Surgical Management of Lung Cancer

Question 1

6 stagings of lung cancer

Answer 1

• Clinical
• CXR
• Blood tests
• CT
• Other tests?
• Surgical

Question 2

Staging of lung cancer - CLINICAL

Answer 2

• History
• Examination

Question 3

Staging of Lung Cancer - CXR

Answer 3

• Pleural effusion
• Chest wall invasion
• Phrenic nerve palsy
• Collapsed lobe or lung

Question 4

Staging of lung cancer - BLOOD TEST

Answer 4

• Anaemia
• Abnormal LFTs
• Abnormal bone profile

Question 5

Staging of lung cancer - CT

Answer 5

• Size of tumour
• Mediastinal nodes
• Metastatic disease - other parts of lungs, liver, adrenals, kidneys
• Proximity to mediastinal structures
• Pleural/pericardial effusion
• Diaphragmatic involvement

Question 6

Staging of lung cancer - OTHER TESTS

Answer 6

• MRI - Useful in determining the degree of vascular and neurological involvement in Pancoast tumour.
• Bone Scan - Good test for chest wall invasion and for bony metastases
• ECHO - Will demonstrate presence or absence of significant pericardial effusion.

Question 7

Staging of lung cancer - SURGICAL

Answer 7

• Bronchoscopy
• Mediastinoscopy

Question 8

Fitness for surgery for lung cancer - clinical assessment

Answer 8

CVS: Angina? Heart problems? Smoking?

RESP: Barrell-chested? Smoking? Asthmatic?

PSYCH: PH of mental illness, severe anxiety, social background, chronic pain problem

OTHER: Pulmonary hypertension, permanent tracheostomy

Question 9

Respiratory function testing

Answer 9

• Spirometry
• Diffusion studies
• ABG on air/SLV
• Fractionated V/Q scan

Question 10

Cardiac assessment

Answer 10

• ECG
• ECHO
• CT scan
• ETT
• Coronary angiogram
• If in doubt, don’t operate

Question 11

Goals of surgical treatment of lung cancer

Answer 11

• Curative resection is the goal
• Remove the minimum amount of lung tissue
• Resection of parietal structures is feasible
• Firm diagnosis of malignancy is highly desirable before lung resection

Question 12

Non-fatal complicatios

Answer 12

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

Question 13

Commonest problems with staging of lung cancer

Answer 13

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