Lung Cancer
Considerations
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Potentially compromised respiratory function with risk of perioperative respiratory complications
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4M’s:
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M ass effects: obstructive pneumonia, lung abscess, SVC syndrome, tracheobronchial distortion, Pancoast’s syndrome, recurrent laryngeal nerve or phrenic nerve paresis, chest wall or mediastinal extension
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M etabolic effects: Lambert–Eaton syndrome, hypercalcemia, hyponatremia, Cushing’s syndrome
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M etastases: particularly to brain, bone, liver, & adrenal
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M edications: chemotherapy agents, pulmonary toxicity (bleomycin, mitomycin), cardiac toxicity (doxorubicin), renal toxicity (cisplatin)
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Need for lung resection, mediastinoscopy/bronchoscopy, non-thoracic surgery
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Comorbidities including smoking, chronic obstructive lung disease, coronary artery disease, hypertension
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Management of cancer pain with multimodal approach
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Goals of care & DNR status