Surgical management of lung cancer Flashcards
(22 cards)
What is the most common spread place of cancer?
Other lung is most common
Can also spread to adrenal gland,liver, brain or bone
What is the history of lung cancer?
Pain, esp bony pain. Headaches or neurological symptoms including personality change. Haematuria.
What is the examination of lung cancer?
Recurrent laryngeal nerve palsy, brachial plexus palsy, SVCO, supraclavicular LNs, soft tissue nodules, Chest wall masses. Pleural/pericardial effusion. Hepatomegaly.
What are the two classifications of lung cancers
Small cell carcinoma and non small cell carcinoma
Which classification more likely treated with surgery?
Non small cell carcinoma
What staging is involved in chest Xray?
May be able to see: Pleural effusion Chest wall invasion Phrenic nerve palsy Collapsed lobe or lung
What are examples of blood tests for testing lung cancer?
Anaemia
Abnormal LFTs
Abnormal bone profile
What can Ct scan show for lung cancer?
Size of tumour Mediastinal nodes Metastatic disease - other parts of lungs, liver, adrenals, kidneys Proximity to mediastinal structures Pleural/pericardial effusion Diaphragmatic involvement
What is the main reason for getting PET?
PET used mainly to see Nodule activity within mediastinum
Why do MRI for lung cancer?
Useful in determining the degree of vascular and neurological involvement in Pancoast tumour.
Why do bone scan for lung cancer?
Good test for chest wall invasion and for bony metastases
Why do ECHO?
Will demonstrate presence or absence of significant pericardial effusion and how well ventricle is functioning and ventricle strain
What are the two surgical investigation methods?
Bronchoscopy and mediastinoscopy
What are things to look out for in the CVS when assessing for fitness?
Angina? Heart problems? HBP, DM, PVD, Smoking, Stroke/TIA, Carotid bruits?, Prev CABG/angioplasty. Heart murmurs?
What are things to look out for in the Resp when assessing for fitness?
Barrell-chested? COAD? Still smoking? Asthmatic? Recent URTI? On oxygen? Exercise capacity. Previous thoracotomy or ICD?
What are things to look out for in the psych when assessing for fitness?
PH of mental illness, severe anxiety, social background, chronic pain problems
What are other things to look out when assessing for fitness?
Pulmonary hypertension, permanent tracheostomy, rheumatoid arthritis, the immobile patient. Cirrhosis, h/o radiotherapy to chest
What are examples of respiratory function testing?
Spirometry
Diffusion studies
ABG on air/SLV
Fractionated V/Q scan
What does cardiac assessment involve?
ECG ECHO CT scan ETT Coronary angiogram If in doubt, don’t operate
What are reasons for preoperative death?
ARDS Bronchopneumonia Myocardial Infarction PTE Pneumothorax Intrathoracic bleeding
What are some non fatal complications after lung cancer surgery?
Post thoracotomy wound pain Empyema BPF Wound infection AF MI Post-op respiratory insufficiency Gastroparesis/constipation
What are the operative mortality for pneumonectomy?
5-10%
