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Systems: Respiratory AB > Surgical Management of Lung Cancer > Flashcards

Surgical Management of Lung Cancer Flashcards

1
Q

What is considered in the assessment of the patient?

A
  • Staging of the lung cancer

- Fitness of the patient

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2
Q

If the hilum of the lung lymph nodes are involved, what is this classed as?

A

N1

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3
Q

Where are the common sites of lung cancer metastasis?

A
  • Brain
  • Skeleton
  • Other lung
  • Adrenal glands
  • Liver
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4
Q

How is lung cancer stages clinically?

A
  • History

- Examination

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5
Q

What may be present in the history of someone with lung cancer?

A
  • Pain (especially bony pain)
  • Headaches
  • Neurological symptoms including personality change
  • Haematuria
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6
Q

What may be present on examination of someone with 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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7
Q

What might be seen on the chest X-ray of someone with lung cancer?

A
  • Pleural effusion
  • Chest wall invasion
  • Phrenic nerve palsy
  • Collapsed lobe or lung
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8
Q

What might blood tests of someone with lung cancer show?

A
  • Anaemia
  • Abnormal LFTs
  • Abnormal bone profile
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9
Q

What might be seen on the CT of someone with lung cancer?

A
  • Size of tumour
  • Mediastinal nodes
  • Metastatic disease
  • Proximity to mediastinal structures
  • Pleural/pericardial effusion
  • Diaphragmatic involvement
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10
Q

What other tests are useful in lung cancer staging?

A
  • MRI
  • Bone scan
  • ECHO
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11
Q

What is an MRI useful for?

A

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

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12
Q

What is a bone scan useful for?

A

Good test for chest wall invasion and for bony metastases

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13
Q

What is an ECHO useful for?

A

Will demonstrate presence or absence of significant pericardial effusion

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14
Q

What surgical assessments can be carried out?

A
  • Bronchoscopy

- Mediastinoscopy

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15
Q

What CV conditions need to considered when assessing fitness for surgery?

A
  • Angina
  • Heart problems
  • HBP
  • DM
  • PVD
  • Smoking
  • Stroke/TIA
  • Carotid bruits
  • Previous CABG/angioplasty
  • Heart murmurs
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16
Q

What respiratory conditions need to be considered when assessing fitness for surgery?

A
  • Barrell-chested
  • COAD
  • Still smoking
  • Asthmatic
  • Recent URTI
  • On oxygen
  • Exercise capacity
  • Previous thoracotomy or ICD
17
Q

What psych conditions need to be considered when assessing fitness for surgery?

A
  • PH of mental illness
  • Severe anxiety
  • Social background
  • Chronic pain problems
18
Q

What other conditions need to be considered when assessing fitness for surgery?

A
  • Pulmonary hypertension
  • Permanent tracheostomy
  • Rheumatoid arthritis
  • The immobile patient
  • Cirrhosis
  • h/o radiotherapy to chest
19
Q

What respiratory function tests should be carried out during fitness for surgery assessment?

A
  • Spirometry
  • Diffusion studies
  • ABG on air/SLV
  • Fractioned V/Q scan
20
Q

What cardiac tests should be carried out during fitness for surgery assessment?

A
  • ECG
  • ECHO
  • CT scan
  • ETT
  • Coronary angiogram
  • If in doubt, don’t operate
21
Q

What are the principles of surgical treatment of lung cancer?

A
  • Curative resection is the goal
  • Remove the 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 the main reasons for peri-operative death?

A
  • ARDS
  • Bronchopneumonia
  • Myocardial infarction
  • PTE
  • Pneumothorax
  • Intrathoracic bleeding
23
Q

What are the main non-fatal complications of lung cancer surgery?

A
  • Post thoracotomy wound pain
  • Empyema
  • BPF
  • Wound infection
  • AF
  • MI
  • Post-op respiratory insufficiency
  • Gasstroparesis/constipation
24
Q

What are the commonest problems with staging of lung cancer?

A
  • Collapse of a lobe or lung makes tumour size difficult to assess
  • Presence of another (usually small) pulmonary nodule
  • Retrosternal thyroid
  • Adrenal nodule
  • CT head is not routinely performed pre-op
25
Q

What are the operative mortality stats?

A
  • Pneumonectomy 8-12%
  • Lobectomy 3-5%
  • Wedge resection 2-3%
  • Open/close thoracotomy 5%
26
Q

What might it be if its not lung cancer?

A
  • Infection: TB, lung abscess
  • Benign tumour: Hamartoma
  • Granuloma: Sarcoid, Wegner’s, Rheumatoid nodule, inflammatory pseudotumour
  • Fibrosis- PMF, organising pulmonary infarct
  • Other- Paraffinoma

Systems: Respiratory AB (39 decks)

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