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Labrador cross with mass on antebrachium (view source)
Revision as of 19:34, 2 October 2012
, 19:34, 2 October 2012no edit summary
feedback3="'''Incorrect'''. Adjuvant chemotherapy for grade 2 STS is not indicated, and is likely to be of little benefit for grade 3 STS. It may have some value for highly anaplastic sarcomas, where immunohistochemistry is required to determine histiogenesis; however, even this is unproven. The chemotherapeutic agent with the most expected benefit is doxorubicin or similar, so this would be inappropriate therapy. Choose again."
feedback3="'''Incorrect'''. Adjuvant chemotherapy for grade 2 STS is not indicated, and is likely to be of little benefit for grade 3 STS. It may have some value for highly anaplastic sarcomas, where immunohistochemistry is required to determine histiogenesis; however, even this is unproven. The chemotherapeutic agent with the most expected benefit is doxorubicin or similar, so this would be inappropriate therapy. Choose again."
feedback4="'''Incorrect'''. Adjuvant chemotherapy for grade 2 STS is not indicated, and is likely to be of little benefit for grade 3 STS. It may have some value for highly anaplastic sarcomas, where immunohistochemistry is required to determine histiogenesis; however, even this is unproven. The chemotherapeutic agent with the most expected benefit is doxorubicin or similar, so this would be inappropriate therapy. Choose again."
feedback4="'''Incorrect'''. Adjuvant chemotherapy for grade 2 STS is not indicated, and is likely to be of little benefit for grade 3 STS. It may have some value for highly anaplastic sarcomas, where immunohistochemistry is required to determine histiogenesis; however, even this is unproven. The chemotherapeutic agent with the most expected benefit is doxorubicin or similar, so this would be inappropriate therapy. Choose again."
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questionnumber="14"
question="You recheck your patient frequently and after 12 months there is evidence of a 5 × 3-cm wide, fixed soft-tissue swelling along one area of the surgical suture line at the proximal lateral antebrachium and overlying the ventrolateral chest wall. You biopsy this swelling as a small wedge biopsy and this confirms local recurrence of tumour, this time as a grade 3 STS. You had warned the clients that amputation was your preferred treatment option due to the difficulty in attaining margins because of tumour size and location, and so they are disappointed but not unprepared. It was also explained to them that recurrent disease has a poorer prognosis than optimally treated first-time, curative intent surgery. What would you do next?"
choice1="Thoracic radiographs + abdominal ultrasound (as now grade 3) before amputation if staging is negative."
choice2="Thoracic radiographs + abdominal ultrasound (as now grade 3) + contrast-enhanced advanced imaging (e.g. CT, magnetic resonance imaging (MRI)) of local disease to ensure recurrent disease is resectable before wide surgical resection (most likely amputation)."
choice3="Thoracic radiographs + abdominal ultrasound (as now grade 3) + contrast-enhanced advanced imaging (e.g. CT, MRI) of local disease followed by marginal resection of local recurrence and adjuvant radiation therapy."
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correctchoice="2"
feedback1="'''Incorrect'''. It is best to have advanced imaging of local tumour before surgery, as this may help you plan your surgery. Choose again."
feedback2="'''Correct'''."
feedback3="'''Incorrect''', because you are irradiating over the chest wall and may incur long-term complications of fibrosis of irradiated lung. Therefore this is not your preferred option, as long as the dog has no intercurrent orthopaedic or neurological disease which precludes amputation. Choose again."
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