Surgical management of lung cancer Flashcards
What does a higher T status mean?
The larger the tumor.
What lymph nodes are dealt with in lung cancer?
Hilar lymph nodes and mediastinal lymph nodes
What percent of patients who come to the hospital are operable?
10%
What are the main T statuses?
T1 <3cm
T2 <5cm
T3 >5cm
T4 is when the tumor is attached to vital structures
What are the main N staging types?
N1 has a much better prognosis than N2
N3 is when the nodes are involved on the other side of the primary tumor or they are involved in the neck.
What is lymph node involvement for in lung cancer?
Recurrent laryngeal palsy (left side) or for phrenic nerve palsy (both sides)
What is the aortapulmoanry window?
It is the region between the aortic region and the left pulmonary artery.
What is the ligamentum arteriosum?
The connection between the aortic arch and the left pulmonary artery.
What is the left laryngeal nerve notorious for?
It is notorious for being involved and destroyed by malignant lymph node processes in the hilium of the left lung.
Where does the phrenic nerve enter the chest?
It enters in relationship to the left subclavian artery.
What does the vagus nerve give rise to and where does it enter the chest?
It gives rise to the recurrent laryngeal nerve and it enters the chest in relation to the left common carotid artery.
What history is taken during the staging of lung cancer?
Pain (especially bony pain), Headaches, or neurological symptoms including personality change. Haematuria
What examination needs to be taken during the staging of lung cancer?
Look for signs of:
- Recurrent laryngeal nerve palsy (hoarsenss)
- Brachial plexus plays
- SVCO (Superior vena cava obstruction)
- Supraclavicular lymph nodes
- Soft nodules
- Pleural/pericardial effusion
- Hepatomegaly
What can be identified in chest X-Ray during the staging of Lung cancer?
- Pleural effusion (not operable)
- Chest wall invasion (possible to resect the invaded ribs and the intervening soft tissue and reconstruct that part with a pericardial patch)
- Phrenic nerve palsy (not operable)
- Collapsed lobe or lung
What can blood tests be used for during the staging of lung cancer?
- Anaemia
- Abnormal LFTs
- Abnormal bone profile
When can the diaphragm be resected?
Only when the central portion is invaded.
What is CT used to see during staging of lung cancer?
- Size of tumor
- Mediastinal nodes
- Metastatic disease - other parts of the lungs, livers, adrenals, kidneys.
- Proximity to mediastinal structures
- Pleural/pericardial effusion
- Diaphragmatic involvement
What other tests are carried out during the staging of lung cancer?
MRI - Useful in determining the degree of vascular and neurological involvement in Pancoast tumor
Bone Scan - Good test for chest wall invasion and for bony metastases
ECHO - will demonstrate the presence or absence of significant pericardial effusion.
What are the surgical methods of staging during lung cancer?
- Bronchoscopy
- Mediastinoscopy
What is the cardiovascular clinical assessment for fitness for surgery?
Angina? Heart Problems? High blood pressure? DM? PVD, Smoking? Stroke? Carotid bruits? Prev Angioplasty? Heart murmurs?
What is the respiratory clinical assessment for fitness for surgery?
Barrell chested? COAD? Still smoking? Asthmatic? Recent URTI? On oxygen? Exercise capacity? Pervious thoracotomy or ICD?
What is the psychiatric clinical assessment for fitness for surgery?
the pH of mental illness, severe anxiety, social background, chronic pain problems.
What are other clinical assessment questions for fitness for surgery?
Pulmonary hypertension? Permanent tracheostomy? Rheumatoid arthritis? Immobile patient? Cirrhosis? Radiotherapy to the chest?
How does circulatory shock happen after surgery?
The liver has an important role in removing fat-soluble poisons from the bloodstream and when a patient has cirrhosis, it is unable to do so and as a result, it causes vasodilation and increased capillary permeability.
