Surgical Management of Lung Cancer Flashcards

1
Q

When is surgery not used for treatment?

A

Lung function is too low for the patient to survive with a lung or lobe removed
Metastases present or other reasons that mean all cancer cannot be removed

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2
Q

What blood tests can be done to stage lung cancer?

A

FBC - anaemia
Abnormal LFTs
Abnormal bone profile

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3
Q

What other features of the tumour are used to stage the lung cancer?

A
Size of tumour
Mediastinal nodes
Metastatic disease - other parts of lungs, liver, adrenals, kidneys
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement
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4
Q

Why are MRIs useful in staging of lung cancer?

A

Determines degree of vascular and neurological involvement in pan coast tumour

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5
Q

Why is a bone scan useful in staging lung cancer?

A

Shows chest wall invasion and bony metastases

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6
Q

Why is an ECHO a useful investigation to stage lung cancer?

A

Presence or absence of significant pericardial effusion

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7
Q

What are the signs in the history that can help stage lung cancer?

A

Pain - bony pain
Headaches
Neurological symptoms: personality change
Haematuria (blood in urine)

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8
Q

What are the signs in the examination that can help stage lung cancer?

A
Recurrent laryngeal nerve palsy 
Brachial plexus palsy 
SVC obstruction 
Supraclavicular LN
Soft tissue nodules 
Chest wall masses
Pleural/pericardial effusion
Hepatomegaly
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9
Q

What should be looked out for in a CXR to stage lung cancer?

A
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung
Size
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10
Q

What surgical methods can be used to stage lung cancer?

A

Bronchoscopy

Mediastinoscopy

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11
Q

What CVS conditions might affect a patient’s fitness for surgery?

A
Angina
Heart problems
High BP
Diabetes M
Peripheral vascular disease
Smoking 
Stroke/TIA
Carotid bruits
Previous CABG/angioplasty 
Heart murmurs
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12
Q

What respiratory conditions might affect a patient’s fitness for surgery?

A
Barrell-chested
COAD
Smoking 
Asthmatic 
Recent URTI 
On O2
Previous thoracotomy or ICD (defibrillator)
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13
Q

What psychological conditions may affect a patients fitness for surgery?

A

PH of mental illness
Severe anxiety
Social background
Chronic pain problems

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14
Q

What other conditions can affect a patients fitness for surgery?

A
Pulmonary hypertension
Tracheostomy 
Rheumatoid arthritis 
Immobile patients 
Cirrhosis
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15
Q

What test are carried out for respiratory function testing to determine fitness for surgery?

A

Spirometry
Diffusion studies (with CO)
ABG on air (PCO2 levels with room air)
Fractionated V/Q scan

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16
Q

What investigations are carried to assessment the heart for fitness for surgery?

A
ECG
ECHO 
CT scan 
ETT
Coronary angiogram 
If in doubt, don't operate
17
Q

What are the aims of surgical treatment for lung cancer?

A

Curative resection
Remove the minimum amount of lung tissue
Resection of parietal structures is feasible
Firm diagnosis of malignancy before lung resection

18
Q

What are reasons for pre-operative death?

A
ARDS
Bronchopneumonia
MI
PTE
Pneumothorax 
Intrathoracic bleeding
19
Q

List non-fatal complications of surgery for lung cancer?

A
Post thoracotomy wound pain 
Empyema 
Bronchopleural fistula 
Wound infection
AF
MI
Post-op respiratory insufficiency
Gastroparesis/constipation
20
Q

What are common problems with staging of lung cancer?

A

Collapse of a lobe or lung makes tumour size difficult
Presence of another pulmonary nodule
Retrosternal thyroid
Adrenal nodule

21
Q

What can the mass that was thought to be a tumour end up to be?

A
Infection - TB, lung abscess
Benign tumour - hamartoma
Granuloma
Fibrosis 
Other - paraffinoma