surgical treatment of lung cancer Flashcards
what is the clinical staging of lung cancer
hostory - pain, boney pain. headaches or neurological symptoms including personality change. haematuria
examination - recurrent laryngeal nerve palsy, brachial plexus palsy, SVCO, supraclavicular LNs, soft tissue nodules, chest walls masses. pleural/pericardial effusion. hepatomegaly
what may be seen in a CXR
pleural effusion
chest wall invasion
phrenic nerve palsy
collapsed lobe or lung
what could be found in a blood test
anaemia
abnormal LFTs
abnormal bone profile
what do you look for in a CT
size of tumour mediastinal nodes metastatic disease - other parts of lungs, liver, adrenals, kidneys proximity to mediastinal structures pleural/pericardial effusion diaphragmatic involvement
what other tests can be used for staging of lung cancer
MRI - useful in determining degree of vascular and neurological involvement in pancoast tumour
bone scan - good test for chest walls invasion. and for bony metastases
ECHO - used to determine fitness for surgery - demonstrates presence or absence of significant pericardial effusion
what are surgical options for staging lung cancer
bronchoscopy
mediatinoscopy
what must be assessed for fitness for surgery to be decided
CVS- angina, heart problems, murmurs etc
resp- recent URTI, on o2 ?
psych - sever anxiety, social background etc
other - cirrhosis, immobile ?
what is involved in a respiratory function test
spirometry
diffusion studies
ABG on air/SLV
fractionated v/w scan
what is used for cardiac assessment
ECG ECHO CT ETT coronary angiogram if in doubt don’t operate
what are t’en surgical treatments of lung cancer
curative resection
remove minimum amount of lung tissue
resection of parietal structures is feasible
firm diagnosis of malignancy is highly desirable befire lung resection
what are some reasons for perioperative death
ARDS bronchopneumonia myocardial infarction PTE pneumothorax intrathroacic bleeding
what are non fatal complications of lung cancer
post thoracotomy wound pain empyema BPF - broncho pleural fistula - latge space w negative pressure, chest wall collapses into that space, can cause air to be sucked in wound infection AF MI post op respiratory i sufficiency gastropatesis
what are the most common problems w staging of lung cancer
collapse of a lobe or lung makes tumour size difficult to assess
presence of another (usuallt small) pulmonary nodule
retrosternal thyroid
adrenal nodule
CT head is not routinely performed pre op
