Thoracic surgery (week 6) Flashcards
Type of surgery for Lung cancer
Lobectomy / Pneumonectomy
Pneumonectomy
Removal of one lung
Lobectomy
Removal of one or more lobes (section) of an organ (i.e. lung, liver, brain, thyroid gland)</p>
Carcinoma
Cancer that begins in the skin or in tissues that line or cover internal organs
Smoking kills ____ New Zealanders every year, which accounts for ___-___% of all deaths from Lung cancer.
___% adults currently smoke in NZ
5,000
92-94%
20%
NZ Maori - lung cancer 2.5 - 3 times higher than that in the NZ European population.
True or False?
True
Risk of lung cancer halved every 5 yrs quiting. T or F?
True
Men who smoke 1 pack a day increases their risk more than 25 times compared with never smokers. T or F?
False … 2 packs a day increase the risk 25 times
Signs & Symprtoms of Lung cancer
- Persistent cough
- Sputum
- Haemoptysis … coughing up blood
- Dyspnoea
- Chest pain … diffuse, constant & poorly localised
(if localised tends to be poor prognosis)
indicates tumor in the chest wall, pleura,
pressing on the wall - Stridor … a whisling soung when breathing
- Wheeze
- Collapse / consolidation / effusion
- Hoarseness … recurrent laryngeal nerve involvement
(tumor in the laryngeal) - Bony pain … Metastasis
To confirm clinical diagnosis of lung cancr
Currently no routine screening
- Biopsy … the removal of cells or tissues for examination by a pathologist.
- Sputum cytology … take sputum sample; chepest way to exam
- Bronchoscopy … a bronchoscope is a thin, tube-like instrument with a light and a lens for viewing the airways (inside of the trachea, bronchi)
- Thoracoscopy / Mediastinoscopy … confirmers
- PET (positive emition tomography) scanning
- CT / MRI / CXR (chest x-ray)
- Blood profile
Lung cancer stages
Stage 1 … No metastasis - survival with surgery up to 75%
Stage 2 … Lymph node involvement - survival 10 - 20%
Stage 3 … Surgery depends upon site, spread - Poor prognosis & survival rates
Stage 4 … Distal metastasis. Inoperatable. Survival 1 yr = 17%, 2 yr = 6%
Small cell lung cancer (SCLC) has better prognosis than Large cell lung cancer. T or F?
False
SCLC - without Rx most aggressive clinical course & survival of only 2 -4 months; Metastates common; 4 - 5 fold improvement with chemotherapy; overall 5 yrs survival only approx 5 %
What does the monophoic wheeze indicate?
Obstruction or narrowing of the large airway = tumor
(the higher the pitch the greater the obstruction)
=> need to take the whole lung out
Preoperative (thoracic surgery) physiotherapy may reduce the development of PPC. T or F?
Yes and No
- PPC occurs irrespective of preop PT education
- Exercise intervention may reduce the development of PPC (Freeney et al, 2011); may increase the Px’s surgery capacity (if the Px on the borderline of
whtat does “VATS” stands for?
Video assisted thoracic surgery
to view the inside of the chest cavity after making only very small incisions
Physiotherapy managemetn post thoracic surgery
- Respiratory care
- shoulder and thoracic cage function
- Early mobilisation … reduce PPC risk; increase respiratory fitness
Incidence of PPC after thoracic surgery
4 - 36% (Reeve et al, 2010)
<p>Post-operative (open thoracotomy) PT is more effective than usual care. T or F?</p>
<p>False According to (Reeve et al, 2009) there was no difference between the PT treatment group and the control group. Low incidence of PPC. However, the usual care involved: early position changes, early mobilisation, frequent pain assessment..., and PT group had: DBE, coughing exercise, assistance with ambulation, progressive shoulder & thoracic cage mobility programme in addition to usual care... so In conclusion, DBE is not necessary in addition to "Early mobilisation"!! done.</p>
A post-operative PT (shoulder exercise programme) improves?
pain & shoulder function, but doesn’t improve ROM, strength
IS (incentive spirometry) reduces the development of PPC. T or F?
False
No documented benefit in reduction of PPC
PPCs specific to thoracic surgery
- Pneumonia, chest infection
- Persistant air leaks
- Empyema … a collection of pus in a body cavity
- Recurrent laryngeal damage
- Broncho pleural fistula … ab abnormal opening between two organs
- Wound infection
- Post thoracic pain
- Surgical emphysema
TENS treatment is effective when used alone in severe post-thoracotomy pain. T or F?
False
It is ineffective when used alone in severe post-thoracotomy pain but useful as an adjunct tto other medications in moderate post-thoracotomy pain and very effective as the sole pain-control treatment in patients with mild post-thoracotomy pain
the criteria for thoracic surgery
-FEV1 > 2L
-FEV1/FVC > 50%
-VO2peak >15ml/kg
(if it doesn’t meet theses, no surgery; not fit enough to do surgery)
90% of thoracic surgical prosedures are
lung cancer
