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Respiratory > Surgical Management of Lung Cancer > Flashcards

Surgical Management of Lung Cancer Flashcards

1
Q

What is the assessment of the patient used to determine?

A

Staging of the lung cancer

Fitness of the patient

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2
Q

What needs to be determined to stage lung cancer?

A

T, N and M status

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3
Q

What are common clinical findings in the history for lung cancer?

A

Pain (especially bone pain)

Headaches or neurological symptoms including personality change

Haematuria (presence of red blood cells in the urine)

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4
Q

What is haematouria?

A

Presence of red blood cells in the urine

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5
Q

What is presence of red blood cells in the urine called?

A

Haematuria

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6
Q

What are common clinical findings in the examination with lung cancer?

A

Recurrent laryngeal nerve palsy

Brachial plexus palsy

Superior vena cava obstruction (SVCO)

Supraclavicular lymph nodes

Soft tissue nodules

Chest wall masses

Pleural/pericardial effusion

Hepatomegaly (enlarged liver)

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7
Q

What is hepatomegaly?

A

Abnormally enlarged liver

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8
Q

What is abnormally enlarged liver called?

A

Hepatomegaly

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9
Q

What can chest X-rays be used to determine?

A

Pleural effusion

Chest wall invasion

Phrenic nerve palsy

Collapsed lobe or lung

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10
Q

What is pleural effusion?

A

Build of of excessive fluid between the pleura

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11
Q

What is the build up of excessive fluid between the pleura called?

A

Pleural effusion

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12
Q

What are some tests that are useful for staging cancer other than CT?

A

MRI

Bone scan

ECHO (echocardiogram)

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13
Q

What does ECHO stand for?

A

Echocardiogram

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14
Q

What is an echocardiogram (ECHO)?

A

Ultrasound scan used to look at the heart and nearby blood vessels

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15
Q

What is MRI useful for?

A

Determine degree of vascular and neurological involvement

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16
Q

What test is best for determining the degree of vascular and neurological involvement?

A

MRI

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17
Q

What is bone scan useful for?

A

Test for chest wall invasion and for bony metastasis

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18
Q

What test is best for checking chest wall invasion or bony metastasis?

A

Bone scan

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19
Q

What is an echocardiogram (ECHO) useful for?

A

Demonstrate presence or absence of significant pericardial effusion

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20
Q

What test is best for demonstrating the presence or absence of pericardial effusion?

A

Echocardiogram (ECHO)

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21
Q

What is used for the surgical staging of lung cancer?

A

Bronchoscopy

Mediastinoscopy

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22
Q

What is the fitness for surgery determined by?

A

Clinical assessment

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23
Q

What systems are looked at during the clinical assessment to determine if someone is fit for surgery?

A

Cardiovascular

Respiratory

Psychological

Other

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24
Q

What, in terms of the cardiovascular system, is check when determining fitness for surgery?

A

Angina

Heart problems

High blood pressure

Diabetes mellitus

Peripheral vascular disease

Smoking

Stroke

Carotid bruits

Heart murmors

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25
Q

What is angina?

A

Chest pain due to not enough blood flow to the heart

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26
Q

What is chest pain due to not enough blood flow to the heart called?

A

Angina

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27
Q

What is carotid bruits?

A

Vascular murmur sound (bruit) heard over the carotid artery

28
Q

What is a vascular murmur sound heard over the carotid artery called?

A

Carotid bruits

29
Q

What is a heart murmur?

A

Unusual sound heard between heart beats

30
Q

What is an unusual sound heard between heart beats called?

A

Heart murmur

31
Q

What, in terms of the respiratory system, is check when determining fitness for surgery?

A

Barrel-chested

COPD

Smoking

Asthmatic

On oxygen

Exercise capacity

Previous thoractomy

32
Q

What is barrel-chested?

A

Broad deep chest

33
Q

What is a broad deep chest called?

A

Barrel-chested

34
Q

What psychologically is checked when determining fitness for surgery?

A

Past history of mental illness

Severe anxiety

Social background

Chronic pain problems

35
Q

What additional things will be checked when determining fitness for surgery?

A

Pulmonary hypertension

Permanent tracheostomy

Rheutamoid artheritis

Immobile patient

Cirrhosis

36
Q

What is cirrhosis?

A

Condition where the liver does not function properly due to long term damage

37
Q

What is a condition where the liver does not function properly due to long term damage?

38
Q

What is respiratory function testing determined by?

A

Spirometry

Diffusion studies

Arterial blood gasses on air

V/Q scan

39
Q

What is cardiac assessment determined by?

A

Electrocardiogram (ECG)

Echocardiogram (ECHO)

CT scan

Exercise tolerance test (ETT)

Coronary angiogram

40
Q

What does ETT stand up for?

A

Exercise tolerance test

41
Q

In terms of operating, what should you do if you are in doubt?

A

Do not operate

42
Q

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

A

Curative resection

43
Q

What firm diagnosis is highly desirably before lung resection?

A

Malignancy

44
Q

What are the aims of surgical treatment of lung cancer?

A

Curative resection

Remove minimal amount of lung tissue

Resection of parietal structure is feasible

45
Q

What does peri-operative deaths mean?

A

During operation

46
Q

What are some reasons for peri-operative deaths?

A

Acute respiratory distress syndrome (ARDS)

Bronchopneumonia

Myocardial infarction

Pulmonary thromboendarectomy (PTE)

Pneumothorax

Intrathoracic bleeding

47
Q

What does ARDS stand for?

A

Acute respiratory distress syndrome

48
Q

What is acute respiratory distress syndrome (ARDS)?

A

The lungs cannot provide the bodies vital organs with enough oxygen

49
Q

What is myocardial infarction?

A

Heart attack

50
Q

What is the medical name for a heart attack?

A

Myocardial infarction

51
Q

What does PTE stand for?

A

Pulmonary thromboendarectomy

52
Q

What is a pulmonary thromboendarectomy (PTE)?

A

Operation that removes thrombus from pulmonary arteries

53
Q

What is the operation that removes thrombus from the pulmonary arteries called?

A

Pulmonary thromboendarectomy (PTE)

54
Q

What are some non-fatal surgical complications?

A

Post thoracotomy wound pain

Empyema

Wound infection

Atrial fibrillation

Myocardial infarction

Post-op respiratory insufficiency

Gastroparesis/constipation

55
Q

What is atrial fibrillation?

A

Irregular and often abnormally fast heart rate

56
Q

What is an irregular and often abnormally fast heart rate called?

A

Atrial fibrillation

57
Q

What are some common problems with the staging of lung cancer?

A

Collapse of a lobe or lung makes tumour size difficult to asses

Presence of another (usually small) pulmonary nodule

Retrosternal thyroid

Adrenal nodule

CT head is not routinely performed preop

58
Q

What is the operative mortality of the most dangerous procedure?

59
Q

What is the operative mortality of a pneumonectomy?

60
Q

What is the operative mortality of a lobectomy?

61
Q

What is the operative mortality of a wedge resection?

62
Q

What is the operative mortality of a open/close thoracotomy?

63
Q

What is the chance of a second primary within 5 years of the operation?

64
Q

What is the 5 year survival, post-operatively, of T1/2/3 and N<2?

A

Between 40-70%

65
Q

What is the 5 year survical, post operatively, of any N2?

Respiratory (37 decks)

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