assessment and surgical treatment of lung cancer

Question 1

staging cancer

Answer 1

T- tumour T1-4
N- nodes N0-3
M- metastases

Question 2

important aspect of mediastinum?

Answer 2

it has nerves within

Question 3

lung metastases spreads to

Answer 3

lymph nodes in the neck

brain 
bone
skin
liver
adrenal glands

Question 4

what signs in the clinical history would indicate lung cancer?

Answer 4

pain esp. bony pain. Headaches or neurological symptoms including personality change.
Haematuria

Question 5

what is a chest x ray used to detect? (4)

Answer 5

Pleural effusion - fluid between pleura layers
Chest wall invasion (by tumour)
Phrenic nerve palsy/paralysis (unilateral diaphragmatic paralysis- one side higher, one lower)
Collapsed lobe or lung

Question 6

By what method does lung cancer usually spread/metastasise?

Answer 6

transcoelomic spread

Question 7

which scan is done in every patient with lung cancer?

Answer 7

PET scan

can combine CT-PET to stage cancer

Question 8

what can a PET scan not be used to examine?

Answer 8

the brain as it is highly metabolically active

Question 9

why is a bronchoscopy done before surgery

Answer 9

to plan the operation by seeing where the tumour lies

Question 10

what 3 blood tests can be used to stage lung cancer?

Answer 10

FBC - anaemia - reduced RBC
biochemistry test - see if cancer has spread to other parts of the body - Lung cancer spreads to lung so abnormal LFTs would be predicted
abnormal bone profile

Question 11

what can a CT scan be used to look for/moniter in lung cancer (5)

Answer 11

size of tumour

mediastinal nodes

metastatic disease- other parts of the lungs, liver, adrenals, kidneys

proximity to mediastinal structures

pleural/pericardial effusion

diaphragmatic involvement

Question 12

MRI use in lung cancer tests

Answer 12

Useful in determining the degree of vascular and neurological involvement in Pancoast tumour (type of lung cancer- in the apex of the lung)

Question 13

bone scan use in lung cancer tests

Answer 13

good test for chest wall invasion and for bony metastases

Question 14

ECHO

Answer 14

ultrasound to show presence or absence of significant pericardial effusion

Question 15

mediastinoscopy

Answer 15

visualisation of the contents of the mediastinum often carried out before surgery

Question 16

what is the mediastinum

Answer 16

region of the body located between the lungs. The heart, the esophagus, the trachea, and large blood vessels lie in this area. Also, lymph nodes.

Question 17

what things do you consider as part of CARDIOVASCULAR SYSTEM in clinical assessment of a patient’s fitness for surgery? (8)

Answer 17

Angina
heart problems
high blood pressure
Diabetes (DM)
smoking
peripheral vascular disease 
previous heart surgery
Heart murmurs

Question 18

what things do you consider as part of RESPIRATORY SYSTEM in clinical assessment of a patient’s fitness for surgery?

Answer 18

Barrell-chested (large, inflated chest may be due to arthritis or COPD)

COAD (chronic obstructive airway disease ie Chronic bronchitis and emphysema)

still smoking?

asthmatic

recent URTI

on oxygen

exercise capacity

Question 19

things to consider with psychiatric fitness for surgery

Answer 19

severe anxiety- may not recover from it or become demotivated from major surgery
social background
chronic pain problems

Question 20

other things to consider when determining fitness of patient for surgery?

Answer 20

Pulmonary hypertension (increased blood pressure within the arteries of the lungs)

permanent tracheostomy (breathing tube)

rheumatoid arthritis

the immobile patient

Cirrhosis (liver not functioning due to long term damage)

h/o radiotherapy to chest

Question 21

what tests are used to test respiratory function for fitness for surgery (3)

Answer 21

spirometry

ABG on air (arterial blood gas test measures oxygen and carbon dioxide levels in your blood)

fractionated V/Q scan- Just the ventilation - shows airflow ie how well O2 and CO2 diffuse

Question 22

what tests should you carry out for cardiac assessment for fitness for surgery

Answer 22

CT 
ECHO
ECG heart dscan
coronary angiogram 
IF IN DOUBT, DON'T OPERATE

Question 23

surgical treatment of lung cancer

Answer 23

Curative resection is the goal ie taking out enough tissue surrounding cancer for it not to grow back

But want to remove minimum amount of lung tissue

Resection of parietal structures is feasible

Firm diagnosis of malignancy is highly desirable before lung resection

Question 24

curative resection?

Answer 24

removing or destroying cancerous tissue

Question 25

reasons for peri-operative death

Answer 25

ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding

Question 26

define peri-operative death

Answer 26

any death occurring within 30 days of surgery

Question 27

what is an ARDS

Answer 27

Acute respiratory distress syndrome (ARDS)

respiratory failure characterised by rapid onset of widespread inflammation in the lungs (ie fluid seeps into lungs)
can be triggered by infection e.g pneumonia

Symptoms include shortness of breath, rapid breathing, and bluish skin coloration (cyanosis)

Question 28

non-fatal complications with surgery for lung cancer (7)

Answer 28

post thoracotomy wound pain

empyemea (collection of pus in the pleural cavity)

wound infection

AF (atrial fibrillation- common abnormal heart rhythm)

MI (myocardial infarction-heart attack)

post-op respiratory insufficiency

constipation

Question 29

Common problems with staging lung cancer

Answer 29

collapse of a lobe or lung- lose definition of tumour

presence of another
pulmonary nodule

retrosternal thyroid- unusual location of thyroid

Question 30

highest rate of operative mortality is in what?

Answer 30

pneumonectomy

Question 31

lung diseases that are non-cancerous but dangerous

Answer 31

infection- TB 
benign tumour - hamartoma
granuloma
fibrosis- PMF
paraffinoma