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Respiratory > Surgical management of lung cancer > Flashcards

Surgical management of lung cancer Flashcards

1
Q

What must be assessed before a patient can undergo surgery?

A

Staging of the lung cancer

Fitness of the patient

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2
Q

Where do lung cancers often metastasise to?

A 
Other lung 
Brain 
Liver 
Adrenals 
Bone
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3
Q

What aspects of a history would help stage lung cancer?

A

Pain - especially bony pain

Headaches or neurological symptoms such as personality changes

Haematuria

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4
Q

What aspects of a clinical exam would help you stage a lung cancer?

A 
Recurrent laryngeal nerve palsy
Brachial plexus palsy
SVCO
Supraclavicular LNs
Soft tissue nodules
Chest wall masses
Pleural/pericardial effusion
Hepatomegaly
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5
Q

What imaging is main stay for staging lung cancer?

A

CXR
CT
PET

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6
Q

Why are CXR’s useful in staging?

A

Can identify:

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

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7
Q

Why are blood tests a useful investigation to stage lung cancer?

A

Measure/identify:

Anaemia
Abnormal LFTs
Abnormal bone profile

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8
Q

Why are CT scans useful investigations for staging lung cancers?

A

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
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9
Q

What other type of imaging can be done alongside a CT?

A

PET

PET-CT

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10
Q

What are the less commonly used types of imaging for staging lung cancer?

A

MRI
Bone scan
ECHO

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11
Q

Why are MRI’s used?

A

Used for patients with pancoast tumours

Useful in determining the degree of vascular and neurological involvement

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12
Q

Why are Bone scans sometimes used?

A

Good test for chest wall invasion and for bony metastases

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13
Q

When would you use an ECHO?

A

Will demonstrate presence or absence of significant pericardial effusion

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14
Q

What surgical investigations are available for staging lung cancer?

A

Bronchoscopy

Mediastinoscopy

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15
Q

What systems are important to investigate in determining the fitness of a patient for surgery?

A

Cardiovascular
Respiratory
Neurological

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16
Q

What aspects of a history would help determine a patient’s cardiovascular fitness for surgery?

A 
Angina? 
Heart problems?
HBP
Diabetes Mellitus
PVD
Smoking
Stroke/TIA
Carotid bruits?
Prev CABG/angioplasty
Heart murmurs?
Do they have an ICD?
17
Q

What aspects of a patient’s respiratory history/examination are useful for determining Fitness for surgery?

A 
Barrell-chested? 
COPD? 
Still smoking? 
Asthmatic? 
Recent URTI? 
On oxygen? 
Exercise capacity?
Previous thoracotomy or ICD?
18
Q

What points would you cover in a history to assess a patients phycological fitness for surgery?

A

PH of mental illness
Severe anxiety
Social background
Chronic pain problems

19
Q

What other features of a clinical assessment are important in determining a patient’s fitness for surgery?

A 
Pulmonary hypertension
Permanent tracheostomy
Rheumatoid arthritis
The immobile patient
Cirrhosis

h/o radiotherapy to chest

20
Q

What tests would you do to measure a patient’s respiratory fitness for surgery?

A

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

21
Q

What investigations are available for measuring the cardiac fitness of a patient for surgery?

A 
ECG
ECHO
CT scan
ETT
Coronary angiogram

If in doubt, don’t operate

22
Q

What are the causes of peri-operative death during lung cancer resection?

A 
ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding
23
Q

What are the commonest problems faced in staging lung cancer?

A

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

24
Q

What are the main types of lung surgery procedures?

A

Pneumonectomy
Lobectomy
Wedge resection
Open/ close thoracotomy

25
Q

What is a pneumonectomy?

A

Surgical removal of a lung

26
Q

What is a lobectomy?

A

Surgical removal of a lobe of a lung (organ)

27
Q

What is a wedge resection?

A

Surgical resection of a triangle shaped portion of tissue containing the tumour (hence it’s named)

28
Q

What is a thoracotomy?

A

Large incision into the chest wall

Often done postero-laterally so it’s the one where the patient lies on their side

Involves a chest drain placement as well, to drain away fluid during procedure and help lungs to reinflate afterwards

29
Q

Which type of surgery for lung cancer is most dangerous?

A

Pneumonectomy 5-10% operative mortality

Thoracotomy 5% operative mortality

30
Q

Which type of surgery for lung cancer is safest?

A

Wedge resection

2-3% operative mortality

31
Q

Which stage of tumour has the best prognosis?

A

T1N0

70% 5 year survival

Respiratory (32 decks)

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