Surgical Management of Lung Cancer Flashcards
What two factors are took into account when assessing a lung cancer patient for surgical treatment?
- staging of LC
- fitness of patient
How many T stages are there within the TNM staging?
4
What does a staging of N1 mean?
Would a surgeon consider operating on this?
cancer has spread to lymph nodes within lung and/or hilum
Yes - survival rate would be around 40% depending on size of tumour.
What does a staging of N3 mean?
Would a surgeon consider operating on this?
cancer has spread to opposite side of chest wall, or to lung apex.
Normally not operable as cancer has spread too far.
If cancer spreads to lymph nodes, which surrounding structures tend to be affected?
What can this lead to?
phrenic/laryngeal nerves
phrenic nerve palsy
What happens with phrenic nerve palsy?
unilateral raised diaphragm
What can tumour compression on laryngeal nerve result in?
voice box affected, hoarseness in voice
Where does lung cancer commonly metastasise to?
5
B BALL
Bone Brain Adrenal glands Liver Lymph nodes
What are the signs from a history that can help stage lung cancer?
(3)
- pain (bony pain)
- neurological (headache, personality changes)
- haematuria
What are the signs from an examination that can help stage lung cancer?
(5)
- Recurrent laryngeal nerve palsy
- supraclavicular LNs
- Chest wall masses
- Pleural/pericardial effusion
- Hepatomegaly
What are red flags for all cancers?
4
- weight loss
- loss of appetite
- fatigue
- night sweats
Which type of cancer is usually treatable by surgery?
NSCCLC
60% adenocarcinoma
40% squamous
What are the most common symptoms of lung cancer?
4
- persistent cough
- SOB
- haemoptysis
- malignant pleural effusion
What can be looked for in a CXR to stage lung cancer?
4
- Pleural effusion (malignancy?)
- Chest wall invasion (mets)
- Phrenic nerve palsy (nodal spread)
- Collapsed lobe or lung
What blood tests can be used to stage cancer and what do they show?
(3)
- anaemia (ca causing blood loss)
- abnormal LFTs (liver mets)
- abnormal bone profile (bone mets)
How can a CT scan be useful in lung cancer staging?
6
- tumour size
- nodal spread (mediastinal)
- mets (BBALL)
- proximity to mediastinal structures
- pleural/pericardial effusion
- diaphragmatic involvement
Which organs have a high glucose uptake on a PET scan?
3
Brain
kidney
heart
What is an isolated uptake indicative of on a PET scan?
tumour
What is MRI useful for when staging lung cancer?
determining the degree of vascular and neurological involvement in pancoast tumour
What is a bone scan useful for when staging lung cancer?
2
- chest wall invasion
- bone mets
what is an ECHO useful for when staging lung cancer?
pericardial effusion
What is a pancoast tumour?
2
- tumour of pulmonary apex
- most are non-small cell cancers
what invasive/surgical methods are used to stage lung cancer?
(2)
bronchoscopy
mediastinoscopy
What CVS conditions may affect a patients fitness for surgery?
(5)
- angina
- hypertension
- peripheral vascular disease
- angioplasty/CABG
- stroke/TIA
What respiratory conditions may affect a patient’s fitness for surgery?
(5)
- COPD
- smoker
- recent URTI
- oxygen use
- exercise capacity
What psychological conditions may affect a patient’s fitness for surgery?
(3)
- PMH mental illness
- severe anxiety
- chronic pain problems
What are some ‘other’ conditions that will affect a patient’s fitness for surgery?
(3)
- pulmonary hypertension
- permanent
tracheostomy - rheumatoid arthritis
What are some respiratory function tests used to assess fitness for surgery?
(4)
- spirometry
- diffusion studies e.g. CO study
- fractionated V/Q scan
- ABG
Which tests can be done to test fitness for surgery (in terms CVS)?
(4)
- ECG
- ECHO
- CT scan – calcification of aorta
- ETT – exercise tolerance test
What is the ultimate goal of surgical treatment of lung cancer?
curative resection by removing the minimum amount of lung
Is resection of the parietal structures feasible?
yes
What is highly desirable before resection?
Why?
firm diagnosis of malignancy
Infections and TB can look like cancer
What (guided) diagnostic technique might be used to confirm whether a tumour is malignant or benign?
CT guided tumour biopsy
What are the reasons for post-operative deaths?
4
- ARDS
- Bronchopneumonia
- MI
- PE
How can pulmonary thromboembolism be prevented?
- heparin s/c
- stockings
What are some non-fatal complications of lung cancer?
5
- empyema
- wound infection
- AF
- MI
- Post-op respiratory insufficiency
What are common problems associated with staging lung cancer?
(3)
- lung collapse masking tumour
- adrenal nodule
- retrosternal thyroid
What are some conditions that can be mistaken for lung cancer?
(5)
- Infection (TB, Lung abscess_
- Benign tumour
- Granuloma (e.g. Sarcoidosis)
- Fibrosis
- Aspergilloma
Which type of tumour removal surgery has the highest mortality?
Which has the least?
pneumonectomy (or thoracotomy)
wedge resection
