Assessment and Surgical Management of Lung Cancer

Question 1

Who should be considered for surgical management of their lung cancer?

Answer 1

Not M disease

N1 might still have good success

Question 2

What other investigations may you require when staging someone with lung cancer?

Answer 2

MRI useful for seeing vascular/neurological involvement in Pancoast tumour
Bone scan if invasions/mets
ECHO to see pericardial infusion

Question 3

Why is the distance from the carina important in lung cancer?

Answer 3

Distance from carina increases change of success wit operation (has to be at least an inch away from it to operate)

Question 4

What resp function tests might you do before surgery to assess the fitness of a patient?

Answer 4

Spriometry, diffusion studies, ABG on air/SLV
Fractioned V/Q scan

Generally if can walk up 2 flights of stairs they are fit for surgery

Question 5

What tests might you do to see if a patient is fit for surgery?

Answer 5

ECG, ECHO, ETT, coronary angiogram

Question 6

What are reasons for perioperative death in lung cancer surgery?

Answer 6

ARDS
Bronchopneumonia
MI
PTE
Pneumothorax
Intrathoracic bleeding

Question 7

What are non-fatal complications of lung cancer surgery?

Answer 7

Post-thoracotomy wound pain 
Empyema 
Bronchopleural fistula
Wound infection 
AF 
MI
Post-op resp insufficiency
Gastroparesis/constipation

Question 8

What lung masses may appear as lung cancer?

Answer 8

TB
Lung abscess
Benign tumour, e.g. hamaratoma
Granuloma - sarcoid/wegener's
Rheumatoid nodule
Infalmmatory pseudotumour
Fibrosis