Clinical Features & Staging of Lung Cancer Flashcards
What are the clinical features we use when staging a lung cancer that would show in a history?
History:
- Any pain, (notably bony)
- Headaches or neurological symptoms.
- Haematuria (RBCs in urine)
When staging what clinical features would we use from an examination?
- Palsy of Recurrent Laryngeal Nerve or Brachial Plexus
- Superior Vena Cava Obstruction
- Supraclavicular Lymph Node enlargement
- Any soft tissue or chest wall masses
- Hepatomegaly
- Pleural/Pericardial effusion
What would show up on a CXR to help us stage a lung cancer?
For starters its size. But also: - Pleural Effusion - Chest wall invasion - Phrenic Nerve Palsy - Collapse
How would phrenic nerve palsy appear on a CXR?
One or both side of the diaphragm would be crazy high up.
If the left is higher than the right or the right higher than the left by an unusual amount.
What blood tests help us stage lung cancer and why?
For Anaemia - Would show ventilation is significantly reduced
Abnormal LFTs - Could show metastatic tumours in liver
Abnormal Bone profile - Could show metastatic tumours in bone
How would an MRI help in staging?
Shows vascular/neurological involvement with a pancoast tumour
How would a bone scan help with staging?
Shows bony metastasis & chest wall invasion
How would an ECHO help with staging?
Shows significant pericardial effusion
What surgical investigations help with staging?
Bronchoscopy & Mediastinoscopy
To have a look at the tumour and sometimes the lymph nodes.
How do we assess a patients fitness for surgery?
Check their for any potentially dangerous or risky Cardio/Resp. problems
Assess their psychological readiness
Assess their respiratory function
Assess their cardiac function
How do we assess a patients respiratory function before surgery?
Arterial blood gasses
Diffusion study to check for alveolar function.
Spirometry
Fractionated V/Q scan
What is the use of a fractionated V/Q scan before surgery?
OFten we wont want to remove a section of lung if the patient is close to having breathing problems.
However if a V/Q scan can show that section of lung isn’t actually ventilated or perfused (due to the tumour) then we can safely remove it.
How would we assess a patient’s cardiac function prior to surgery?
Exercise Tolerance Testing (ETT)
ECHO
Coronary Angiogram
ECG
What are some reasons for peri-operative death with lung cancer ops?
- Acute Respiratory Distress Syndrome (ARDS)
- Bronchopneumonia
- MI
- Pneumothorax
- Intrathoracic Bleeding
What are some non-fatal complications of lung cancer ops?
Wound pain Empyema Wound infection MI Post-op respiratory Insufficiency