Lung Cancer - Surgical Management Flashcards
How do you assess the patient for lung cancer?
Staging of the lung cancer.
Fitness of the patient.
What is the clinical history of lung cancer?
Pain (esp. bone pain).
Headaches.
Neurological symptoms (including personality change).
Haematuria.
What is the clinical examination of lung cancer?
Recurrent laryngeal nerve / brachial plexus palsy.
SVC syndrome.
Supraclavicular LNs.
Soft tissue nodules.
Chest wall masses.
Pleural/pericardial effusion.
Hepatomegaly.
What does a CXR check for in lung cancer?
Pleural effusion.
Chest wall invasion.
Phrenic nerve palsy.
Collapsed lobe or lung.
What is between the aortic arch and the left pulmonary artery?
The aorto-pulmonary window.
The connection between the two vessels is the ligamentum arteriosum.
Why is the recurrent laryngeal nerve particularly susceptible to lymph node metastases?
The RLN hooks around the medial side of the ligamentum arteriosum to gain a gap between the trachea and oesophagus, where it rises up into the neck to innervate the left vocal cord.
What blood tests are done for lung cancer?
Anaemia.
Abnormal LFTs or bone profile.
What is CT used for in lung cancer?
Size of tumour.
Mediastinal nodes.
Metastatic disease (other parts of lungs, liver, adrenals, kidneys).
Proximity to mediastinal structures.
Pleural/pericardial effusion.
Diaphragmatic involvement.
What is an MRI used for in lung cancer?
Useful in determining the degree of vascular and neurological involvement in a Pancoast tumour.
What is a bone scan used for in lung cancer?
To see chest wall invasions and bony metastases.
What is ECHO used for in lung cancer?
The presence or absence of significant pericardial effusion.
What are the two main surgeries for lung cancer?
Bronchoscopy and mediastinoscopy.
What respiratory aspects must be considered for fitness for surgery?
Barrel chest.
COPD.
Smoking.
Asthma.
Recent URTIs.
On O2.
Exercise capacity.
Previous thoracotomy or ICD.
What cardiovascular aspects must be considered for fitness for surgery?
Angina.
Heart problems.
HBP / DM / PVD.
Smoking.
Stroke / TIA.
Carotid bruits.
Previous CABG / angioplasty.
Heart murmurs.
What psychological aspects must be considered for fitness for surgery?
PMH of mental illness.
Severe anxiety.
Social background.
Chronic pain problems.
What other aspects must be considered for fitness for surgery?
Pulmonary hypertension.
Permanent tracheostomy.
Rheumatoid arthritis.
Mobility.
Cirrhosis.
Heterotopic ossification (h/o) radiotherapy to the chest.
What respiratory function tests are done for lung cancer?
Spirometry.
Diffusion studies.
ABG on air / SLV.
Fractionated V/Q scan.
What cardiac assessment is done for lung cancer?
ECG.
ECHO.
CT.
ETT.
Coronary angiogram.
What occurs in surgical treatment of lung cancer?
Curative resection of parietal structures.
Removing the least amount of lung tissue.
Firm diagnosis of malignancy is highly desirable before lung resection.
What are causes of peri-operative death?
ARDS.
Bronchopneumonia.
MI.
PTE.
Pneumothorax.
Intrathoracic bleeding.
What are non-fatal complications of lung cancer therapy?
Post-thoracotomy wound pain.
Empyema.
BPF / AF / MI.
Wound infection.
Post-op respiratory insufficiency.
Gastroparesis/constipation.
What are common problems with lung cancer staging?
Collapsed lobes or lungs make tumour size difficult to assess.
Presence of another pulmonary nodule.
Retrosternal thyroid.
Adrenal nodule.
Head CT is not routinely performed pre-op.
What are the different mortalities of lung cancer operations?
Pneumonectomy - 5-10%.
Open/close thoracotomy - 5%.
Lobectomy - 3-5%.
Wedge resection - 2-3%.
What are the different 5YS post-op percentages for different lung cancer stages?
T1N0 - 70%.
T2N0 - 60%.
T3N0 - 50%.
T1N1 or T2N1 - 40%.
Any N2 - 16%.
Chance of a second primary - 5%.
What are examples of non-lung cancers?
Infection - TB and lung abscess.
Benign tumour - hamartoma.
Granuloma - sarcoid, Wegener’s, rheumatoid nodule, inflammatory pseudotumour.
Fibrosis - PMF, organising pulmonary infarct.
Paraffinoma.
