AOCNP Surgical Oncology and Perioperative Care 1 — Questions and Answers
Question 1: Neoadjuvant therapy in surgical oncology refers to treatment given:
- After surgery to eliminate residual disease
- Before surgery to downstage tumors and improve resectability (Correct answer)
- During surgery as intraoperative chemotherapy
- Only to patients who are not surgical candidates
Correct answer: Before surgery to downstage tumors and improve resectability
Neoadjuvant therapy is administered before the definitive surgical procedure with goals of tumor downstaging, improving resectability (e.g., rectal cancer, locally advanced breast cancer), eliminating micrometastases, and assessing tumor biology based on pathologic response. It may convert unresectable tumors to resectable.
Question 2: A pathologic complete response (pCR) after neoadjuvant chemotherapy for breast cancer is most significant because it is associated with:
- No further need for adjuvant therapy
- Improved disease-free and overall survival (Correct answer)
- Eligibility for less extensive surgery only
- Automatic classification as stage I disease
Correct answer: Improved disease-free and overall survival
Pathologic complete response (no residual invasive cancer in the breast or lymph nodes at surgery) following neoadjuvant chemotherapy is a strong prognostic marker associated with significantly improved disease-free and overall survival, particularly in HER2-positive and triple-negative breast cancer.
Question 3: Sentinel lymph node biopsy (SLNB) is performed to assess regional lymph node status while avoiding which complication of full axillary lymph node dissection?
- Wound infection
- Lymphedema (Correct answer)
- Hematoma formation
- Seroma formation exclusively
Correct answer: Lymphedema
SLNB was developed to accurately stage regional lymph nodes while minimizing the morbidity of complete axillary lymph node dissection (ALND), particularly lymphedema. The sentinel node (first draining node) is identified using blue dye and/or radioactive tracer; if negative, ALND is avoided.
Question 4: R0 resection in surgical oncology means:
- Residual microscopic disease at the margins
- Complete resection with negative (clear) surgical margins (Correct answer)
- Palliative debulking with gross disease remaining
- Resection with intraoperative frozen section only
Correct answer: Complete resection with negative (clear) surgical margins
R0 resection indicates microscopically negative surgical margins (no residual tumor), representing the gold standard goal of curative surgery. R1 resection has microscopic positive margins; R2 has macroscopic residual disease. R0 status is a major determinant of recurrence risk and survival.
Question 5: Enhanced Recovery After Surgery (ERAS) protocols in oncologic surgery are designed to achieve which primary goal?
- Eliminate the need for postoperative pain medication
- Reduce surgical stress response, accelerate recovery, and decrease complications (Correct answer)
- Avoid nutritional support in the perioperative period
- Mandate 5-day hospital stays after major resections
Correct answer: Reduce surgical stress response, accelerate recovery, and decrease complications
ERAS (Enhanced Recovery After Surgery) multimodal pathways reduce postoperative complications and hospital LOS by minimizing physiologic stress through measures including preoperative carbohydrate loading, multimodal analgesia, early ambulation, early enteral nutrition, and restrictive IV fluid management.
Question 6: Hyperthermic intraperitoneal chemotherapy (HIPEC) is most commonly combined with cytoreductive surgery for which cancer type?
- Metastatic breast cancer
- Peritoneal carcinomatosis from colorectal cancer or appendiceal malignancy (Correct answer)
- Locally advanced pancreatic cancer
- Thoracic mesothelioma
Correct answer: Peritoneal carcinomatosis from colorectal cancer or appendiceal malignancy
HIPEC involves delivering heated chemotherapy (typically 41–43°C, oxaliplatin or mitomycin-C) directly into the peritoneal cavity during surgery after maximal cytoreduction. It is most established for colorectal peritoneal metastases and pseudomyxoma peritonei from appendiceal tumors, improving survival in selected patients.
AOCNP Surgical Oncology and Perioperative Care 1
Neoadjuvant therapy in surgical oncology refers to treatment given: