surgical management of lung cancer Flashcards
when my surgery to remove a lung cancer be turned down?
- if lung function is too low for the patient to survive with a lung or lobe removed
- metastases present or other reasons that mean all cancer cannot be removed
what is phrenic nerve palsy?
a cancer invades a phrenic nerve, meaning that one side of the diaphragm is not innervated so sits much higher than normal
are tumours invading the trachea operable?
no
what are some metastatic sites for lung cancer?
brain liver bone eg. vertebrae adrenal glands lung
what are the signs in the history that can help stage lung cnacer?
pain, especially bony pain
headaches or neurological symptoms including personality change
haematuria (blood in urine)
what features on examination help to stage lung cancer?
- recurrent laryngeal nerve palsy
- brachial plexus palsy
- SVCO (superior vena cava obstruction)
- supraclaviclar lymph nodes
- soft tissue nodules
- chest wall masses
- pleural/pericardial effusion
- hepatomegaly
what can be looked for in a CXR to stage lung cancer?
pleural effusion chest wall invasion phrenic nerve palsy collapsed lobe or lung size
what blood tests can be used to stage cancer and what do they show?
-anaemia cancer causing severe blood loss
abnormal LFTs (liver function tests) (?liver metastases)
abnormal bone profile (?bone metastases)
what can CT scanning be useful to find out about a lung cancer to stage it?
- size of tumour
- mediastinal nodes
- metastatic disease
- proximity to mediastinal structures
- pleural/pericardial effusion
- diaphragmatic involvement
what is MRI useful for when staging lung cancer?
determining the degree of vascular and neurological involvement in pancoast tumour
what is a bone scan useful for when staging lung cancer?
good test for chest wall invasion and bony metastases
what is an echocardiogram useful for when staging lung cancer?
will demonstrate the presence or absence of pericardial effusion
what surgical methods are used to stage lung cancer?
bronchoscopy
mediastinoscopy
what cvs conditions may affect a patients fitness for surgery?
- angina
- heart problems
- HBP
- diabetes mellitus
- peripheral vascular disease
- smoking
- stroke or transient ischaemic attack
- carotid bruits (cystolic noises heard in catotid artery)
- previous coronary artery bypass graft
- angioplasty (widening or coronary artery)
- heart murmurs
what respiratory conditions may affect a patient’s fitness for surgery?
barrell-chested COPD smoking asthmatic recent URTI on oxygen exercise capacity previous thoracotomy or ICD (implantable cardioverter-defibrillator)
what psychological conditions may affect a patient’s fitness for surgery?
- PH of mental illness
- severe anxiety
- social background
- chronic pain problems
what are some ‘other’ conditions that will affect a patient’s fitness for surgery?
-Pulmonary hypertension
-permanent
tracheostomy
-rheumatoid arthritis
-immobile patient Cirrhosis
h/o radiotherapy to chest
what are some respiratory function tests used to assess fitness for surgery?
- spirometry
- diffusion studies eg. CO study
- fractionated V/Q scan
- arterial blood gas
which tests can be done to test fitness for surgery (in terms cvs)?
ECG ECHO CT scan ETT (exercise tolerance test) Coronary angiogram
what is the ultimate goal of surgical treatment of lung cancer?
curative resection by removing the minimum amount of lung
is resection of the parietal structures faesible?
yes
what is highly desirable before resection?
firm diagnosis of malignancy
what are the reasons for post operative death?
- adult respiratory distress syndrome (fluid collects in the lungs)
- Bronchopneumonia
- Myocardial Infarction
- PTE (pulmonary thromboembolism)
- Pneumothorax
- Intrathoracic bleeding
what are some non-fatal complications of lung cancer?
- Post thoracotomy wound pain
- Empyema
- BPF (broncho-pleural fissula, stitches/ staples loosen and air leaks into interpleural space
- Wound infection
- AF-atrial fibrilation
- MI
- Post-op respiratory insufficiency
- Gastroparesis/constipation
what are some conditions that can be mistaken for lung cancer?
Infection - TB, Lung abscess
Benign tumour - Hamartoma
Granuloma - Sarcoid, Wegener’s, Rheumatoid nodule, inflammatory pseudotumour
Fibrosis - PMF, organising pulmonary infarct
Other - Paraffinoma
what are some problems with staging lung cancer?
- 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
