Surgical Management of Lung Cancer Flashcards
RECAP- what does T refer to in the TNC classification for tumours?
Size of tumour
Anatomical position of tumour
How big would a tumour be to be considered T1?
<3cm
How big would a tumour be to be considered T2?
<5cm
How big would a tumour be to be considered T3?
> 5cm
What does a T4 classification mean?
Tumour is attached to vital structures like the trachea and superior vena cava.
RECAP- what does N refer to in the TNM classification for tumours?
Whether or not lymph nodes are involved with the tumour.
In lung cancer, what type of lymph node are we dealing with?
Hilar lymph nodes
Mediastinal lymph nodes
In the TNM classification, the higher the number after the N…?
The higher the number of lymph node affected by the tumour.
Lymph node involvement in lung cancer can lead to which nerve complications?
Recurrent laryngeal nerve palsy
Phrenic nerve palsy.
RECAP- what does M in the TNM classification of tumours refer to?
Distant metastasis.
Name some common metastases of lung cancer tumours.
The brain, the bones, the liver, the adrenals, other parts of the lungs
Name some symptoms in a history taking which may suggest lung cancer.
Pain, esp. bony pain.
Headaches or neurological symptoms including personality change. Haematuria*.
*blood in urine
List some of the things that might be seen in the examination of someone with lung cancer.
Recurrent laryngeal nerve palsy
Brachial plexus palsy
SVCO, supraclavicular LN
Soft tissue nodules
Chest wall masses.
Pleural/pericardial effusion.
Hepatomegaly*.
*enlarged liver
What might you see in a chest x-ray of someone with lung cancer?
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung
What feature in a chest x-ray would make a surgeon come to the decision that a patient is unoperable?
Pleural effusion- surgery will not get rid of disease
Phrenic nerve palsy- extensive invasion of mediastinum so inoperable.
What would you check for in blood tests may you take in someone with lung cancer?
Anaemia
Abnormal LFT’s
Abnormal bone profile
What gets injected into a patient during a PET scan?
Fluorodeoxyglucose
What test is used on every patient with lung cancer to test their fitness for surgery?
ECHO as shows if there is significant pericardial effusion
What test is a good test for chest wall invasion and for bony metastases?
Bone scan
Which test may be useful in determining the degree of vascular and neurological involvement in Pancoast tumour?
MRI
In terms of fitness for surgery, what types of cardio questions would you ask the pateint?
Angina?
Heart problems?
HBP, DM, PVD, Smoking, Stroke/TIA, Carotid bruits?
Prev CABG/angioplasty?
Heart murmurs?
In terms of fitness for surgery, what types of respiratory questions would you ask the pateint?
Barrell-chested?
COAD?
Still smoking?
Asthmatic?
Recent URTI?
On oxygen?
Exercise capacity.
Previous thoracotomy or ICD?
In terms of fitness for surgery, what types of psych questions would you ask the pateint?
PH of mental illness?
Severe anxiety?
Social background
Chronic pain problems
In terms of fitness for surgery, what types of cardio questions would you ask the pateint?
Which respiratory tests are regularly carried out on lung cancer patients?
Spirometry
Diffusion studies
ABG (arterial blood gases) on air/SLV
Fractionated V/Q scan
Which cardiac tests may be carried out on lung cancer patients being operating?
ECG
ECHO
CT scan
ETT
Coronary angiogram
List some causes of death around the time of the operation for lung cancer patients.
ARDS (adult respiratory distress syndrome).
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding
List some of the non-fatal complications of surgery on lung cancer patients.
Post thoracotomy wound pain
Empyema
BPF- bronchopleural fistula
Wound infection
Post-op respiratory insufficiency
Gastroparesis/constipation
What type of lung cancer surgery has the highest mortality rate approx?
Pneumonectomy
For those who have had an operation to remove lung cancer, what % chance is there that they will develop another lung cancer in their lifetime?
5%
