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Respiratory System > Surgical Management of Lung Cancer > Flashcards

Surgical Management of Lung Cancer Flashcards

1
Q

What two factors are took into account when assessing a lung cancer patient for surgical treatment?

A
  • staging of LC

- fitness of patient

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2
Q

How many T stages are there within the TNM staging?

A

4

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3
Q

What does a staging of N1 mean?

Would a surgeon consider operating on this?

A

cancer has spread to lymph nodes within lung and/or hilum

Yes - survival rate would be around 40% depending on size of tumour.

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4
Q

What does a staging of N3 mean?

Would a surgeon consider operating on this?

A

cancer has spread to opposite side of chest wall, or to lung apex.

Normally not operable as cancer has spread too far.

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5
Q

If cancer spreads to lymph nodes, which surrounding structures tend to be affected?

What can this lead to?

A

phrenic/laryngeal nerves

phrenic nerve palsy

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6
Q

What happens with phrenic nerve palsy?

A

unilateral raised diaphragm

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7
Q

What can tumour compression on laryngeal nerve result in?

A

voice box affected, hoarseness in voice

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8
Q

Where does lung cancer commonly metastasise to?

5

A

B BALL

Bone
Brain
Adrenal glands
Liver
Lymph nodes
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9
Q

What are the signs from a history that can help stage lung cancer?

(3)

A
  • pain (bony pain)
  • neurological (headache, personality changes)
  • haematuria
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10
Q

What are the signs from an examination that can help stage lung cancer?

(5)

A
  • Recurrent laryngeal nerve palsy
  • supraclavicular LNs
  • Chest wall masses
  • Pleural/pericardial effusion
  • Hepatomegaly
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11
Q

What are red flags for all cancers?

4

A
  • weight loss
  • loss of appetite
  • fatigue
  • night sweats
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12
Q

Which type of cancer is usually treatable by surgery?

A

NSCCLC

60% adenocarcinoma
40% squamous

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13
Q

What are the most common symptoms of lung cancer?

4

A
  • persistent cough
  • SOB
  • haemoptysis
  • malignant pleural effusion
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14
Q

What can be looked for in a CXR to stage lung cancer?

4

A
  • Pleural effusion (malignancy?)
  • Chest wall invasion (mets)
  • Phrenic nerve palsy (nodal spread)
  • Collapsed lobe or lung
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15
Q

What blood tests can be used to stage cancer and what do they show?

(3)

A
  • anaemia (ca causing blood loss)
  • abnormal LFTs (liver mets)
  • abnormal bone profile (bone mets)
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16
Q

How can a CT scan be useful in lung cancer staging?

6

A
  • tumour size
  • nodal spread (mediastinal)
  • mets (BBALL)
  • proximity to mediastinal structures
  • pleural/pericardial effusion
  • diaphragmatic involvement
17
Q

Which organs have a high glucose uptake on a PET scan?

3

A

Brain
kidney
heart

18
Q

What is an isolated uptake indicative of on a PET scan?

A

tumour

19
Q

What is MRI useful for when staging lung cancer?

A

determining the degree of vascular and neurological involvement in pancoast tumour

20
Q

What is a bone scan useful for when staging lung cancer?

2

A
  • chest wall invasion

- bone mets

21
Q

what is an ECHO useful for when staging lung cancer?

A

pericardial effusion

22
Q

What is a pancoast tumour?

2

A
  • tumour of pulmonary apex

- most are non-small cell cancers

23
Q

what invasive/surgical methods are used to stage lung cancer?

(2)

A

bronchoscopy

mediastinoscopy

24
Q

What CVS conditions may affect a patients fitness for surgery?

(5)

A
  • angina
  • hypertension
  • peripheral vascular disease
  • angioplasty/CABG
  • stroke/TIA
25
Q

What respiratory conditions may affect a patient’s fitness for surgery?

(5)

A
  • COPD
  • smoker
  • recent URTI
  • oxygen use
  • exercise capacity
26
Q

What psychological conditions may affect a patient’s fitness for surgery?

(3)

A
  • PMH mental illness
  • severe anxiety
  • chronic pain problems
27
Q

What are some ‘other’ conditions that will affect a patient’s fitness for surgery?

(3)

A
  • pulmonary hypertension
  • permanent
    tracheostomy
  • rheumatoid arthritis
28
Q

What are some respiratory function tests used to assess fitness for surgery?

(4)

A
  • spirometry
  • diffusion studies e.g. CO study
  • fractionated V/Q scan
  • ABG
29
Q

Which tests can be done to test fitness for surgery (in terms CVS)?

(4)

A
  • ECG
  • ECHO
  • CT scan – calcification of aorta
  • ETT – exercise tolerance test
30
Q

What is the ultimate goal of surgical treatment of lung cancer?

A

curative resection by removing the minimum amount of lung

31
Q

Is resection of the parietal structures feasible?

A

yes

32
Q

What is highly desirable before resection?

Why?

A

firm diagnosis of malignancy

Infections and TB can look like cancer

33
Q

What (guided) diagnostic technique might be used to confirm whether a tumour is malignant or benign?

A

CT guided tumour biopsy

34
Q

What are the reasons for post-operative deaths?

4

A
  • ARDS
  • Bronchopneumonia
  • MI
  • PE
35
Q

How can pulmonary thromboembolism be prevented?

A
  • heparin s/c

- stockings

36
Q

What are some non-fatal complications of lung cancer?

5

A
  • empyema
  • wound infection
  • AF
  • MI
  • Post-op respiratory insufficiency
37
Q

What are common problems associated with staging lung cancer?

(3)

A
  • lung collapse masking tumour
  • adrenal nodule
  • retrosternal thyroid
38
Q

What are some conditions that can be mistaken for lung cancer?

(5)

A
  • Infection (TB, Lung abscess_
  • Benign tumour
  • Granuloma (e.g. Sarcoidosis)
  • Fibrosis
  • Aspergilloma
39
Q

Which type of tumour removal surgery has the highest mortality?

Which has the least?

A

pneumonectomy (or thoracotomy)

wedge resection

Respiratory System (26 decks)

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