Assessment and Surgical Treatment of Lung Cancer

Question 1

How is Patient assessed?

Answer 1

• Staging of lung cancer

- Fitness of the patient

Question 2

Lung cancer often metastasises to?

Answer 2

Adrenal glands

Question 3

How would stage of lung cancer be assessed with history?

Answer 3

Pain? (especially bony)
Headaches
Neurological symptoms including personailty change
Haematuria

Question 4

How would stage of lung cancer be assessed with a physical exam?

Answer 4

• Recurrent laryngeal nerve palsy
• SVCO (Superior vena cava obstruction)
• Supraclavicular LN`s
• Soft tissue nodules
• Chest wall masses
• PLeural/pericardial effusion
• Hepatomegaly

Question 5

What would show on blood tests if lung cancer was present?

Answer 5

• Anaemia
• Abonormal LFT`s
• Abnormal bone profile

Question 6

What is a mediastinoscopy?

Answer 6

Cut made just below breast bone to inspect nodes

Question 7

What questions should be asked about respiratory system before surgery?

Answer 7

• Barrell-chested?
• COAD?
• Still smoking?
• Asthmatic?
• Recent URTI?
• On oxygen?
• Exercise capacity?
• Previous thoracotomy or ICD?

Question 8

What questions should be asked regarding CVS before surgery?

Answer 8

• Angina?
• Heart Problems?
• HBP
• DM?
• PVD?
• Smoker?
• Stroke/TIA?
• Carotid bruits?
• Revious CABG/angioplasty
• Heart murmurs

Question 9

What physchological clinical questions should be asked?

Answer 9

• PH of mental illness
• Severe anxiety
• Social background
• Chronic pain problems

Question 10

What other questions should be asked in regarding fitness for surgery?

Answer 10

• Pulmonary hypertension
• Permanent tracheostomy
• Rheumatoid arthritis

Question 11

How is respiratory fitness assessed?

Answer 11

• Spirometry
• Diffusion studies
• ABG (arterial blood gas) on air
• SLV
• Fractionated V/Q

Question 12

How is fractionated V/Q measured?

Answer 12

Inhaling radioactive zeon and distributes around lung

Question 13

What cardiac tests should be done to assess fitness for surgery?

Answer 13

• ECG
• ECHO
• CT scan
• ETT
• Coronary angiogram

Question 14

What are the reasons for peri-operative death

Answer 14

• ARD`s
• Bronchopneumonia
• Myocardial Infarction
• PTE (pulmonary thromboembololus)
• Pneumothorax
• Intrathoracic bleeding

Question 15

What are some non-fatal complications for thoracic surgery?

Answer 15

• Post thoracotomy wound pain
• Empyema
• BPF
• Wound infection
• AF
• MI
• Post op respiratory insufficiency
• Gastroparesis/constipation

Question 16

What are the commonest problems with staging lung cancer?

Answer 16

-Collapse
of a lobe or lung makes tumour size difficult to assess
-Prescence of another (usually small) pulmonary nodule
-Retrosternal thyroid
-Adrenal nodule
-CT Head is not routinely performed

Question 17

What can often be mistaken for lung cancer?

Answer 17

• Infection (TB, Lung abcess)
• Benign tumour -( Hamartoma)
• Granuloma -Sarcoid, Wegener`s, Rheumatoid nodule,inflammatory pseudotumour
• Fibrosis -PMF, Organising pulmonary infarct
• Others- Paraffinoma