By Vijay P. Khatri MD FACS
This designated case-based overview of surgical oncology bargains very good guidance for oral board examinations, which emphasize either normal wisdom and case administration. The ebook provides ninety one situations dependent to mirror the surgeon's decision-making technique. every one case starts off with a sufferer presentation and imaging reviews or pathology effects and proceeds via a sequence of selection points—differential analysis, requests for added exams, analysis, surgical procedure, dialogue of power pitfalls, and follow-up. instances are grouped via organ procedure and every part ends with a remedy set of rules summarizing the choice issues. approximately four hundred radiologic photographs and different appropriate illustrations accompany the text.
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Extra info for Clinical Scenarios in Surgical Oncology
Regional neck node recurrence is most often managed with radical neck dissection. New 3dimensional RT planning and delivery techniques, such as intensity-modulated radiation therapy (IMRT) and stereotactic RT, can also be considered for selected patients with local recurrence, depending on the tumor extent and tolerance of adjacent tissues to reirradiation. For patients with distant metastases, or patients whose recurrent disease is not amenable to local therapy, systemic chemotherapy would be an option.
CT Scan CT Scan Report Computed tomography (CT) scan of the parotid region of the head and neck shows a 4-cm enhancing mass involving the right parotid gland. 3 4961_Khatri_ch07_pp023-028 7/21/05 11:12 AM Page 25 25 Case 7 Discussion FNA biopsy of salivary tumors has been established as an accurate and safe procedure, with a sensitivity and specificity well over 90% with experienced cytopathologists. FNA has been found to alter management of salivary masses in 35% of patients biopsied. In this case, the distinction needs to be made between a primary and a metastatic lesion that will effect management of the neck.
Up to 25% of patients overall may develop recurrence in the neck, with half or more of these in the contralateral neck. Ongoing surveillance is mandatory if these patients are to achieve optimal outcomes. Although presentation with metastases implies advanced disease from the outset, aggressive treatment is warranted, because ultimate rates of disease control in the ipsilateral neck are more than 90%, and disease-specific survival at 4 years is more than 60%, with advancing neck stage adversely influencing the outcome.
Clinical Scenarios in Surgical Oncology by Vijay P. Khatri MD FACS