Surgical management of lung cancer Flashcards
What does a higher T status mean?
larger tumour
What does N status refer to?
whether regional lymph nodes are involved.
Suggests a more advanced stage as lymph nodes involved can compress or invade nearby nerves
What is lymph node involvement in lung cancer responsible for damaging ?
recurrent laryngeal nerve ( can cause hoarseness as nerve controls voice box) or phrenic nerve( cause breathing difficulty)
what is aorto pulmonary window?
region between aortic arch and left pulmonary artery (important area where lymph nodes sit)
What is the connection between aortic arch and left pulmonary artery called?
ligamentum arteriosum- near where recurrent laryngeal nerve loops around
What is the recurrent laryngeal nerve notorious for being involved with?
being destroyed by malignant lymph node processes in the hilum of the left lung- which have spread into mediastinum tissues adjacent to hilum of left lung (where nerve lies)
Where does phrenic nerve enter the chest?
in relationship to left subclavian artery on the left side and then comes to lie anteriorly in relation to hilum of the lung
Where does vagus nerve enter the chest?
gives rise to the recurrent laryngeal nerve and enters the chest in relation to the left common carotid artery and vagus nerve comes to lie posterior to the hilum of the lung
What is lung cancer M status?
reflects distant metastasis
M0- no distant spread M1-spread to distant organs
History of lung cancer?
painful, esp if in bones.
Headaches or neurological symptoms including personality change.
On examination , what to look for?
recurrent nerve palsy (hoarse), brachial nerve palsy, SVCO, supraclavicular lymph nodes, soft tissue nodules (inoperable disease)
Pleural effusion?
could be malignant
surgery cannot get rid of this
Chest wall invasion?
possible to resect the invaded ribs and intervening soft tissues.
Can reconstruct that part of chest wall with a pericardial patch
Phrenic nerve palsy?
extensive invasion of the mediastinum- not operable
Collapsed lobe or lung?
need to work out how much is tumour and how much is lung
Tests for lung cancer?
bone scan
abnormal LFTs - ultrasound of liver
abnormal bone profile
What does staging of lung cancer take into account?
size of tumour
mediastinal nodes
metastatic disease
proximity to mediastinal structures- that can’t be resected
pleural/ pericardial effusion- inoperable
diaphragmatic involvement- central bit can be resected
Scans used in detecting lung cancer?
PET scan
MRI-degree of vascular and neurological involvement in pancoast tumour
Bone scan-good for chest wall invasion and bony metastases
ECHO- pericardial effusion- might be malignant
Why is bronchoscopy and mediastinoscopy undertaken?
see if theres two cm of normal main bronchus before tumour
need to see if normal bronchus on proximal side of tumor
mediastinoscopy- telescope placed to small incision above sternum and sternal notch and can take biopsies of lymph nodes- then reject
Clinical assessment for fitness for surgery?
CVS problems- previous CABG/ angioplasty- would want to get an angiogram.
Resp problems
assessing psych background - not for severe mental condition
pulmonary hypertension, cirrhosis of liver(important role in removing poisons after surgery- if not working there is possibility of circulatory shock)
What are the routine lung function tests on lung cancer patients?
spirometry
diffusion studies
ABG on air/SLV
Fractionated V/Q scan
Cardio assessment for fitness for surgery?
ECG
ECHO
CT Scan
ETT
Coronary angiogram
What are the reasons for peri-operative death?
Adult resp distress syndrome (interstitial lung disease)
Bronchopneumonia
myocardial infarction
pulmonary embolism
pneumothorax
intrathoracic bleeding
Non fatal complications after surgery?
wound pain
empyema
BPF (broncho pleural fistula)
wound infection
AF
MI
Post op respiratory insufficiency
constipation
