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Respiratory System DO > Surgical Management of Lung Cancer > Flashcards

Surgical Management of Lung Cancer Flashcards

1
Q

What does the assessment of a patient involve

A

Staging of the patient

Fitness of the patient

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2
Q

What does the assessment of a patient involve

A

Staging of the patient

Fitness of the patient

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3
Q

What can a chest X-Ray show when trying to stage a patient

A

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

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4
Q

What can blood tests show when trying to stage a patient

A

Anaemia
Abnormal LFTs
Abnormal bone profile

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5
Q

What will a CT scan help identifying when staging lung cancer

A 
Size of tumour
Mediastinal nodes
Metastatic disease to other parts of the lungs, liver, adrenals or kidneys
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement
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6
Q

Name 3 other tests which can be used in lung cancer staging

A

MRI
Bone scan
ECHO

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7
Q

What is a MRI useful for in lung cancer staging

A

In determining the degree of vascular and neurological involvement in a Pancoast tumour

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8
Q

What can a bone scan check for

A

Chest wall invasion

Bony metastases

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9
Q

What can an ECHO identify

A

Presence or absence of significant pericardial effusion

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10
Q

What CVS factors should be considered when assessing a patient’s fitness for surgery

A 
Angina
Heart problems
High Blood Pressure
Diabetes Mellitus
PVD
Smoking
Stroke/TIA
Carotid bruits
Prev CABG/angioplasty
Heart murmurs
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11
Q

What respiratory factors should be considered when assessing a patient’s fitness for surgery

A 
Barrell-chested
COAD
Still smoking
Asthmatic
Recent URTI
On oxygen
Exercise capacity
Previous thoracotomy or ICD
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12
Q

What psych factors should be considered when assessing a patient’s fitness for surgery

A

Previous history of mental illness
Severe anxiety
Social background
Chronic pain problems

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13
Q

What other factors should be considered when assessing a patient’s fitness for surgery

A 
Pulmonary hypertension
Permanent tracheostomy
Rheumatoid arthritis
Immobile patient
Cirrhosis
h/o radiotherapy to chest
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14
Q

What respiratory function tests are available

A

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

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15
Q

What cardiac assessment tests are available

A 
ECG
ECHO
CT scan
ETT
Coronary angiogram
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16
Q

What is the goal of surgery

A

Curative resection while removing the minimum amount of lung tissue

17
Q

Is the resection of parietal structures feasible

A

Yes

18
Q

What is highly desirable before a lung resection

A

Firm diagnosis of malignancy

19
Q

What are the reasons for pre-operative death

A 
ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding
20
Q

What are some non-fatal complication of surgery

A 
Post thoracotomy wound pain
Empyema
BPF
Wound infection
AF
MI
Post-op respiratory insufficiency
Gastroparesis/constipation
21
Q

Name 5 common problems when trying to stage cancer

A
  1. A collapsed lobe or lung will make assessing the tumour size difficult
  2. The presence of another (usually small) pulmonary nodule
  3. Retrosternal thyroid
  4. Adrenal nodule
  5. A head CT is not routinely performed pre-op
22
Q

What is the mortality rate of a pneumonectomy

A

8-12%

23
Q

What is the mortality rate of a lobectomy

A

3-5%

24
Q

What is the mortality rate of a wedge resection

A

2-3%

25
Q

What is the mortality rate of a open/close thoractomy

A

5%

26
Q

What is the 5-year post-operative survival rate for a T1N0 tumour

A

70%

27
Q

What is the 5-year post-operative survival rate for a T2N0 tumour

A

60%

28
Q

What is the 5-year post-operative survival rate for a T3N0 tumour

A

50%

29
Q

What is the 5-year post-operative survival rate for a T1N1/T2N1 tumour

A

40%

30
Q

What is the 5-year post-operative survival rate for a any N2 tumour

A

16%

31
Q

What is the 5-year post-operative chance of obtaining a second primary tumour

A

5%

Respiratory System DO (33 decks)

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