Surgical management of lung cancer Flashcards
can tumours survive in hypoxic environment?
yes
what information on lung cancer staging can you get from a CXR?
- pleural effusion
- chest wall invasion
- phrenic nerve paralysis
- collapsed lobe or lung
what information on lung cancer staging can you get from a blood test?
- anaemia
- abnormal LFTs (liver function test)
- abnormal bone profile
what information on lung cancer staging can you get from 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 information on lung cancer staging can you get from a MRI?
degree of vascular and neurological involvement in Pancoast tumour
what information on lung cancer staging can you get from a bone scan?
good test for chest wall invasion and for bony metastases
what information on lung cancer staging can you get from ECHO?
demonstrates presence or absence of significant pericardial effusion
what do you check in the CVS to clear a patient for surgery?
angina, heart problem, HBP, DM, PVD, smoking, stroke/ TIA, carotid bruits, pre CABG/ angioplasty, heart murmurs
what do you check in the respiratory system to clear a patient for surgery?
barrell-chested, COAD, still smoking, asthmatic, recent URTI, on oxygen, exercise capacity, previous thoracotomy or ICD
what psychiatric information do you check to clear a patient for surgery?
PH of mental illness, severe anxiety, social background, chronic pain problems
what other information needs to be checked before clearing a patient for surgery?
pulmonary hypertension, permanent tracheostomy, rheumatoid arthritis, the immobile patient, cirrhosis history of radiotherapy to chest
how do you check the respiratory system for fitness for surgery? (what tests)
- spirometry
- diffusion studies
- ABG on air/ SLV
- fractionated V/Q scan
how do you check the CDV system for fitness for surgery? (what tests)
- ECG
- ECHO
- CT scan
- ETT
- coronary angiogram
if in doubt on any of these, do you operate?
no
what are the objectives of lung cancer treatment?
- curative resection
- remove the minimum amount of lung tissue
- resection of parietal structures is feasible
- firm diagnosis of malignancy is highly desirable before lung resection
