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Systems: Resp. WK > 21. Surgical Treatment of Lung Cancer > Flashcards

21. Surgical Treatment of Lung Cancer Flashcards

1
Q

What 2 main factors need to be considered during the assessment of the patient for surgery?

A
  1. staging of lung cancer

2. fitness of the patient

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2
Q

What are the clinical signs in patient history that suggest progressive staging of lung cancer (worsening of cancer) (3)

A
  • pain (esp. bony pain)
  • headaches/ neurological symptoms (incl. personality change)
  • haematuria (blood in urine)
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3
Q

What are the clinical signs in patient examination that suggest progressive staging of lung cancer? (worsening of cancer) (8)

A
  • recurrent laryngeal nerve palsy
  • brachial plexus palsy
  • SVCO;superior vena cava obstruction
  • supraclavicular lymph nodes
  • soft tissue nodules
  • chest wall masses
  • pleural/pericardial effusion
  • hepatomegaly
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4
Q

What 4 things can be seen on a chest x ray which suggest staging of lung cancer?

A
  1. pleural effusion
  2. chest wall invasion
  3. phrenic nerve palsy
  4. collapsed lobe or lung
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5
Q

What 3 main things do blood tests show in staging of lung cancer?

A
  1. anaemia
  2. abnormal LFTs (liver function tests)
  3. abnormal bone profile
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6
Q

When looking at a CT and determining staging of lung cancer, what elements are mainly looked at? (6)

A
  1. size of tumour
  2. mediastinal nodes
  3. metastatic disease; other parts of the lung, liver, adrenals, kidneys
  4. proximity to mediastinal structures
  5. pleural/pericardial effusion
  6. diaphragmatic involvement
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7
Q

What is MRI good for testing in staging of lung cancer?

A

Useful in determining the degree of vascular and neurological involvement in Pancoast tumour (tumour of pulmonary apex)

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8
Q

What is a Bone Scan good for testing in staging of lung cancer?

A

Good test for chest wall invasion and for bony metastases

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9
Q

What is an ECHO good for testing in staging of lung cancer?

A

Will demonstrate presence or absence of significant pericardial effusion

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10
Q

What are respiratory function tests used to assess fitness for pulmonary surgery?

A
  1. asking patient to walk a short distance (simple)
  2. spirometry
  3. diffusion studies
  4. ABG on air/ SLV (arterial blood gas)
  5. fractionated V/Q scan
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11
Q

How does a diffusion study work to assess lung fitness?

A

Patient inhales very small doses of CO, and the amount of CO absorbed in a single breath is measured showing how well alveolar membrane is functioning (if fibrous tissue blocks alveoli then gas exchange is poor)

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12
Q

In fractionated V/Q scan, what element is inhaled and distributed where air is in the lungs?

A

Xenon

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13
Q

What 2 surgical methods are used to detect lung cancer staging?

A
  1. bronchoscopy

2. mediastinoscopy

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14
Q

What occurs during bronchoscopy?

A

Bronchoscope is put through the patient’s mouth who is anaesthetised to look at major airways and biopsies can be taken if needed

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15
Q

What occurs during mediastinoscopy?

A

Cut made above the breast bone and allows us to sample paratracheal lymph nodes; biopsies taken (first sites of mets from lung cancer)

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16
Q

What cardio clinical assessment is made to assess fitness for a pulmonary surgery?

A
  • angina?
  • heart problem?
  • high blood pressure?
  • peripheral vascular disease?
  • diabetes mellitus?
  • smoking?
  • stroke/ transient ischemic attack (mini stroke)
  • heart murmurs?
  • Prev. CANG/ angioplasty
  • carotid bruits
17
Q

What respiratory clinical assessment is made to assess fitness for pulmonary surgery?

A
  • barrell chested?
  • COAD?
  • smoking?
  • asthmatic?
  • recent URTI? On O2?
  • Exercise capacity?
  • previous thoracotomy or ICD? ( implantable cardioverter defibrillator)
18
Q

What cardiac assessment can be done on patients considered for lung surgery? (5)

A
  • ECG
  • ECHO (type of ultrasound)
  • CT scan
  • ETT; exercise tolerance testing
  • Coronary angiogram
19
Q

What is always needed before a lung resection in terms of the diagnosis?

A

Firm diagnosis needs to be made and all tumours should be pre-identified.

20
Q

What effect does lung cancer have on finger shape?

A

Causes clubbing (which can also be idiopathic)

21
Q

What are main causes for peri-operative deaths in lung cancer surgeries? (6)

A
  • ARDS; acute respiratory distress syndrome
  • Bronchopneumonia
  • myocardial infarction
  • PTE; pulmonary thromboendartectomy
  • pneumothorax
  • intrathoracic bleeding
22
Q

What is ARDS? (acuter resp. distress syndrome)

A

Lungs become severely inflamed due to infection/injury and this causes fluid from nearby blood vessels to leak into the alveoli making breathing very difficult

23
Q

What is pulmonary thromboendertectomy?

A

Operation which removes a blood clot from a pulmonary artery

24
Q

What are some non-fatal complications associated with lung cancer surgeries? (7)

A
  • post thoracotomy wound pain
  • empyema; pus in pleural space
  • BPF; bronchopleural fistula
  • wound infection
  • AF; arterial fibrillation
  • MI; myocardial infarction
  • post-op respiratory insufficiency
25
Q

What are the commonest problems with staging of lung cancer? (5)

A
  1. collapse of a lobe or lung makes tumour size difficult to assess
  2. presence of another (usually small) pulmonary nodule
  3. retrosternal thyroid (thyroid moves downwards into sternum area)
  4. adrenal nodule
  5. CT head is not routinely performed pre-op
26
Q

What lung related surgery has the highest mortality rate?

A

Pneumonectomy ( then open/close thoracotomy, lobectomy and wedge resection)

27
Q

Mets in the lung very commonly come from which two regions?

A
  1. kidney
  2. bowel
    ( and many other body regions)
28
Q

What are the 5 year survival rates for the following:

T1N0, T2N0, T3N0, T1N1/T2N1, Any N2 and chance of secondary.

A 
T1N0: 70% 
T2N0: 60% 
T3N0: 50% 
T1N1/ T2N1: 40% 
Any N2: 16% 
Chance of second primary: 5%
29
Q

What are common masses which appear as lung cancer but aren’t? ( the non-lung cancer masses) (5)

A
  1. Infection; TB, lung abscess
  2. Benign tumour; harartoma
  3. Granuloma; Sarcoid, Wegener’s, Rheumatoid nodule, inflammatory pseudotumour
  4. Fibrosis; PMF (progressive massive fibrosis), organising pulmonary infarct
  5. Other; paraffinoma (chronic granuloma on exposure to paraffin)
30
Q

What is the most common of non-lung cancer mass that appears in lungs?

31
Q

What is a hamartoma?

A
  • benign neoplasm in the tissue of its origin
  • grows at same rate as surrounding tissues
  • never malignant
  • composed of cartilage, fat, muscle, connective tissue and bone
  • accounts for ~8% of all lung neoplasms
  • controlled (if surrounding tissue stops growing, then it also stops)
32
Q

What is a teratoma?

A
  • tumour with more than one germ layer
  • contains tissue and organ structures
  • not local/ foreign; arises from other tissues
  • is a neoplasm often affecting testes and ovaries

Systems: Resp. WK (40 decks)

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