Assessment and surgical management of lung cancer

Question 1

Name the 2 components of assessing the patient

Answer 1

staging of the lung cancer

fitness of the patient

Question 2

Name the 3 letters used in the staging process

Answer 2

T N M

Question 3

In N1 disease where has the cancer spread to?

Answer 3

hilum
left main bronchus
main pulmonary vein

Question 4

In N2 disease where has the cancer spread?

Answer 4

mediastinum

Question 5

In N3 disease where has the cancer spread?

Answer 5

supraclavicular

aortal pulmonary window

Question 6

Name some symptoms in the clinical history of the patient

Answer 6

pain - especially bone
headaches
haematuria

Question 7

Name some symptoms in the clinical examination of the patient

Answer 7

nerve palsy - brachial and laryngeal = hoarse voice and raised diaphragm
supraclavicular lymph nodes and chest wall masses
hepatomegaly

Question 8

Name the 4 things an x ray can identify

Answer 8

pleural effusion
chest wall invasion
phrenic nerve palsy
collapsed lung or lobe

Question 9

What would a blood test show?

Answer 9

anaemia

bone profile - raised calcium

Question 10

What can a CT be useful to show in the staging of lung cancer?

Answer 10

The size of tumour
metastases
mediastinal proximity and nodes 
diaphragm
pleural effusion

Question 11

Name 3 other tests done in lung cancer staging

Answer 11

MRI
Bone scan
ECHO

Question 12

Name 2 surgical methods to stage lung cancer

Answer 12

bronchoscopy

mediastinoscopy

Question 13

Name the 4 main areas focused on in the clinical assessment to determine the fitness for surgery

Answer 13

Cardiovascular
respiratory
psychological
other

Question 14

Name some main things looked at in the CVS

Answer 14

Angina 
heart problems
high blood pressure 
stroke 
peripheral vascular disease

Question 15

Name some main things looked for in the respiratory clinical assessment

Answer 15

asthma
smoker 
recent URTI 
barrel chested 
COAD

Question 16

Name the main things concentrated on in the psychological assessment

Answer 16

mental illness
anxiety
chronic pain

Question 17

Name some other things looked at in the clinical assessment

Answer 17

pulmonary hypertension
rheumatoid arthritis
cirrhosis

Question 18

Name the 4 respiratory lung function tests used

Answer 18

spirometry
diffusion studies
ABG on air/SLV
V/Q

Question 19

Name some scans used for the cardiac assessment

Answer 19

ECG
ECHO
CT
coronary angiogram

Question 20

State the main goals of lung cancer surgery

Answer 20

Cure the patient
remove as little as possible
be sure it is cancer and not an infection

Question 21

Name some reasons why people die in surgery

Answer 21

bleeding
MI
ARDS
pneumothorax

Question 22

List some non fatal complications of lung cancer surgery

Answer 22

wound pain
empyema
infection
MI
constipation
blood pressure

Question 23

Name some of the main problems encountered when trying to stage lung cancer

Answer 23

collapse lung or lobe
prescence of another nodule
retrosternal thyroid

Question 24

What is the post operative mortality for a pneumonectomy?

Answer 24

8-12% ==> the less of the lung resected the better the prognosis after surgery

Question 25

Name some things that can be confused with lung cancer but are non lung cancer

Answer 25

infection - TB
benign tumour - hamartoma
sarcoid - granuloma
fibrosis

Question 26

What is a hamartoma?

Answer 26

Tumour with the components usually found in that organ