Surgical Management of Lung Cancer Flashcards
What might be included in the history for someone with lung cancer?
Bone Pain
headaches,
neurological symptoms, personality change
Haematuria (blood in urine)
What might you notice during an examination of someone with lung cancer?
Recurrent laryngeal palsy,
brachial plexus palsy
SVCO
Supraclavicular lymph nodes,
soft tissue nodules,
chest wall masses.
Pleural/pericardial effusion.
Hepatomegaly
What is recurrent laryngeal nerve palsy?
Paralysis of larynx (voice box)
Caused by damage to recurrent laryngeal nerve/vagus nerve (RLN)
Originates in brainstem & runs down to colon.
RLN supplies larynx
What can a chest X-ray indicate?
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung
What can blood tests indicate?
Anaemia
Abnormal LFTs (liver function tests)
Abnormal bone profile
What does a CT scan show you?
Size of tumour
Mediastinal nodes
Metastatic disease (other parts of lungs, liver, adrenals or kidneys)
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement
What other tests besides X-ray, blood tests and CT scans might help a diagnosis?
MRI
Bone Scan
ECHO
What is an MRI useful for?
Determining degree of vascular & neurological involvement in pancoast tumour
What is a Bone scan a good test for?
Chest wall invasion
Bone metastases
What is an ECHO good for?
Demonstrating presence or absence of significant pericardial effusion.
What are the surgical methods of lung cancer staging?
Bronchoscopy
Mediastinoscopy
What considerations would you have to make before operating?
Any diseases/problems related to:
CVS
Respiratory
Psychology
What are the respiratory function tests needed to assess fitness for surgery?
Spirometry
Diffusion studies
ABG on air/SLV
Fractioned V/Q scan
What is ABG?
Arterial blood gas (ABG)
Samples levels of O2 and CO2 in blood
In Arteries (not venous blood)
Acidity/pH, of blood is measured simultaneously with gas levels in ABG sampling
How do you assess someones heart before surgery?
ECG - (electrocardiogram)
ECHO - (echocardiography) - heart US
CT scan
ETT - (exercise tolerance test, exercise ECG)
Coronary angiogram
What must be determined before resection?
Firm diagnosis of malignancy
What is the goal in surgical treatment of cancer?
Curative resection, with minimal removal of lung tissue
Is resection of the parietal structures possible?
Yes, feasible
What is peri-operative death?
Death within 2 weeks of a surgical procedure
What are the reasons for peri-operative death?
ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding
What is ARDS?
Acute respiratory distress syndrome
Leads to low O2 levels blood.
Fluid builds up in air sacs
Prevents lungs from filling with air & moving enough oxygen into bloodstream.
What does PTE stand for?
Pulmonary thromboembolism
What non-fatal complications exist after an operation?
Pain
Empyema
BPF
Wound infection
AF (atrial fibrillation - unusually fast HR)
MI
Post-op respiratory insufficiency
Gastroparesis/constipation.
What does BPF stand for?
Bronchopulmonary fistula
