mass untill the


last single Cancer cells
No touch method: en bloc excision
Margin of safety in healthy tissue
Dissection of every suspected lymphnode . Mind Sentinel lymph-node
Prevent spillage of Cancer cells
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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Surgery for Endocrine Tumors

Good differentiated Thyroid Tumor ( Papilary and


Follicular thyroid Cancer)
Medullar / C Cell thyroid Cancer
Anaplastic thyroid Ca: for diagnosis, release
airway
Adrenal tumor ( Pheochromocytome)
Hypophysis Tumor
Rare Pancreatic Tumor ( Insulinoma etc)
Testicular and ovary Cancer
Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Recent advances in Surgical tools


Cutting

instruments
Conventional disposable blade
laser
Gamma knife
Harmonic knife
Anastomosis instruments
Suture materials :finer and stronger
Tissue glue
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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Automatic suturing instrument

11

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Deep recto-anal Anastomosis instrument

12

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

da Vinci robotic surgical device

13

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Laser knife in using

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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Recent advances in surgical method

15

Minimal invasive Surgery


Endoscopic Surgeries:
Transurethral Prostaat Resection
Panendoscopic Biopsies ,Polyp-resection
Transarterial intervention surgery
Laparascopic resection
Robotic Surgery ( Robot assisted surgery)

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Other new Instruments in surgery


RFA :

Radio Frequency Ablation


HIFU:High Intensity Frequency Ultrasound
Cryosurgery
Stereotatic Gamma Knife surgery

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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Gamma knife surgical Instrument

17

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Stereotatic Gamma knife surgery

18

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

19

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Meticulous targeted surgery

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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Cryosurgery instruments

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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Different kinds
of Cryosurgery instruments

22

Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Spray type Cryosurgery

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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Trends in Cancer surgical Modality


Less

mutilation procedures
Cape : Not less radical method
Pre operative Tumor down sizing
by neo adjuvant Chemotherapy
neo adjuvant Radiotherapy
neo adjuvant Radiochemotherapy

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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon

Thank you

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Tuesday

October
29 2013

Medical Faculty Ukrida University


Henry Naland Oncologist Surgeon