surgical management of lung cancer Flashcards
what are two factors when assessing the patient?
staging of the lung cancer
fitness of the patient
in staging of lung cancer, by taking the history what should be in it to help you undertand if it is lung cancer and what stage?
pain, esp bony pain
headaches or neurological symptoms including personality change
haematuria
what kind of testing would you use to check: Pleural effusion Chest wall invasion Phrenic nerve palsy Collapsed lobe or lung
CXR (chest x ray)
what would you be looking at if you are doing blood tests?
Anaemia
Abnormal LFTs
Abnormal bone profile
when looking at CT scan what would you be looking for?
Size of tumour Mediastinal nodes Metastatic disease - other parts of lungs, liver, adrenals, kidneys Proximity to mediastinal structures Pleural/pericardial effusion Diaphragmatic involvement
what other tests can you do to see the stage of lung cancer?
MRI - Useful in determining the degree of vascular and neurological involvement in Pancoast tumour.
Bone Scan - Good test for chest wall invasion and for bony metastases
ECHO - Will demonstrate presence or absence of significant pericardial effusion.
what surgical testing would you use for determining the stage of lung cancer?
Bronchoscopy
Mediastinoscopy
what are the questions you would ask yourself when determining a patient fit for surgery in the CVS
Angina? Heart problems? HBP, DM, PVD, Smoking, Stroke/TIA, Carotid bruits?, Prev CABG/angioplasty. Heart murmurs?
what are the questions you would ask yourself when determining a patient fit for surgery in the resp
\: Barrell-chested? COAD? Still smoking? Asthmatic? Recent URTI? On oxygen? Exercise capacity. Previous thoracotomy or ICD?
what are the questions you would ask yourself when determining a patient fit for surgery in the Psych
PH of mental illness, severe anxiety, social background, chronic pain problems
what are the respiratory function testing to test fitness for surgery?
Spirometry
Diffusion studies
ABG on air/SLV
Fractionated V/Q scan
what are the cardiovascular function testing to test fitness for surgery?
ECG ECHO CT scan ETT Coronary angiogram If in doubt, don’t operate
what are the aims of surgical treatment of the lung cancer?
Curative resection is the goal
Remove the minimum amount of lung tissue
Resection of parietal structures is feasible
Firm diagnosis of malignancy is highly desirable before lung resection
what are the reasons for peri-operative death?
ARDS Bronchopneumonia Myocardial Infarction PTE Pneumothorax Intrathoracic bleeding
what are non-fatal complications of surgery for lung cancer?
Post thoracotomy wound pain Empyema BPF Wound infection AF MI Post-op respiratory insufficiency Gastroparesis/constipation
what are the commonest problems with staging of 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
what is the operative mortality for pneumonectomy
8-12%
what is the operative mortality for lobectomy
3-5%
what is the operative mortality for wedge resection?
2-3%
what is the operative mortality for open-close thoractomy
5%
what is the percentage of 5 year survival postop with T1N0?
70%
what is the percentage of 5 year survival postop with T2N0
60%
what is the percentage of 5 year survival postop with T3N0?
50%
what is the percentage of 5 year survival postop with T1N1?T2N1?
40%
