FRCS Pre/Postoperative Care & Surgical Oncology 2

Question 1

In colorectal cancer staging using the TNM system, what does a T4b classification indicate?

Accepted Answer

Tumour directly invades or adheres to adjacent organs

Answer

In the TNM classification for colorectal cancer: T1 = submucosa, T2 = muscularis propria, T3 = pericolorectal tissues, T4a = visceral peritoneum, T4b = directly invades or is adherent to adjacent organs/structures (e.g., bladder, small bowel). T4b requires multivisceral resection and carries worse prognosis.

Question 2

Which tumour marker is used to monitor recurrence after curative resection of colorectal cancer?

Accepted Answer

CEA (carcinoembryonic antigen)

Answer

CEA is the primary tumour marker used for monitoring post-operative recurrence in colorectal cancer. Rising CEA after curative resection (especially rising to >10 ng/mL) should trigger imaging to exclude recurrence. CEA lacks the specificity for primary diagnosis but is useful for surveillance.

Question 3

What is the concept of 'surgical margins' in oncological surgery, and why does an R0 resection matter?

Accepted Answer

R0 means microscopically clear margins; R1 means microscopic residual disease; R2 means macroscopic residual disease

Answer

The R classification describes completeness of surgical resection: R0 = complete resection with microscopically clear margins (curative intent achieved); R1 = microscopic residual tumour at margins; R2 = macroscopic residual tumour. R0 resection is the primary determinant of long-term cure in solid organ malignancies.

Question 4

A breast cancer patient is found to have a sentinel lymph node biopsy positive for macrometastasis. What is the implication?

Accepted Answer

Axillary lymph node dissection or axillary radiotherapy should be considered

Answer

Sentinel lymph node biopsy (SLNB) positive for macrometastasis (>2 mm) typically warrants completion axillary lymph node dissection (ALND) or axillary radiotherapy (ACOSOG Z0011, AMAROS trials have refined criteria). The decision depends on tumour characteristics, patient fitness, and planned systemic therapy.

Question 5

Which principle describes the surgical approach to ensuring adequate lymph node harvest in cancer surgery?

Accepted Answer

En bloc resection with regional lymphadenectomy removes the primary tumour and its regional lymph node drainage field together

Answer

En bloc resection removes the primary tumour along with its regional lymphatic drainage field in continuity. This achieves both local disease control and accurate pathological staging. In colorectal, gastric, and oesophageal surgery, adequate lymph node harvest (e.g., D2 gastrectomy) affects staging accuracy and survival.

FRCS Part A Practice Test

FRCS Part A Practice Test

FRCS Pre/Postoperative Care & Surgical Oncology 2