Key information (information to look for and pay attention
to and to document with regard to collecting pertinent information
about the patient's cancer): surgeon's comments on involvement
of adjacent organs and structures; fixation of tumor; invasion
of major blood vessels; physical description of organ (hard,
leathery, wine sack appearance); depth of organ cavity, for
example,"sounding" of uterus; tumor encompassing nerves or
blood vessels; fixed or matted lymph nodes; tissues or areas
involved that are not included in the pathology specimen,
names of organs or tissues removed; number, site, and involvement
of lymph nodes removed; anatomic site and
|
name of all involved lymph nodes not removed
during the resection; site and description of any gross
tumor not removed, any tumor on or in the liver that
is not biopsied, appearance and size of organ, extent
of involvement of other organs in same body cavity tumor
implants, seeding, implants, talcum powder appearance,
encasement, nodularity of viscera, frozen pelvis, which
organs were removed, results of examination under anesthesia.
|
EXAMINATION UNDER ANESTHESIA
(EUA) bimanual examination of the pelvis and external
abdomen while patient is anesthetized, using one hand in the
pelvis and the other hand to press on the organs externally.
INTRAOPERATIVE EVALUATION
OF DIAPHRAGM--visual and manual inspection of the diaphragm,
particularly the right leaf, during laparotomy for treatment
of ovarian cancer. Optimally, the intraoperative evaluation
of the diaphragm should occur prior to any dissection of pelvic
organs. Evaluation of the diaphragm is an important part of
accurate staging of ovarian cancer.
STAGING LAPAROTOMY--evaluation
of the contents of the abdomen for the purpose of determining
the extent of disease. A staging laparotomy is not routinely
done for Hodgkin's disease, unless the opportunity for obtaining
better staging information exceeds the risk of operative morbidity.
An adequate staging laparotomy includes abdominal exploration,
wedge and needle biopsies of the liver, multiple lymph node
biopsies, bone marrow biopsy, and splenectomy. Staging laparotomy
is considered a diagnostic procedure rather than surgical
treatment. The staging laparotomy is an opportunity to identify
landmarks within the abdomen, such as unresectable large nodes
or the splenic pedicle, which will affect the design of radiation
treatment for the patient. Precise staging is important for
Hodgkin's disease and to a lesser extent non-Hodgkin's lymphoma.
STAGING PROCEDURES FOR OVARY
Adequate staging procedures during laparotomy should include
evaluation of the undersurface of the diaphragm, pelvic and
abdominal peritoneum biopsies, pelvic and paraaortic lymph
node biopsies, peritoneal washings, and biopsies of any suspicious
nodules or masses. The surgeon's report should reflect the
results of these procedures.
SURGICAL STAGING: radical
orchiectomy with laparotomy and removal of bilateral retroperitoneal
lymph nodes to determine the histologic cell type, remove
the primary tumor, and evaluate the lymph nodes of the retroperitoneum.
Surgical staging also provides debulking of tumor if lymph
nodes are positive. Also called: retoperitoneal lymphadenectomy.
|