Assessment and surgical treatment of Lung cancer

Question 1

What are the two factors that will asses if the patient gets surgery

Answer 1

Staging of the Lung cancer

Fitness of the patient

Question 2

When does CT staging of lung cancer show that will make surgery difficult

Answer 2

Sizing of the tumour 
Mediastinal nodes - involve 2 surgeries 
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement
Metastatic disease - other parts of lungs, liver, adrenals, kidneys

Question 3

What varies tests are taken place to check the fitness of the individual

Answer 3

Spirometry -
Climbing the stairs - asses breathlessness
Diffusion studies
Fractioned V/Q studies

Question 4

How do diffusion studies occur

Answer 4

Inhalation of CO and the amount absorbed in a single breath is measure - shows alveolar diffusion capacity

Question 5

What does Fractioned V/Q studies measure

Answer 5

The ventilation and perfusion

Question 6

What substance is used in the Fractioned V/Q studies and how does this measure ventilation

Answer 6

Inhale radioactive substance (zenone) and it distributes accordingly to where airflow distributes

Question 7

If ventilation shows up poor in V/Q studies does this means surgery can processed, why?

Answer 7

Yes, as there is no chance in making it worse

Question 8

What substance is used in the Fractioned V/Q studies and how does this measure perfusion

Answer 8

Radioactive substances are injected into a vein in the arm and more images taken to see blood flow

Question 9

If perfusion shows up poor in V/Q studies does this means surgery can processed, why?

Answer 9

No as there is a chance of blood clotting in surgery making the situation worse

Question 10

What is the 4 different types of lung surgeries

Answer 10

o Open/Closed Thoracotomy
o Pneumonectomy
o Lobectomy
o Wedge resection

Question 11

What is a thoracotomy and its percentage morality

Answer 11

surgical incision into the chest wall - 5%

Question 12

What is a Pneumonectomy and its percentage morality

Answer 12

surgical removal of a lung or part of a lung (8-12% mortality)

Question 13

What is a lobectomy and its percentage morality

Answer 13

surgical removal of a lobe of the lung (3-5% mortality)

Question 14

What is a wedge dissection and its percentage morality

Answer 14

just take out the tumour from the lung tissue (2-3% mortality)

Question 15

What is a list of the fatal complications that can occur during surgery

Answer 15

♣ ARDS = adult respiratory distress syndrome – unknown cause, lots of fluid in lung
♣ Pneumonia = very common especially if patient has COPD
♣ MI (heart attack)
♣ PTE = pulmonary thrombus/embolism
♣ Pneumothorax
♣ Intrathroracic bleeding

Question 16

What is examples of non fatal complications of surgery

Answer 16

ϖ Wound pain/infection
ϖ Empyema (pus in the pleural space)
ϖ BTF (broncho-pleural fistula)
ϖ Post-op respiratory insufficiency

Question 17

Certain lung masses and leisons can occur and be mistaken as lung cancer, name 5 examples

Answer 17

TB 
Abscess
Benign tumour (Hamartoma) – made up of collage,     cartilage etc.
Granuloma
Fibrosis

Question 18

What is the most common lung mass/leison thing that can be mistaken as lung cancer

Answer 18

TB

Question 19

What can a chest X-ray show in the affects of lung cancer staging

Answer 19

Pleural effusion - excess fluid
Chest wall invasion
Phrenic nerve paralysis - affect diaphragm
Collapsed lobe or lung

Question 20

What can a blood tests show in the affects of lung cancer staging

Answer 20

anemia
abnormal bone profile
abnormal liver function tests
(show the effects of mestatasis)

Question 21

What is the main aim of surgical envelopment

Answer 21

Curative resection in removing as little as possible

Question 22

How will a bone scan help in the staging of lung cancer

Answer 22

Good test for chest wall invasion and for bony metastases

Question 23

How is a MRI useful in helping the staging of lung cancer

Answer 23

Useful in determining the degree of vascular and neurological involvement in Pancoast tumour (tumour in the apex)

Question 24

How is a ECHO useful in helping the staging of lung cancer

Answer 24

Will demonstrate presence or absence of significant pericardial effusion.

Question 25

What two surgical procedures help in the diagnosis of the staging of lung cancer

Answer 25

Bronchoscopy

Mediastinoscopy

Question 26

What does a bronchoscopy asses

Answer 26

the major airways

Question 27

What does a Mediastinoscopy asses

Answer 27

examine the lymph nodes wuth cut just above the breast bone

Question 28

What problems can make the staging of lung cancer difficult

Answer 28

Collapse of a lobe or lung makes tumour size difficult to assess
Presence of another (usually small) pulmonary nodule
Retrosternal thyroid - unusual thyroid placement below the sternum

Question 29

What is an example of an idiopathic symptom of lung cancer

Answer 29

finger clubbing