assessment and surgical treatment of lung cancer Flashcards
staging cancer
T- tumour T1-4
N- nodes N0-3
M- metastases
important aspect of mediastinum?
it has nerves within
lung metastases spreads to
lymph nodes in the neck
brain bone skin liver adrenal glands
what signs in the clinical history would indicate lung cancer?
pain esp. bony pain. Headaches or neurological symptoms including personality change.
Haematuria
what is a chest x ray used to detect? (4)
Pleural effusion - fluid between pleura layers
Chest wall invasion (by tumour)
Phrenic nerve palsy/paralysis (unilateral diaphragmatic paralysis- one side higher, one lower)
Collapsed lobe or lung
By what method does lung cancer usually spread/metastasise?
transcoelomic spread
which scan is done in every patient with lung cancer?
PET scan
can combine CT-PET to stage cancer
what can a PET scan not be used to examine?
the brain as it is highly metabolically active
why is a bronchoscopy done before surgery
to plan the operation by seeing where the tumour lies
what 3 blood tests can be used to stage lung cancer?
FBC - anaemia - reduced RBC
biochemistry test - see if cancer has spread to other parts of the body - Lung cancer spreads to lung so abnormal LFTs would be predicted
abnormal bone profile
what can a CT scan be used to look for/moniter in lung cancer (5)
size of tumour
mediastinal nodes
metastatic disease- other parts of the lungs, liver, adrenals, kidneys
proximity to mediastinal structures
pleural/pericardial effusion
diaphragmatic involvement
MRI use in lung cancer tests
Useful in determining the degree of vascular and neurological involvement in Pancoast tumour (type of lung cancer- in the apex of the lung)
bone scan use in lung cancer tests
good test for chest wall invasion and for bony metastases
ECHO
ultrasound to show presence or absence of significant pericardial effusion
mediastinoscopy
visualisation of the contents of the mediastinum often carried out before surgery
what is the mediastinum
region of the body located between the lungs. The heart, the esophagus, the trachea, and large blood vessels lie in this area. Also, lymph nodes.
what things do you consider as part of CARDIOVASCULAR SYSTEM in clinical assessment of a patient’s fitness for surgery? (8)
Angina heart problems high blood pressure Diabetes (DM) smoking peripheral vascular disease previous heart surgery Heart murmurs
what things do you consider as part of RESPIRATORY SYSTEM in clinical assessment of a patient’s fitness for surgery?
Barrell-chested (large, inflated chest may be due to arthritis or COPD)
COAD (chronic obstructive airway disease ie Chronic bronchitis and emphysema)
still smoking?
asthmatic
recent URTI
on oxygen
exercise capacity
things to consider with psychiatric fitness for surgery
severe anxiety- may not recover from it or become demotivated from major surgery
social background
chronic pain problems
other things to consider when determining fitness of patient for surgery?
Pulmonary hypertension (increased blood pressure within the arteries of the lungs)
permanent tracheostomy (breathing tube)
rheumatoid arthritis
the immobile patient
Cirrhosis (liver not functioning due to long term damage)
h/o radiotherapy to chest
what tests are used to test respiratory function for fitness for surgery (3)
spirometry
ABG on air (arterial blood gas test measures oxygen and carbon dioxide levels in your blood)
fractionated V/Q scan- Just the ventilation - shows airflow ie how well O2 and CO2 diffuse
what tests should you carry out for cardiac assessment for fitness for surgery
CT ECHO ECG heart dscan coronary angiogram IF IN DOUBT, DON'T OPERATE
surgical treatment of lung cancer
Curative resection is the goal ie taking out enough tissue surrounding cancer for it not to grow back
But want to remove minimum amount of lung tissue
Resection of parietal structures is feasible
Firm diagnosis of malignancy is highly desirable before lung resection
curative resection?
removing or destroying cancerous tissue
reasons for peri-operative death
ARDS Bronchopneumonia Myocardial Infarction PTE Pneumothorax Intrathoracic bleeding
define peri-operative death
any death occurring within 30 days of surgery
what is an ARDS
Acute respiratory distress syndrome (ARDS)
respiratory failure characterised by rapid onset of widespread inflammation in the lungs (ie fluid seeps into lungs)
can be triggered by infection e.g pneumonia
Symptoms include shortness of breath, rapid breathing, and bluish skin coloration (cyanosis)
non-fatal complications with surgery for lung cancer (7)
post thoracotomy wound pain
empyemea (collection of pus in the pleural cavity)
wound infection
AF (atrial fibrillation- common abnormal heart rhythm)
MI (myocardial infarction-heart attack)
post-op respiratory insufficiency
constipation
Common problems with staging lung cancer
collapse of a lobe or lung- lose definition of tumour
presence of another
pulmonary nodule
retrosternal thyroid- unusual location of thyroid
highest rate of operative mortality is in what?
pneumonectomy
lung diseases that are non-cancerous but dangerous
infection- TB benign tumour - hamartoma granuloma fibrosis- PMF paraffinoma
