Surgical management of cancer Flashcards
Why wouldn’t people be suitable for surgery?
Many reasons:
If tumour has spread (many metastases)
If tumour attached to main structures
If they aren’t fit enough other health wise e.g. smokers have increased risk of ischemic heart disease/COPD
Of those that undergo surgery, how many are cured?
About 50%
Where are hila lymph nodes?
Within the lung, located in the area where the bronchus enters the lung.
Can lymph node involvement be responsible for phrenic nerve palsy and recurrent laryngeal nerve palsy?
yes
What does the left recurrent larryngeal nerve hook around? What does it innvervate?
Ligamentum arteriosum - within the aorto-pulmonary window which links between arch of aorta and left pulmonary artery. Innervates the left vocal chord.
Common metastases locations
Brain, bones, liver, adrenals, controlateral lung
Are metastases painful? Can you get a personality change?
Yes, they can be v painful, esp brain and bones. You can get personality change if metastases in the brain.
What is Pancost syndrome?
Tumour invades brachial plexus, leading to weakness/numbness down one arm.
Chances of permanent cure for surgical removal metastases?
Low, about 25%
If there is plural effusion what are your concerns? Would you perform surgery?
Is it malignant? If so surgery would not get rid of disease.
Chest wall invasion resected reconstructed with?
Pericardial patch
Is phrenic nerve palsy operable? Why?
No, because it means that there is extensive invasion of mediastinum
Careful of what re collapsed lung?
What extent the tumour is - PET scanning can help with this.
Bone marrow involvement signs?
Anaemia
Altered bone profile
What goesup when there is liver met or bone met?
Alkaline phosphatase
When can the diaphragm be resected?
Only if central portion is the part which has been invaded. Not if it is the costophrenic recess parts!
What does an ECHO show for all patients who are being considered for surgery?
Heart health and if there is pulmonary hypertension., also any pericardial effusion, which could be malignant.
Criteria for pneumectomy if tumour in bronchus
Approx 2cm clear of carina (down the way)
What is mediastinoscopy?
Small incision in the sternal notch, telescope inserted adjacent, anteriorly and laterally to trachea - where we may find lymph nodes - can take biopsies.
Factors affecting fitness for surgery
Cardiovascular health
e.g Angina/HBP/Smoking/Stroke/TIA/previous CABG (coronary artery bypass surgery)/angioplasty
Respiratory health
still smoking/exercise capacity/barrell chested/COPD/recent URTI/Asthmatic
Mental health.
due to severe pain after operation and on recovery
Others
eg pulmonary hypertension, chirrhosis, rheumatoid arthritis, immobile patient
What is a well known cause of death in surgery and it risk factor, how is this picked up?
Damage to pulmonary arteries, as they are thinned walled, patient bleeds to death. Often in patients with pulmonary hypertension, which is picked up with an echo scan.
Why is cirrhosis considered?
Liver excretes fat soluble poisons.
Surgery causes fat soluble poisons, a lot of cellular debris, which contains fats.
Additionally if become infected post op, bacteria release endotoxins, usually fat soluble substances broken down by liver. If not broken down, cause systemic vasodilation - shock - death.
Lung function testing done before – what types and what expected
Spirometry
Diffusion studies
May do ABG on air/SLV
Fractionated V/Q scan (patient inhales Xenon- shows up as inhaled part on scan, and injected with technetium -shows blood distribution) - can work out what post operative lung function would be.
We want FEV of greater than 1 litre in an adult post operatively.
What test for coronary arterty calcifications?
Coronary angiogram
