Assessment and surgical management of lung cancer Flashcards
Name the 2 components of assessing the patient
staging of the lung cancer
fitness of the patient
Name the 3 letters used in the staging process
T N M
In N1 disease where has the cancer spread to?
hilum
left main bronchus
main pulmonary vein
In N2 disease where has the cancer spread?
mediastinum
In N3 disease where has the cancer spread?
supraclavicular
aortal pulmonary window
Name some symptoms in the clinical history of the patient
pain - especially bone
headaches
haematuria
Name some symptoms in the clinical examination of the patient
nerve palsy - brachial and laryngeal = hoarse voice and raised diaphragm
supraclavicular lymph nodes and chest wall masses
hepatomegaly
Name the 4 things an x ray can identify
pleural effusion
chest wall invasion
phrenic nerve palsy
collapsed lung or lobe
What would a blood test show?
anaemia
bone profile - raised calcium
What can a CT be useful to show in the staging of lung cancer?
The size of tumour metastases mediastinal proximity and nodes diaphragm pleural effusion
Name 3 other tests done in lung cancer staging
MRI
Bone scan
ECHO
Name 2 surgical methods to stage lung cancer
bronchoscopy
mediastinoscopy
Name the 4 main areas focused on in the clinical assessment to determine the fitness for surgery
Cardiovascular
respiratory
psychological
other
Name some main things looked at in the CVS
Angina heart problems high blood pressure stroke peripheral vascular disease
Name some main things looked for in the respiratory clinical assessment
asthma smoker recent URTI barrel chested COAD
Name the main things concentrated on in the psychological assessment
mental illness
anxiety
chronic pain
Name some other things looked at in the clinical assessment
pulmonary hypertension
rheumatoid arthritis
cirrhosis
Name the 4 respiratory lung function tests used
spirometry
diffusion studies
ABG on air/SLV
V/Q
Name some scans used for the cardiac assessment
ECG
ECHO
CT
coronary angiogram
State the main goals of lung cancer surgery
Cure the patient
remove as little as possible
be sure it is cancer and not an infection
Name some reasons why people die in surgery
bleeding
MI
ARDS
pneumothorax
List some non fatal complications of lung cancer surgery
wound pain empyema infection MI constipation blood pressure
Name some of the main problems encountered when trying to stage lung cancer
collapse lung or lobe
prescence of another nodule
retrosternal thyroid
What is the post operative mortality for a pneumonectomy?
8-12% ==> the less of the lung resected the better the prognosis after surgery
