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respiratory system year 1 > surgical management of lung cancer > Flashcards

surgical management of lung cancer Flashcards

1
Q

when is surgery the treatment of choice

A

early and localised lung cancer

patient can make a full recovery

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2
Q

what are the 2 stages in assessing a patient for surgical management of lung cancer

A

staging of the lung cancer

fitness of the patient

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3
Q

what does T status involve

A

site of tumour
size of tumour
involvement of mediastinum and chest wall

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4
Q

what does N status involve

A

lymph node involvement

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5
Q

describe the general spread of cancer in the lungs

A

within the lung that it originated in
ipsilateral regional lymph nodes in the mediastinum
contralateral lymph nodes
other tissues in the body

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6
Q

N2 status

A

lots of nodes found in the aortic pulmonary window

phrenic nerve palsy can indicate these lymph nodes are involved

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7
Q

M status

A 
metastases
look at brain
look at same lung (different lobes) or other lung 
adrenal gland 
liver 
bones

Whole body CT to look for distant mets

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8
Q

what is the most common presentation for early stage lung cancer

A

persistent cough

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9
Q

how are lots of early stage lung cancers diagnosed

A

incidentally

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10
Q

red flag symptoms

A

weight loss
fatigue
night sweats
loss of appetite

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11
Q

clinical staging of lung cancer

A

hx: pain (bony), headaches or neurological symptoms
examination: recurrent laryngeal nerve palsy, brachial plexus palsy, SVCO, supraclavicular LNs, soft tissue nodules, chest wall masses, pleural/pericardial effusion, hepatomegaly

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12
Q

is surgical treatment helpful in SCLC

A

very aggressive and invasive cancer
lots of mets
surgical treatment isn’t helpful

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13
Q

staging of lung cancer on CXR

A

pleural effusion
chest wall invasion
phrenic nerve palsy
collapsed lobe or lung

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14
Q

staging of lung cancer - bloods

A

anaemia
abnormal LFTs - liver mets
abnormal bone profile - bone mets

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15
Q

staging of lung cancer on CT

A 
size of tumour 
mediastinal nodes
mets 
proximity to mediastinal structures
pleural/pericardial effusion
diaphragmatic involvement
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16
Q

lymph node appearance on CT

A

enlarged = >1cm

homogenous enlargement = unlikely to be lung cancer

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17
Q

PET scanning

A

highlights high metabolic rates of tumours in the body

useful for diagnosing nodal activity in the mediastinum

18
Q

MRI for staging

A

useful for determining the degree of vascular and neurological involvement

19
Q

bone scan for staging

A

chest wall invasion

bone mets

20
Q

ECHO for staging

A

demonstrates presence of absence of significant pericardial effusion
L ventricle function and R ventricle strain (hypertension)

21
Q

bronchoscopy surgical staging

A

most common
sample tumours of the airway
EBUS to sample mediastinal lymph nodes

22
Q

mediastinoscopy surgical staging

A

sample lymph nodes

more open procedure

23
Q

clinical assessment of fitness for surgery

A

CVS
Resp
psych
other

24
Q

clinical assessment of fitness for surgery CVS

A 
angina 
heart problems 
HT
DM
PVD
smoking 
stroke/TIA
carotid bruits
prev CABG/angioplasty 
heart murmurs

independence with adlS

25
Q

clinical assessment of fitness for surgery resp

A 
barrel chested
COPD
smoker
asthma 
recent URTI
on oxygen 
exercise capacity
prev thoracotomy or ICD
26
Q

clinical assessment of fitness for surgery psych

A 
lung cancer surgery can be a big operation - depression post-op isn't uncommon 
PH of mental illness
severe anxiety 
social background 
chronic pain problems
27
Q

clinical assessment of fitness for surgery other

A

pulmonary HT - higher risk of post-op bleed
immobility
liver cirrhosis - can have severe post-op septic shock episodes
hx of radiotherapy to the chest - inflammation

28
Q

fitness for surgery respiratory function testing

A

spirometry - FEV1, predictive post-op FEV1
diffusion studies - amount of oxygen absorbed and used by the lung
ABG on air/SLV
fractionated V/Q scan

29
Q

fitness for surgery cardiac assessment

A 
ECG 
echo 
CT - coronary and aortic calcification
ETT - exercise tolerance test 
coronary angiogram
30
Q

what is the goal of surgical treatment of lung cancer

A

curative resection
remove the minium amount of lung tissue to maximise post-op function
firm diagnosis of malignant is highly desirable before resection

31
Q

why is minimally invasive surgery more commonly used

A

quicker recovery
reduced pain than with thoracotomy
less incidents of chronic neuropathic pain in the long term

32
Q

reasons for peri-operative death

A 
Acute respiratory distress syndrome 
bronchopneumonia 
MI
PTE
pneumothorax
intrathoracic bleeding
33
Q

acute respiratory distress syndrome

A

acute inflammation of both lungs
usually due to the stress of the operation
reduced ventilation and severe hypoxaemia
difficult to ventilate once intubated

34
Q

why can bronchopneumonia occur post-op

A

not able to take a deep breath due to pain to be able to cough out

35
Q

why can MI occur post-op

A

heart needs to pump the same amount of blood to more resistance following resection
heart is under more stress

36
Q

what measures can be taken to prevent PTE

A

compression stockings

heparin injections

37
Q

non-fatal complications of surgery

A 
post thoracotomy wound pain
empyema 
BPF
wound infection
AF - common after pneumonectomy
MI
post-op respiratory insufficiency 
gastroparesis/constipation
38
Q

BPF

A

bronchopleural fistula

increases chance of infection

39
Q

gastroparesis/constipation post-op

A

due to morphine/analgesia
abdomen becomes distended
compresses base of lungs
prone to infection

40
Q

commnest problems with staging of lung cancer

A

collapse of lobe or lung makes tumour size difficult to assess
presence of another pulmonary nodule changes staging
retrosternal thyroid
adrenal nodule

41
Q 
MORTALITY 
pneumonectomy 
lobectomy 
wedge resection 
open/close thoracotomy
A

pneumonectomy 5-10%
lobectomy 2%
wedge resection <1%
open/close thoracotomy 5%

42
Q

5YS post-op

A 
T1N0 70%
T2N0 60%
T3N0 50%
T1N1/T2N1 40%
N2 16%
chance of 2nd 1y 5%

respiratory system year 1 (25 decks)

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