Surgical management of lung cancer Flashcards
The non-lung cancer
- Infection: TB, Lung abscess
- Benign tumour (hamartoma)
- Granuloma: ( sarcoid, Wegener’s, rheumatoid nodule, inflammatory pseudotumour
- Fibrosis: PMF, organising pulmonary infract
- Other: paraffinoma
What type of cancer is likely to not undergo surgery + why?
- Small cell lung cancer carcinoma as it is very aggressive and metastasis is likely to occur.
- If there is a wide spread metastasis of cancer, surgery is unlikey
- preferred chemotherapy
What tests are required in staging of lung cancer?
Clinical - History, TNM status, CXR, blood tests, CT, PET, MRI, Bone scanm ECHO
Surgical - bronchoscopy, mediastinoscopy,
What is TNM staging?
- assess tumour size/position, lymph node involvement and metastasis
Lung cancer staging - state the T status + their meaning
T1 - < 3cm
T2 - 3-7cm
T3 - > 7cm
T4 - any size that invades outside of lungs (mediastinum, heart, G vessels, trachea, carina, oesophogus + vertebral bodies.
Lung cancer staging - state the N status + their meaning
N1 - ipsilateral peribronchial hilar
N2 - ipsilateral mediastinal, subcarinal
N3 - contralateral mediastinal, scalene, supravlavicular
State the performance status and their meaning
Stage 1 Features
0 -Asymptomatic, well
1 -Symptomatic, able to do light work
2 -Has to rest for <50% a day
3 -Has to rest for> 50% a day
4 -Bed bound
State the rests required for fitness for surgery
Clinical - CVS, Respiratory, Psych,
Staging of lung cancer: CXR
Checking for the following:
- Pleural effusion
- Chest wall invasion
- Phrenic nerve palsy
- Collapsed lobe/lung
What are signs of phrenic nerve palsy on a CXR?
- flat/unilateral raised diaphragm + a collapsed lobe.
Staging of lung cancer: Blood tests
Checking for the following:
-anaemia, abnormal LFT(liver function test), abnormal bone profile
Staging of lung cancer: CT
Checking for the following:
- Size of tumour
- Mediastinal nodes
- metastatic disease; other regions of lungs, liver, adrenals + kidneys
- Pleural/pericardial effusion
- diaphragmatic involvement
Staging of lung cancer: PET
- can be used to show areas of metabolic activity ( tumours, kidneys, brain heart will show bright due to MA)
- also can be used to diagnose nodule activity within mediastinum
Staging of lung cancer: MRI
-determines degree of vascular and neurological involvement in pancoast tumour(tumour of apex of lung)
Staging of lung cancer: Bone Scan
-assessing chest wall invasion + bony metastases
Staging of lung cancer: ECHO(echocardiogram)
- Demonstrates presence/absence of significant pericardial effusion( abnormal accumulation of fluid in pericardial cavity)
- type of ultrasound scan near heart + nearby BVs
Staging of lung cancer: Surgical methods
- Bronchoscopy : sample mediastinal lymph node. EBUS
- Mediastinoscopy: small cut above breast bone and follow plane of trachea untill tracheal bifucation + laryngoscope is used to sample nodes
Fitness for surgery - State the clinical assestments
CVS:
Resp:
Fitness for surgery: Respiratory function testing
- Spirometry ( test lung function)
- Diffusion studies ( how well O2 is dealt with by lungs)
- ABG on air/SLV(single lung ventilation)
- Fractionated V/Q scan(measuring amount of air that goes into lung + measure of perfusion)
Fitness for surgery: Cardiac assestment
- ECG
- ECHO
- ETT
- Croronary angiogram
State reasons for peri-operative death
- ARDS
- Bronchopneumonia
- MI
- PTE
- Pneumothorax
- Intrathhoracic bleeding
State the non-fatal complications of surgery for lung cancer?
- Post thoracotomy wound pain
- Empyema
- BPF
- Wound infection
- Atrial fibrilation
- MI
- Post op respiratory insufficient
- Gastroparesis/constipation
State the common problems with staging of lung cancer
- collapse of a love/lung makes tumour difficult to assess
- presence of another pulmonary nodule
- retrosternal thyroid
- adrenal nodule
- CT head is not routinely performed
Types of surgery
Lobectomy - removing a lobe
Pneumonectomy - removing a whole lung
Wedge resection - Removing a small section of lung
Segmentectomy - Removing larger segment
Open/close thoracotomy - open lung + close without actually operating
