Surgical Management of Lung Cancer Flashcards
What does the assessment of a patient involve
Staging of the patient
Fitness of the patient
What does the assessment of a patient involve
Staging of the patient
Fitness of the patient
What can a chest X-Ray show when trying to stage a patient
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung
What can blood tests show when trying to stage a patient
Anaemia
Abnormal LFTs
Abnormal bone profile
What will a CT scan help identifying when staging lung cancer
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
Name 3 other tests which can be used in lung cancer staging
MRI
Bone scan
ECHO
What is a MRI useful for in lung cancer staging
In determining the degree of vascular and neurological involvement in a Pancoast tumour
What can a bone scan check for
Chest wall invasion
Bony metastases
What can an ECHO identify
Presence or absence of significant pericardial effusion
What CVS factors should be considered when assessing a patient’s fitness for surgery
Angina Heart problems High Blood Pressure Diabetes Mellitus PVD Smoking Stroke/TIA Carotid bruits Prev CABG/angioplasty Heart murmurs
What respiratory factors should be considered when assessing a patient’s fitness for surgery
Barrell-chested COAD Still smoking Asthmatic Recent URTI On oxygen Exercise capacity Previous thoracotomy or ICD
What psych factors should be considered when assessing a patient’s fitness for surgery
Previous history of mental illness
Severe anxiety
Social background
Chronic pain problems
What other factors should be considered when assessing a patient’s fitness for surgery
Pulmonary hypertension Permanent tracheostomy Rheumatoid arthritis Immobile patient Cirrhosis h/o radiotherapy to chest
What respiratory function tests are available
Spirometry
Diffusion studies
ABG on air/SLV
Fractionated V/Q scan
What cardiac assessment tests are available
ECG ECHO CT scan ETT Coronary angiogram
What is the goal of surgery
Curative resection while removing the minimum amount of lung tissue
Is the resection of parietal structures feasible
Yes
What is highly desirable before a lung resection
Firm diagnosis of malignancy
What are the reasons for pre-operative death
ARDS Bronchopneumonia Myocardial Infarction PTE Pneumothorax Intrathoracic bleeding
What are some non-fatal complication of surgery
Post thoracotomy wound pain Empyema BPF Wound infection AF MI Post-op respiratory insufficiency Gastroparesis/constipation
Name 5 common problems when trying to stage cancer
- A collapsed lobe or lung will make assessing the tumour size difficult
- The presence of another (usually small) pulmonary nodule
- Retrosternal thyroid
- Adrenal nodule
- A head CT is not routinely performed pre-op
What is the mortality rate of a pneumonectomy
8-12%
What is the mortality rate of a lobectomy
3-5%
What is the mortality rate of a wedge resection
2-3%
What is the mortality rate of a open/close thoractomy
5%
What is the 5-year post-operative survival rate for a T1N0 tumour
70%
What is the 5-year post-operative survival rate for a T2N0 tumour
60%
What is the 5-year post-operative survival rate for a T3N0 tumour
50%
What is the 5-year post-operative survival rate for a T1N1/T2N1 tumour
40%
What is the 5-year post-operative survival rate for a any N2 tumour
16%
What is the 5-year post-operative chance of obtaining a second primary tumour
5%
