Surgical Oncology Principles

A 52-year-old man from rural India presents with a 6-month history of progressive dysphagia to solids, weight loss of 8 kg, and epigastric discomfort. Endoscopy reveals a 4 cm ulcerated lesion in the gastric antrum with surrounding erythema. Biopsy confirms adenocarcinoma. CT staging shows the tumour invading the muscularis propria with 2 regional lymph nodes involved (T3N1M0). The patient is otherwise fit for surgery with no comorbidities. What is the most appropriate surgical management for this patient?

A 58-year-old woman from Delhi undergoes screening mammography and is found to have a 2.5 cm mass in the upper outer quadrant of the left breast with microcalcifications. Core needle biopsy confirms invasive ductal carcinoma, grade 2, ER/PR positive, HER2 negative. Staging CT shows no distant metastasis. Sentinel lymph node biopsy is negative (pN0). The tumour is clinically mobile with no skin involvement or nipple retraction. What is the most appropriate surgical management?

In surgical oncology, which principle best describes the concept of 'R0 resection'?

A 52-year-old woman from Delhi presents with a palpable mass in the upper outer quadrant of the right breast discovered on self-examination. Mammography shows a 2.5 cm irregular mass with microcalcifications. Core needle biopsy confirms invasive ductal carcinoma (IDC), grade II. Immunohistochemistry shows ER+, PR+, HER2−. Staging investigations (CT chest/abdomen, bone scan) reveal no distant metastases. Axillary ultrasound shows one lymph node with short axis 1.2 cm and normal morphology. The patient is counseled about treatment options. Which of the following represents the most appropriate initial surgical approach for this patient?

A 58-year-old man from rural Maharashtra presents with a 6-month history of progressive dysphagia, initially to solids and now to liquids. He has a 40 pack-year smoking history and consumes alcohol daily. On upper endoscopy, a 4 cm irregular, ulcerated lesion is seen in the mid-esophagus with shouldering at the margins. Biopsy confirms squamous cell carcinoma. CT chest shows the tumor invades the muscularis propria but does not breach the adventitia; no distant metastases are seen. Regional lymph nodes are not enlarged. According to TNM staging, what is the T stage of this tumor?