Cardio: Surgical Aspects of Lung Tumours Flashcards
how many lobes do the lungs have?
right - 3 lobes
left - 2 lobes
how many fissure do the lung have and what do they separate?
horizontal fissure - superior from middle right lobe
oblique fissure - superior left from inferior left; inferior right from superior and middle right lobes
what separates the lung from the chest wall?
pleura
how many layers of pleura do we have?
- parietal (next to chest wall)
- visceral (next to lung)
how many segmenta bronchi do we have on each side?
10
staging according to the lymph node infiltration
L0 - no infiltration
L1 - hilar nodes
L2 - ipsilateral nodes
L3 - contralateral nodes
during which procedure are lymph node samples taken?
lobectomy
what happens if there is tumour after the surgery
you shrink the tumour using chemotherapy
what 2 things should you consider about a lung tumour?
- operability
- resectability
what does operability depend on
the patient i.e. how fit he is for surgery
what does resectability depend on?
the tumour i.e. the size, type and extent of the tumour
which stages of cancer can you do surgery on?
anywhere between Stage I and IIB, you can resect; further stages are less and less likely to resect, especially if the mediastinal nodes have been affected
what can be used to assess the patient for operability
anaesthesia and fitness tests; signs and symptoms of the patient give an indication of the extent of the cancer
signs and symptoms of lung cancer
signs: jaundice, anaemia, hepatomegaly, enlarged lymph nodes, cachexia, neurological symptoms, pleural effusion
symptoms: weight loss, SOB, bone pain, nausea & vomiting, headaches, LOC
investigations for staging a tumour
- CXR
- pulmonary function tests
- V/Q scans
- HRCT/PET
- lung biopsy (transbronchial/CT guided)
- cervical mediastinoscopy
how are ventilation/perfusion scans done?
ventilation: radioactive Xenon is given as an aerosol via mask
perfusion: radioactive technectium macro aggregated albumin given by intravenous injection
CXR for comparison
how do you do cervical mediastinoscopy?
- make an incision in the suprasternal notch
- insert the scope through the hole
- visualise the nodes and extract them from there
types of lobectomy
- segmental resection
- wedge resection
complication of a pneumonectomy
postpneumonectomy empyema
management of lung cancer
- surgery
- neoadjuvant therapy
what happens in Pancoast tumours?
- nerve invasion
- Horner’s syndrome
what are the features of Horner’s syndrome?
- miosis (constricted pupil)
- ptosis (droopy eyelid)
- enophthalmos (inset eyeball)
- anhydrosis (decreased sweating)
