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Respiratory > Surgical Management of Lung Cancer > Flashcards

Surgical Management of Lung Cancer Flashcards

1
Q

What might be included in the history for someone with lung cancer?

A

Bone Pain
headaches,
neurological symptoms, personality change
Haematuria (blood in urine)

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2
Q

What might you notice during an examination of someone with lung cancer?

A

Recurrent laryngeal palsy,
brachial plexus palsy
SVCO
Supraclavicular lymph nodes,
soft tissue nodules,
chest wall masses.
Pleural/pericardial effusion.
Hepatomegaly

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3
Q

What is recurrent laryngeal nerve palsy?

A

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

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4
Q

What can a chest X-ray indicate?

A

Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung

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5
Q

What can blood tests indicate?

A

Anaemia
Abnormal LFTs (liver function tests)
Abnormal bone profile

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6
Q

What does a CT scan show you?

A

Size of tumour
Mediastinal nodes
Metastatic disease (other parts of lungs, liver, adrenals or kidneys)
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement

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7
Q

What other tests besides X-ray, blood tests and CT scans might help a diagnosis?

A

MRI
Bone Scan
ECHO

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8
Q

What is an MRI useful for?

A

Determining degree of vascular & neurological involvement in pancoast tumour

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9
Q

What is a Bone scan a good test for?

A

Chest wall invasion
Bone metastases

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10
Q

What is an ECHO good for?

A

Demonstrating presence or absence of significant pericardial effusion.

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11
Q

What are the surgical methods of lung cancer staging?

A

Bronchoscopy
Mediastinoscopy

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12
Q

What considerations would you have to make before operating?

A

Any diseases/problems related to:

CVS
Respiratory
Psychology

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13
Q

What are the respiratory function tests needed to assess fitness for surgery?

A

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

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14
Q

What is ABG?

A

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

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15
Q

How do you assess someones heart before surgery?

A

ECG - (electrocardiogram)
ECHO - (echocardiography) - heart US
CT scan
ETT - (exercise tolerance test, exercise ECG)
Coronary angiogram

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16
Q

What must be determined before resection?

A

Firm diagnosis of malignancy

17
Q

What is the goal in surgical treatment of cancer?

A

Curative resection, with minimal removal of lung tissue

18
Q

Is resection of the parietal structures possible?

A

Yes, feasible

19
Q

What is peri-operative death?

A

Death within 2 weeks of a surgical procedure

20
Q

What are the reasons for peri-operative death?

A

ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding

21
Q

What is ARDS?

A

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.

22
Q

What does PTE stand for?

A

Pulmonary thromboembolism

23
Q

What non-fatal complications exist after an operation?

A

Pain
Empyema
BPF
Wound infection
AF (atrial fibrillation - unusually fast HR)
MI
Post-op respiratory insufficiency
Gastroparesis/constipation.

24
Q

What does BPF stand for?

A

Bronchopulmonary fistula

25
Q

What does MI stand for?

A

Myocardial infarction

26
Q

What is gastroparesis?

A

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

27
Q

When is it difficult to assess the size of a tumour?

A

Due to collapse of a lobe or lung

28
Q

What are the commonest problems with staging of lung cancer?

A

Presence of another pulmonary nodule
Retrosternal thyroid
Adrenal Nodule - benign tumour in adrenal gland

29
Q

What is a retrosternal thyroid?

A

Abnormal location of all/part of thyroid gland below the breastbone (sternum)

30
Q

Define pneumonectomy

A

Surgical removal of a lung or part of a lung.

31
Q

When might be confused for cancer?

A

Tb, lung abscess
Benign tumour - hamartoma
Granuloma
Fibrosis
Paraffinoma

32
Q

Define hamartoma

A

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

33
Q

Define parrafinoma

A

Injection of paraffin causing a tumefaction, usually a granuloma

(tumefaction - process of swelling or becoming tumorous)

34
Q

What is the operative mortality rates for lung cancer

A

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

Respiratory (30 decks)

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