Assessment and surgical treatment of Lung cancer Flashcards
What are the two factors that will asses if the patient gets surgery
Staging of the Lung cancer
Fitness of the patient
When does CT staging of lung cancer show that will make surgery difficult
Sizing of the tumour Mediastinal nodes - involve 2 surgeries Proximity to mediastinal structures Pleural/pericardial effusion Diaphragmatic involvement Metastatic disease - other parts of lungs, liver, adrenals, kidneys
What varies tests are taken place to check the fitness of the individual
Spirometry -
Climbing the stairs - asses breathlessness
Diffusion studies
Fractioned V/Q studies
How do diffusion studies occur
Inhalation of CO and the amount absorbed in a single breath is measure - shows alveolar diffusion capacity
What does Fractioned V/Q studies measure
The ventilation and perfusion
What substance is used in the Fractioned V/Q studies and how does this measure ventilation
Inhale radioactive substance (zenone) and it distributes accordingly to where airflow distributes
If ventilation shows up poor in V/Q studies does this means surgery can processed, why?
Yes, as there is no chance in making it worse
What substance is used in the Fractioned V/Q studies and how does this measure perfusion
Radioactive substances are injected into a vein in the arm and more images taken to see blood flow
If perfusion shows up poor in V/Q studies does this means surgery can processed, why?
No as there is a chance of blood clotting in surgery making the situation worse
What is the 4 different types of lung surgeries
o Open/Closed Thoracotomy
o Pneumonectomy
o Lobectomy
o Wedge resection
What is a thoracotomy and its percentage morality
surgical incision into the chest wall - 5%
What is a Pneumonectomy and its percentage morality
surgical removal of a lung or part of a lung (8-12% mortality)
What is a lobectomy and its percentage morality
surgical removal of a lobe of the lung (3-5% mortality)
What is a wedge dissection and its percentage morality
just take out the tumour from the lung tissue (2-3% mortality)
What is a list of the fatal complications that can occur during surgery
♣ ARDS = adult respiratory distress syndrome – unknown cause, lots of fluid in lung
♣ Pneumonia = very common especially if patient has COPD
♣ MI (heart attack)
♣ PTE = pulmonary thrombus/embolism
♣ Pneumothorax
♣ Intrathroracic bleeding
What is examples of non fatal complications of surgery
ϖ Wound pain/infection
ϖ Empyema (pus in the pleural space)
ϖ BTF (broncho-pleural fistula)
ϖ Post-op respiratory insufficiency
Certain lung masses and leisons can occur and be mistaken as lung cancer, name 5 examples
TB Abscess Benign tumour (Hamartoma) – made up of collage, cartilage etc. Granuloma Fibrosis
What is the most common lung mass/leison thing that can be mistaken as lung cancer
TB
What can a chest X-ray show in the affects of lung cancer staging
Pleural effusion - excess fluid
Chest wall invasion
Phrenic nerve paralysis - affect diaphragm
Collapsed lobe or lung
What can a blood tests show in the affects of lung cancer staging
anemia
abnormal bone profile
abnormal liver function tests
(show the effects of mestatasis)
What is the main aim of surgical envelopment
Curative resection in removing as little as possible
How will a bone scan help in the staging of lung cancer
Good test for chest wall invasion and for bony metastases
How is a MRI useful in helping the staging of lung cancer
Useful in determining the degree of vascular and neurological involvement in Pancoast tumour (tumour in the apex)
How is a ECHO useful in helping the staging of lung cancer
Will demonstrate presence or absence of significant pericardial effusion.
What two surgical procedures help in the diagnosis of the staging of lung cancer
Bronchoscopy
Mediastinoscopy
What does a bronchoscopy asses
the major airways
What does a Mediastinoscopy asses
examine the lymph nodes wuth cut just above the breast bone
What problems can make the staging of lung cancer difficult
Collapse of a lobe or lung makes tumour size difficult to assess
Presence of another (usually small) pulmonary nodule
Retrosternal thyroid - unusual thyroid placement below the sternum
What is an example of an idiopathic symptom of lung cancer
finger clubbing
