Surgical management of lung cancer Flashcards
What must be assessed before a patient can undergo surgery?
Staging of the lung cancer
Fitness of the patient
Where do lung cancers often metastasise to?
Other lung Brain Liver Adrenals Bone
What aspects of a history would help stage lung cancer?
Pain - especially bony pain
Headaches or neurological symptoms such as personality changes
Haematuria
What aspects of a clinical exam would help you stage a lung cancer?
Recurrent laryngeal nerve palsy Brachial plexus palsy SVCO Supraclavicular LNs Soft tissue nodules Chest wall masses Pleural/pericardial effusion Hepatomegaly
What imaging is main stay for staging lung cancer?
CXR
CT
PET
Why are CXR’s useful in staging?
Can identify:
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung - atelectasis
Why are blood tests a useful investigation to stage lung cancer?
Measure/identify:
Anaemia
Abnormal LFTs
Abnormal bone profile
Why are CT scans useful investigations for staging lung cancers?
Allow you to measure/identify:
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 type of imaging can be done alongside a CT?
PET
PET-CT
What are the less commonly used types of imaging for staging lung cancer?
MRI
Bone scan
ECHO
Why are MRI’s used?
Used for patients with pancoast tumours
Useful in determining the degree of vascular and neurological involvement
Why are Bone scans sometimes used?
Good test for chest wall invasion and for bony metastases
When would you use an ECHO?
Will demonstrate presence or absence of significant pericardial effusion
What surgical investigations are available for staging lung cancer?
Bronchoscopy
Mediastinoscopy
What systems are important to investigate in determining the fitness of a patient for surgery?
Cardiovascular
Respiratory
Neurological
What aspects of a history would help determine a patient’s cardiovascular fitness for surgery?
Angina? Heart problems? HBP Diabetes Mellitus PVD Smoking Stroke/TIA Carotid bruits? Prev CABG/angioplasty Heart murmurs? Do they have an ICD?
What aspects of a patient’s respiratory history/examination are useful for determining Fitness for surgery?
Barrell-chested? COPD? Still smoking? Asthmatic? Recent URTI? On oxygen? Exercise capacity? Previous thoracotomy or ICD?
What points would you cover in a history to assess a patients phycological fitness for surgery?
PH of mental illness
Severe anxiety
Social background
Chronic pain problems
What other features of a clinical assessment are important in determining a patient’s fitness for surgery?
Pulmonary hypertension Permanent tracheostomy Rheumatoid arthritis The immobile patient Cirrhosis
h/o radiotherapy to chest
What tests would you do to measure a patient’s respiratory fitness for surgery?
Spirometry
Diffusion studies
ABG on air/SLV
Fractionated V/Q scan
What investigations are available for measuring the cardiac fitness of a patient for surgery?
ECG ECHO CT scan ETT Coronary angiogram
If in doubt, don’t operate
What are the causes of peri-operative death during lung cancer resection?
ARDS Bronchopneumonia Myocardial Infarction PTE Pneumothorax Intrathoracic bleeding
What are the commonest problems faced in 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
What are the main types of lung surgery procedures?
Pneumonectomy
Lobectomy
Wedge resection
Open/ close thoracotomy
