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Respiration > Surgical management of lung cancer > Flashcards

Surgical management of lung cancer Flashcards

1
Q

What history signs help with staging lung cancer?

A

Pain (especially bone pain)
Headaches or neurological symptoms (e.g. personality changes)
Haematuria

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2
Q

What examination signs help with staging lung cancer?

A

Recurrent laryngeal nerve palsy
Brachial plexus palsy
SVCO
Supraclavicular LNs
Soft tissue nodules
Chest wall masses
Pleural/pericardial effusion
Hepatomegaly

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3
Q

What are you looking for on a CXR?

A

Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lob/lung

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4
Q

What does phrenic nerve palsy show?

A

Extensive invasion of the mediastinum
Not inoperable

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5
Q

What can collapsed lobe or lung show?

A

Extent of tumour via PET scanning
How much collapsed lung is tumour or normal tissue

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6
Q

What blood tests would you do when staging/diagnosing lung cancer?

A

Anaemia
Abnormal LFTS
Abnormal bone profile

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7
Q

What does anaemia show in terms of lung cancer?

A

If anaemic then likely metastasis to the bone, there would be abnormal uptake in the skeleton consistent with metastatic disease.

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8
Q

What does a PET CT scan show?

A

Areas of high metabolic activity
- Metastatic tumours

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9
Q

What other tests can be done to stage lung cancer?

A

MRI
Bone scan
ECHO

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10
Q

What does an MRI tell us about lung cancer?

A

Useful in determining the degree of vascular and neurological involvement in Pancoast tumour.

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11
Q

What can a bone scan tell us about lung cancer?

A

Checks for chest wall invasion and for bony metastasis

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12
Q

What does an ECHO show us?

A

Demonstrates presence or absence of significant pericardial effusion

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13
Q

What are the means of surgical staging?

A

Bronchoscopy
Mediastinoscopy

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14
Q

What is the most important factor in assessing fitness for surgery?

A

Do they have heart or respiratory problems

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15
Q

What heart problems are of note in terms of fitness?

A

Angina
HBP
Diabetes (DM)
Peripheral vascular disease (PVD)
Stroke
Carotid bruits
Previous CABG/angioplasty
Heart murmurs

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16
Q

What respiratory problems are of note in terms of fitness?

A

Barrel chested
COAD
Still smoke
Asthmatic
Recent URTI
On oxygen
Exercise capacity
Previous thoracotomy or ICD

17
Q

What are the key psychiatric issues to determine before surgery?

A

History of mental illness
Sever anxiety
Social background
Chronic pain problems

18
Q

What other factors need to be assessed in assessing fitness for surgery?

A

Pulmonary hypertension
Permanent tracheostomy
Rheumatoid arthritis
Immobile patient
Cirrhosis of liver - reject for surgery, suggest radiotherapy instead
h/o radiotherapy to chest

19
Q

What routine lung function tests are done on surgery patients?

A

Spirometry
Diffusion studies
ABG on air/SLV
Fractionated V/Q scan

20
Q

What investigations are done in cardiac assessment?

A

ECG
ECHO
CT scan
ETT (exercise test)
Coronary angiogram

21
Q

What are the aims of surgical treatment?

A

Curative resection
Remove minimum amount of lung tissue
Resection of parietal structures is feasible
Firm diagnosis of malignancy is highly desirable before lung resection

22
Q

What are some reasons for pre-operative death?

A

ARDS - adult respiratory distress syndrome
Bronchopneumonia
Myocardial infarction
PTE
Pneumothorax
Intrathoracic bleeding

23
Q

What are some non-fatal complications of surgery?

A

Wound pain
Empyema
BPF = broncho pleural fistula
Wound infection
AF
MI
Post-operative respiratory insufficiency
Gastroparesis/constipation

24
Q

What are some common problems encountered when staging tumours?

A

Collapse of a lobe or lung makes tumour size difficult to assess
Presence of another pulmonary nodule
Retrosternal thyroid
Adrenal nodule

25
Q

What are the common 4 procedures performed on lung cancer patients and what are the mortality rates?

A

Pneumonectomy 5-10%
Lobectomy 3-5%
Wedge resection 2-3%
Open/close thoracotomy 5%

26
Q

What are some differential diagnosis’s of lung cancer?

A

Infection
○ Lung abscess
○ TB
Benign tumour
○ Hamartoma
Granuloma
○ Sarcoid
○ Wegener’s
○ Rheumatoid nodule
○ Inflammatory pseudotumor
Fibrosis
○ PMF
○ Organising pulmonary infarct
Paraffinoma

Respiration (27 decks)

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