Flashcards in THORACIC Deck (39)
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1
major points of VATS
Camera port
Fifth intercostal space mid axillary line
Working ports
Fourth or seven intercostal space
2
Solitary pulmonary nodule if it is cancer what is the most common type expected
75% are NSCLC.
3
Solitary pulmonary nodule what is most common benign diagnosis
80% are infectious granulomas.
4
Solitary pulmonary nodule
Six important factors that significantly increase the likelihood of an SPN being cancer
(1) age > 60 years,
(2) tobacco history > 20 pack-years,
(3) prior history of cancer,
(4) size > 2 cm on chest x-ray or CT,
(5) the presence of spiculations on chest x-ray or CT,
(6) doubling size
5
Solitary pulmonary nodule > 1 cm who have an intermediate probability are managed hwo
FDG-PET scan
to assess the need for surgical excision
versus
surveillance with serial CT scans.
6
Solitary pulmonary nodule high clinical and/ or radiographic probability of cancer
undergo surgical excision
even without tissue (like whipple)
7
For patients with stage 1a what is recommended treatement
This is ONLY I AAAA (all the other stage I get chemo)
lobectomy alone is recommended.
8
For patients with stage 1 what is recommended treatement
stage 1 SCLC, lobectomy followed by platinum-based adjuvant chemotherapy is recommended.
9
IIIb disease tx
no surgery
cisplantinum
and
xrt
10
who gets preop chemo
IIIA
pancost tumor and ipsilateral node
11
mass and ipsilateral node
mediastinoscopy
shows positive
this is stage IIIa - needs neoadjuvant
12
mass and contralateral node
mediastinoscopy
shows positive
this is stage IIIb
no surgery
cisplantinum
and
xrt
13
pulmonary function
FEV1
1.6 need for lobectomy
each lobe is about 20%
Can do functional reserve with V/Q.
14
FEV1 needed for pneumontectomy
Greater than 2 L
15
FEV1 needed for lobectomy
Greater than one 1.6 L
16
FEV1 needed for wedge resection
Greater than 0.6 0.8
17
Pre-op testing for considered long resection
PFTs
VQ scan predicted postop FEV1
ABG
CT pet - include liver and adrenals
If any nodes light-up:
medianstinoscopy
18
Contraindications for surgery on lung cancer
T4
N3 - contralateral positive node
Post our predicted FEV1 less than 0.8
Malignant affusion
Extra thoracic metastasis (CAREFUL - may still go for care if isolated brain met!)
STC syndrome
Recurrent laryngeal your nerve involvement
Phrenic nerve paralysis
Great vessel involvement
Small cell lung cancer (these get chemoradiation)
Horner syndrome
Positive cervical lymph node
Tracheoesophageal fistula
19
When is the pneumonectomy resection required
hilar lesion
Crosses the fishers and involves all lobes
20
When should you do a Chamberlain procedure
Right-sided nodes
Left para tracheal nodes
21
Hormones that long cancer Cancer secrete
squamous
PTH like hormones squamous
both squamous and calcium can affect the skin.
small cell
(SIADH) in small cell
"systemic therapy so systemic diuresis"
22
Still go for cure in non-small cell lung cancer
IIIa
up to T3 (pericardium, chest wall, bronchus) N1 (ipsilateral)
T2 N2 (ipsilateral mediastiunm)
23
Differential diagnosis of mediastinal tumor
Anterior:
Thymoma, teratoma, terrible lymphoma
Medial
Pericardial
Bronchogenic
Sarcoid
Posterior
Mesothelioma
Neurogenic
(the Esophageal duplication)
Germ cell tumor
Substernal thyroid
Sarcoidosis
Neurogenic humor
24
What physical examinations do a mediastinal mask patient need
Testicles exam!
Heading and neck exam
25
What laboratory studies does a mediastinal mass patient meet
Baby hCG
AFP
LDH
Metanephrines
TSH
26
Treatment of mediastinal non-seminoma
Chemotherapy alone
27
Treatment of mediastinal seminoma
Chemotherapy and XRT
Very do you sensitive
28
Treatment of male genitalia
Wide local excision
XRT
Chemotherapy
29
Treatment of thymoma
Preoperative plasmapheresis to remove anti-cholenergic receptor antibody
Steroids
Excision via MEDIAN sternotomy
30
