Surgical management of lung cancer Flashcards

1
Q

The non-lung cancer

A
  • Infection: TB, Lung abscess
  • Benign tumour (hamartoma)
  • Granuloma: ( sarcoid, Wegener’s, rheumatoid nodule, inflammatory pseudotumour
  • Fibrosis: PMF, organising pulmonary infract
  • Other: paraffinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of cancer is likely to not undergo surgery + why?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What tests are required in staging of lung cancer?

A

Clinical - History, TNM status, CXR, blood tests, CT, PET, MRI, Bone scanm ECHO

Surgical - bronchoscopy, mediastinoscopy,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is TNM staging?

A
  • assess tumour size/position, lymph node involvement and metastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lung cancer staging - state the T status + their meaning

A

T1 - < 3cm
T2 - 3-7cm
T3 - > 7cm
T4 - any size that invades outside of lungs (mediastinum, heart, G vessels, trachea, carina, oesophogus + vertebral bodies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lung cancer staging - state the N status + their meaning

A

N1 - ipsilateral peribronchial hilar
N2 - ipsilateral mediastinal, subcarinal
N3 - contralateral mediastinal, scalene, supravlavicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

State the performance status and their meaning

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

State the rests required for fitness for surgery

A

Clinical - CVS, Respiratory, Psych,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Staging of lung cancer: CXR

A

Checking for the following:

  • Pleural effusion
  • Chest wall invasion
  • Phrenic nerve palsy
  • Collapsed lobe/lung
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are signs of phrenic nerve palsy on a CXR?

A
  • flat/unilateral raised diaphragm + a collapsed lobe.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Staging of lung cancer: Blood tests

A

Checking for the following:

-anaemia, abnormal LFT(liver function test), abnormal bone profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Staging of lung cancer: CT

A

Checking for the following:

  • Size of tumour
  • Mediastinal nodes
  • metastatic disease; other regions of lungs, liver, adrenals + kidneys
  • Pleural/pericardial effusion
  • diaphragmatic involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Staging of lung cancer: PET

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Staging of lung cancer: MRI

A

-determines degree of vascular and neurological involvement in pancoast tumour(tumour of apex of lung)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Staging of lung cancer: Bone Scan

A

-assessing chest wall invasion + bony metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Staging of lung cancer: ECHO(echocardiogram)

A
  • Demonstrates presence/absence of significant pericardial effusion( abnormal accumulation of fluid in pericardial cavity)
  • type of ultrasound scan near heart + nearby BVs
17
Q

Staging of lung cancer: Surgical methods

A
  • 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
18
Q

Fitness for surgery - State the clinical assestments

A

CVS:
Resp:

19
Q

Fitness for surgery: Respiratory function testing

A
  • 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)
20
Q

Fitness for surgery: Cardiac assestment

A
  • ECG
  • ECHO
  • ETT
  • Croronary angiogram
21
Q

State reasons for peri-operative death

A
  • ARDS
  • Bronchopneumonia
  • MI
  • PTE
  • Pneumothorax
  • Intrathhoracic bleeding
22
Q

State the non-fatal complications of surgery for lung cancer?

A
  • Post thoracotomy wound pain
  • Empyema
  • BPF
  • Wound infection
  • Atrial fibrilation
  • MI
  • Post op respiratory insufficient
  • Gastroparesis/constipation
23
Q

State the common problems with staging of lung cancer

A
  • 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
24
Q

Types of surgery

A

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