Severe lung dx, minor surgery

Male 77yo with a known bladder cancer for cystoscopy and diathermy.


  • HTN
  • COPD 48% FEV1
  • Smoker – 120PYH
  • Post-polio syndrome with chronic pain
  • Chronic lower back pain
  • Opioid tolerant ++ (160mg BD MS Contin, 10mg QID endone)


  • Incidental finding of LUL lesion (SCC ON BX)
    • T3N0M0
    • May be a candidate for curative surgery


  • Should surgery proceed?
    • Similar level of morbidity to many of our urological patients
    • Minimally invasive procedure
    • Potential for significant morbidity prevention; diathermy of a small bladder cancer recurrence now will prevent large tumour (requiring larger procedure) or anaemia from bleeding at a later date
    • Low analgesia requirements so patient’s existing opioid tolerance not a huge concern
  • Opportunities for optimisation looking towards possible thoracic surgery
    • Smoking cessation
    • Opioid reduction


  • Proceed with urology procedure
  • Contact GP/patient about optimisation opportunities