Surgical Management of Lung Cancer Flashcards
What might be included in the history for someone with lung cancer?
Pain, headaches, neurological symptoms including personality change. Haematuria
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 the larynx (voice box) caused by damage to the recurrent laryngeal nerve or its parent nerve, the vagus nerve, which originates in the brainstem and runs down to the colon. The recurrent laryngeal nerve supplies the larynx (voice box).
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?
The size of the tumour Mediastinal nodes Metastatic disease (other parts of the 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 the degree of vascular and neurological involvement in pancoast tumour
What is a Bone scan a good test for?
Good test for chest wall invasion and for bony metastases
What is an ECHO good for?
Demonstrating the 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?
CVS, respiratory, psychology
CVS - Angina, heart problems, High blood pressure, Pulmonary vascular disease, smoking, Stroke, Transient ischemic attack. Carotid bruits (systolic sound), previous coronary artery bypass, angioplasty (stent), heart murmurs
Resp: Barrell chested, (COPD – chest always slightly expanded, COAD (chronic obstructive airway disease), Still smoking, Asthmatic, Recent URTI, On oxygen, Exercise capacity. Previous thoracotomy or ICD (implantable cardioverter – defibrilator)
Psych: PH of mental illness, severe anxiety, social background, chronic pain problems
Other: Pulmonary hypertension, permanent tracheostomy, rheumatoid arthritis, immobile patient, cirrhosis
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): The sampling of the blood levels of oxygen and carbon dioxide within the arteries, as opposed to the levels of oxygen and carbon dioxide in venous blood. Typically the acidity, or pH, of the blood is measured simultaneously with the gas levels in ABG sampling.
How do you assess someones heart before surgery?
ECG - (electrocardiogram)
ECHO - echocardiography - ultrasound of the heart
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 peroperative death?
ARDS Bronchopneumonia Myocardial Infarction PTE Pneumothorax Intrathoracic bleeding
What is ARDS?
Acute respiratory distress syndrome - Condition that leads to low oxygen levels in the blood. Fluid builds up in the air sacs. This prevents the lungs from filling with air and moving enough oxygen into the bloodstream.
What does PTE stand for?
Pulmonary thromboembolism
What non-fatal complications exist after an operation?
Pain Empyema BPF Wound infection AF MI Post-op respiratory insufficiency Gastroparesis/constipation.
What does BPF stand for?
Bronchopulmonary fistula
What does MI stand for?
Myocardial infarction
What is gastroparesis?
Spontaneous movement of the muscles (motility) in your stomach does not function normally
When is it difficult to assess the size of a tumour?
Because of collapse of a lobe or lung
What are the commonest problems with staging of lung cancer?
Presence of another pulmonary nodule
Retrosternal thyroid
Adrenal Nodule - benign tumour in the adrenal gland
What is a retrosternal thyroid?
The abnormal location of all or part of the thyroid gland below the breastbone (sternum)
Define pneumonectomy
Surgical removal of a lung or part of a lung.
When might be confused for cancer?
Tb, lung abscess Benign tumour - hamartoma Granuloma Fibrosis Paraffinoma
Define hamartoma
Disorganised mass of cells. The cells are the same as those found in the local area, non- malignant. Growth rate is equal to that of the surrounding area
Define parrafinoma
Injection of paraffin causing a tumefaction, usually a granuloma
