assessment and surgical treatment of lung cancer Flashcards Preview

1ST YEAR SYSTEMS: Respiratory > assessment and surgical treatment of lung cancer > Flashcards

Flashcards in assessment and surgical treatment of lung cancer Deck (31)
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1
Q

staging cancer

A

T- tumour T1-4
N- nodes N0-3
M- metastases

2
Q

important aspect of mediastinum?

A

it has nerves within

3
Q

lung metastases spreads to

A

lymph nodes in the neck

brain 
bone
skin
liver
adrenal glands
4
Q

what signs in the clinical history would indicate lung cancer?

A

pain esp. bony pain. Headaches or neurological symptoms including personality change.
Haematuria

5
Q

what is a chest x ray used to detect? (4)

A

Pleural effusion - fluid between pleura layers
Chest wall invasion (by tumour)
Phrenic nerve palsy/paralysis (unilateral diaphragmatic paralysis- one side higher, one lower)
Collapsed lobe or lung

6
Q

By what method does lung cancer usually spread/metastasise?

A

transcoelomic spread

7
Q

which scan is done in every patient with lung cancer?

A

PET scan

can combine CT-PET to stage cancer

8
Q

what can a PET scan not be used to examine?

A

the brain as it is highly metabolically active

9
Q

why is a bronchoscopy done before surgery

A

to plan the operation by seeing where the tumour lies

10
Q

what 3 blood tests can be used to stage lung cancer?

A

FBC - anaemia - reduced RBC
biochemistry test - see if cancer has spread to other parts of the body - Lung cancer spreads to lung so abnormal LFTs would be predicted
abnormal bone profile

11
Q

what can a CT scan be used to look for/moniter in lung cancer (5)

A

size of tumour

mediastinal nodes

metastatic disease- other parts of the lungs, liver, adrenals, kidneys

proximity to mediastinal structures

pleural/pericardial effusion

diaphragmatic involvement

12
Q

MRI use in lung cancer tests

A

Useful in determining the degree of vascular and neurological involvement in Pancoast tumour (type of lung cancer- in the apex of the lung)

13
Q

bone scan use in lung cancer tests

A

good test for chest wall invasion and for bony metastases

14
Q

ECHO

A

ultrasound to show presence or absence of significant pericardial effusion

15
Q

mediastinoscopy

A

visualisation of the contents of the mediastinum often carried out before surgery

16
Q

what is the mediastinum

A

region of the body located between the lungs. The heart, the esophagus, the trachea, and large blood vessels lie in this area. Also, lymph nodes.

17
Q

what things do you consider as part of CARDIOVASCULAR SYSTEM in clinical assessment of a patient’s fitness for surgery? (8)

A
Angina
heart problems
high blood pressure
Diabetes (DM)
smoking
peripheral vascular disease 
previous heart surgery
Heart murmurs
18
Q

what things do you consider as part of RESPIRATORY SYSTEM in clinical assessment of a patient’s fitness for surgery?

A

Barrell-chested (large, inflated chest may be due to arthritis or COPD)

COAD (chronic obstructive airway disease ie Chronic bronchitis and emphysema)

still smoking?

asthmatic

recent URTI

on oxygen

exercise capacity

19
Q

things to consider with psychiatric fitness for surgery

A

severe anxiety- may not recover from it or become demotivated from major surgery
social background
chronic pain problems

20
Q

other things to consider when determining fitness of patient for surgery?

A

Pulmonary hypertension (increased blood pressure within the arteries of the lungs)

permanent tracheostomy (breathing tube)

rheumatoid arthritis

the immobile patient

Cirrhosis (liver not functioning due to long term damage)

h/o radiotherapy to chest

21
Q

what tests are used to test respiratory function for fitness for surgery (3)

A

spirometry

ABG on air (arterial blood gas test measures oxygen and carbon dioxide levels in your blood)

fractionated V/Q scan- Just the ventilation - shows airflow ie how well O2 and CO2 diffuse

22
Q

what tests should you carry out for cardiac assessment for fitness for surgery

A
CT 
ECHO
ECG heart dscan
coronary angiogram 
IF IN DOUBT, DON'T OPERATE
23
Q

surgical treatment of lung cancer

A

Curative resection is the goal ie taking out enough tissue surrounding cancer for it not to grow back

But want to remove minimum amount of lung tissue

Resection of parietal structures is feasible

Firm diagnosis of malignancy is highly desirable before lung resection

24
Q

curative resection?

A

removing or destroying cancerous tissue

25
Q

reasons for peri-operative death

A
ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding
26
Q

define peri-operative death

A

any death occurring within 30 days of surgery

27
Q

what is an ARDS

A

Acute respiratory distress syndrome (ARDS)

respiratory failure characterised by rapid onset of widespread inflammation in the lungs (ie fluid seeps into lungs)
can be triggered by infection e.g pneumonia

Symptoms include shortness of breath, rapid breathing, and bluish skin coloration (cyanosis)

28
Q

non-fatal complications with surgery for lung cancer (7)

A

post thoracotomy wound pain

empyemea (collection of pus in the pleural cavity)

wound infection

AF (atrial fibrillation- common abnormal heart rhythm)

MI (myocardial infarction-heart attack)

post-op respiratory insufficiency

constipation

29
Q

Common problems with staging lung cancer

A

collapse of a lobe or lung- lose definition of tumour

presence of another
pulmonary nodule

retrosternal thyroid- unusual location of thyroid

30
Q

highest rate of operative mortality is in what?

A

pneumonectomy

31
Q

lung diseases that are non-cancerous but dangerous

A
infection- TB 
benign tumour - hamartoma
granuloma
fibrosis- PMF
paraffinoma