Cancer, Lung Parenchyma

Lung cancer is the primary cause of cancer death.

Asbestos exposure increases risk 5-fold.

Smoking increases risk 15-fold.

Radon exposure increases risk 2-fold.

Associated CAD

Pulm insufficiency following lung tissue resection

Optimization of preop pulmonary status

Issues secondary to metastatic spread, such as superior vena caval syndrome

Myasthenic syndrome (Eaton-Lambert) with oat cell carcinoma

Massive hemoptysis with cancer invasion of bronchial arteries

Active pneumonia in pulm parenchyma distal to obstructed bronchioles

Development of postop ARDS, pneumonia, or respiratory failure in 15–20%; higher in elderly

Development of cardiac complications in 10–15%; higher in elderly

Four primary types of lung cancers: squamous cell, or bronchogenic; adenocarcinoma (most common); large cell carcinoma; and small cell carcinoma.

70% of pts with COPD need extra postop pulm care.

Pts often nutritionally depleted.

Many pts have alcohol abuse history.

Preop pulm state may limit option of lobectomy.

Hormonal imbalances common due to hormone secreting tumors:

• 3% of pts are Cushingoid.

• 70% of pts with bronchogenic carcinomas have increased ACTH or pro-ACTH.

• Up to 60% of pts with lung cancer have inappropriate ADH.

Myasthenic syndrome occurs owing to decreased release of nerve-ending acetylcholine, leading to increased sensitivity to all muscle relaxants.

Environmental factors important (smoking, asbestos exposure, radon exposure).

Higher incidence in areas located near oil refineries.