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Respiratory System & CVS Physiology Year 1 > Surgical management of lung cancer > Flashcards

Surgical management of lung cancer Flashcards

1
Q

What does a higher T status mean?

A

The larger the tumor.

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2
Q

What lymph nodes are dealt with in lung cancer?

A

Hilar lymph nodes and mediastinal lymph nodes

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3
Q

What percent of patients who come to the hospital are operable?

A

10%

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4
Q

What are the main T statuses?

A

T1 <3cm
T2 <5cm
T3 >5cm
T4 is when the tumor is attached to vital structures

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5
Q

What are the main N staging types?

A

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.

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6
Q

What is lymph node involvement for in lung cancer?

A

Recurrent laryngeal palsy (left side) or for phrenic nerve palsy (both sides)

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7
Q

What is the aortapulmoanry window?

A

It is the region between the aortic region and the left pulmonary artery.

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8
Q

What is the ligamentum arteriosum?

A

The connection between the aortic arch and the left pulmonary artery.

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9
Q

What is the left laryngeal nerve notorious for?

A

It is notorious for being involved and destroyed by malignant lymph node processes in the hilium of the left lung.

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10
Q

Where does the phrenic nerve enter the chest?

A

It enters in relationship to the left subclavian artery.

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11
Q

What does the vagus nerve give rise to and where does it enter the chest?

A

It gives rise to the recurrent laryngeal nerve and it enters the chest in relation to the left common carotid artery.

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12
Q

What history is taken during the staging of lung cancer?

A

Pain (especially bony pain), Headaches, or neurological symptoms including personality change. Haematuria

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13
Q

What examination needs to be taken during the staging of lung cancer?

A

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
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14
Q

What can be identified in chest X-Ray during the staging of Lung cancer?

A
  • 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
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15
Q

What can blood tests be used for during the staging of lung cancer?

A
  • Anaemia
  • Abnormal LFTs
  • Abnormal bone profile
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16
Q

When can the diaphragm be resected?

A

Only when the central portion is invaded.

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17
Q

What is CT used to see during staging of lung cancer?

A
  • Size of tumor
  • Mediastinal nodes
  • Metastatic disease - other parts of the lungs, livers, adrenals, kidneys.
  • Proximity to mediastinal structures
  • Pleural/pericardial effusion
  • Diaphragmatic involvement
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18
Q

What other tests are carried out during the staging of lung cancer?

A

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.

19
Q

What are the surgical methods of staging during lung cancer?

A
  • Bronchoscopy

- Mediastinoscopy

20
Q

What is the cardiovascular clinical assessment for fitness for surgery?

A

Angina? Heart Problems? High blood pressure? DM? PVD, Smoking? Stroke? Carotid bruits? Prev Angioplasty? Heart murmurs?

21
Q

What is the respiratory clinical assessment for fitness for surgery?

A

Barrell chested? COAD? Still smoking? Asthmatic? Recent URTI? On oxygen? Exercise capacity? Pervious thoracotomy or ICD?

22
Q

What is the psychiatric clinical assessment for fitness for surgery?

A

the pH of mental illness, severe anxiety, social background, chronic pain problems.

23
Q

What are other clinical assessment questions for fitness for surgery?

A

Pulmonary hypertension? Permanent tracheostomy? Rheumatoid arthritis? Immobile patient? Cirrhosis? Radiotherapy to the chest?

24
Q

How does circulatory shock happen after surgery?

A

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.

25
Q

What lung function tests is done to test for fitness for surgery?

A
  • Spirometry
  • Diffusion studies
  • ABG on-air/SLV
  • Fractioned V/Q scan
26
Q

What cardiac assessments can be done for fitness for surgery?

A
  • ECG
  • ECHO
  • CT SCAN
  • ETT
  • Coronary angiogram
  • If in doubt dont operate
27
Q

Explain the surgical treatment of lung cancer?

A
  • Curative resection is the goal
  • Remove the minimum amount of lung tissue
  • Resection of parietal structures is feasible
  • Firm diagnosis of malignancy is highly desirable before lung resection
28
Q

What are the reasons for peri-operative death?

A
  • Adult Respiratory Distress Syndrome
  • Bronchopneumonia
  • Myocardial Infarction
  • PTE (pulmonary thromboembolism)
  • Pneumothorax
  • Intrathoracic bleeding
29
Q

What is the mortality for ARDS following lung resection?

A

at least 50%

30
Q

What are the non fatal complications of lung cancer surgery?

A
  • Post thoracotomy wound pain
  • Empyema
  • BPF (bronchopleural fistula)
  • Wound infection
  • AF
  • MI (myocardial infarction)
  • Post-op respiratory insufficiency
  • Gastroparesis/constipation
31
Q

What are the most common problems with the staging of lung cancer?

A
  • Collapse of the lobe or lung makes tumor size difficult to assess
  • Presence of another pulmonary nodule
  • Retrosternal thyroid
  • Adrenal nodule
  • CT head is not routinely performed pre-op
32
Q

What is recurrent laryngeal nerve palsy?

A

Paralysis of the larynx (voice box) caused by damage to the recurrent laryngeal nerve or its parent nerve, the vagus nerve, which originates in the brainstem and runs down to the colon. The recurrent laryngeal nerve supplies the larynx (voice box).

32
Q

What is recurrent laryngeal nerve palsy?

A

Paralysis of the larynx (voice box) caused by damage to the recurrent laryngeal nerve or its parent nerve, the vagus nerve, which originates in the brainstem and runs down to the colon. The recurrent laryngeal nerve supplies the larynx (voice box).

33
Q

What is ABG?

A

Arterial blood gas (ABG): The sampling of the blood levels of oxygen and carbon dioxide within the arteries, as opposed to the levels of oxygen and carbon dioxide in venous blood. Typically the acidity, or pH, of the blood is measured simultaneously with the gas levels in ABG sampling.

34
Q

What is peri-operative death?

A

Death within 2 weeks of a surgical procedure

35
Q

What is ARDS?

A

Acute respiratory distress syndrome - Condition that leads to low oxygen levels in the blood. Fluid builds up in the air sacs. This prevents the lungs from filling with air and moving enough oxygen into the bloodstream.

36
Q

What is gastroparesis?

A

Spontaneous movement of the muscles (motility) in your stomach does not function normally

37
Q

What is a retrosternal thyroid?

A

The abnormal location of all or part of the thyroid gland below the breastbone (sternum)

37
Q

What is a retrosternal thyroid?

A

The abnormal location of all or part of the thyroid gland below the breastbone (sternum)

38
Q

When might be confused for cancer?

A

Tb, lung abscess
Benign tumour - hamartoma

Granuloma
Fibrosis
Paraffinoma

39
Q

When might be confused for cancer?

A

Tb, lung abscess
Benign tumour - hamartoma

Granuloma
Fibrosis
Paraffinoma

40
Q

Define hamartoma

A

Disorganised mass of cells. The cells are the same as those found in the local area, non- malignant. Growth rate is equal to that of the surrounding area

41
Q

Define parrafinoma

A

Injection of paraffin causing a tumefaction, usually a granuloma

Respiratory System & CVS Physiology Year 1 (58 decks)

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