Surgical management of lung cancer Flashcards
What % of lung cancer cases are linked to asbestos exposure?
4%
What are the symptoms of lung cancer?
Cough Fatigue weight loss SOB haemoptysis chest pain recurrent chest infections wheeze hoarse voice dysphagia fever face swelling
What are the symptoms of metastatic lung cancer, in addition to general symptoms?
bone pain spinal compression limb weakness paraesthesia bladder/bowel dysfunction vomiting dizziness headache ataxia focal weakness thrombosis
Paraneoplastic effects of lung cancer:
Hyponatraemia SIADH Anaemia Hypercalcaemia Parathyroid hormone related protein
What are the clinical signs of lung cancer?
Finger clubbing Lymphadenopathy Horners syndrome from Pancoast tumour Superior vena cava obstruction Hepatomegaly Skin nodules Lung signs
Where are large cell tumours likely to found?
Anywhere in the lungs
Where are the adenocarcinoma tumours likely to be found?
Develop from mucus producing cells found on the outer edges of the lungs
Where are the squamous tumours likely to be found?
Originiate from epithelium of the airways, mainly affect the centre of the lungs
Where are SCLC tumours likely to be found?
Larger airways and in major bronchus wall
What imaging can be used when investigating lung cancer?
CXR CT PET Isotope bone scan Head CT
What techniques can be used for tissue diagnosis of lung cancer?
Bronchoscopy EBUS Image guided lung/liver biopsy Fine needle aspiration Excision of cerebral metastases Boe biopsy Mediastinoscopy/otomy Surgical excision biopsy
What % of patients undergo surgery?
18%
What drugs are suggested for squamous cell carcinoma?
Cisplatin or gemcitabine
What drugs are suggested for small cell carcinoma?
Cisplatin or etoposide
What drugs are suggested for adenocarcinoma?
Cisplatin or pemetrexed
Describe how we classify performance status
0 = fully active 1 = symptoms but ambulatory 2 = up and about >50%, cant work 3 = up and about <50%, limited self care 4 = bed or chair bound
From CXR for suspected lung cancer, what other differential diagnoses can be found?
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung
What cardiovascular symptoms affect fitness for lung surgery?
Angina Hypertension Diabetes mellitus Peripheral vascular disease Smoking Stroke/TIA Carotid bruits Previous CABG/angioplasty Murmurs ICD
What respiratory symptoms affect fitness for lung surgery?
Barrel chested COPD Smoking Asthma Recent URTI On oxygen Exercise capacity Previous thoracotomy Pulmonary hypertension Permanent tracheostomy History of radiotherapy to the chest
What psychosocial symptoms affect fitness for lung surgery?
PH of mental illness Severe anxiety Social background Chronic pain problems Immobil patient
Describe some methods of testing respiratory function when assessing fitness for surgery?
Spirometry
Diffusion studies
Arterial blood gases
Fractionated V/Q scans
Describe some methods of testing CV function when assessing fitness for surgery?
ECG ECHO CT ETT (exercise tolerance tests) Coronary angiogram
What are some reasons for peri-operative death during lung surgery?
ARDS Bronchopneumonia MI PTE Pneumothorax Intrathoracic bleeding
What are some non-fatal complications of surgery for lung cancer?
Post thoracotomy wound pain Empyema Bronchopleural fistula Wound infection Atrial fibrillation Post op respiratory insufficiency Gastroparesis (delayed gastric emptying) Constipation
What infections can cause lesions that look like lung tumours?
TB
Lung abscess
What benign tumours can cause lesions that look like lung tumours?
Hamartoma
What granulomas can cause lesions that look like lung tumours?
Sarcoid Wegeners Rheumatoid nodule Inflammatory psuedotumour Paraffinoma
What fibrotic diseases can cause lesions that look like lung tumours?
Primary myelofibrosis
Organising pulmonary infarct
