Surgical Management of Lung Cancer

Question 1

What two factors are used in the assessment of whether surgery is an option for a patient?

Answer 1

The stage of the lung cancer and the fitness of the patient

Question 2

What scan can be used to determine whether patients with lung cancer have metastasis?

Answer 2

PET Scan

Question 3

What symptoms can be used to stage lung cancer?

Answer 3

Pain (esp. bony pain), headaches, neurological symptoms including personality change and haematuria

Question 4

What signs can be used to stage lung cancer?

Answer 4

Laryngeal nerve/brachial plexus palsy, SVCO, supraclavicular LNs, soft tissue nodules, chest wall masses, pleural/pericardial effusion and hepatomegaly

Question 5

What can be seen on a CX-Ray that could assist with staging the lung cancer?

Answer 5

Pleural effusion, chest wall invasion, phrenic nerve palsy and a collapsed lobe/lung

Question 6

What abnormalities might a blood test show up in someone with lung cancer?

Answer 6

Anaemia, abnormal LFTs and an abnormal bone profile

Question 7

What features of lung cancer might show up on a CT scan?

Answer 7

Size, mediastinal nodes, metastatic disease, proximity to mediastinal structures, pleural/pericardial effusion and diaphragmatic involvement

Question 8

What other scans/tests (Besides CX-Ray, CT and blood tests) may be useful?

Answer 8

MRI, bone scan and ECHO

Question 9

What surgical procedures may be useful in staging lung cancer?

Answer 9

Bronchoscopy and Mediastinoscopy

Question 10

What cardiovascular factors need taken into account in the clinical assessment?

Answer 10

Heart problems, high blood pressure, angina, smoking etc.

Question 11

What respiratory factors need taken into account in the clinical assessment?

Answer 11

COAD, smoking, recent URTI, oxygen etc.

Question 12

What psychological factors need taken into account in the clinical assessment?

Answer 12

Past history of mental illness, severe anxiety, social background and chronic pain

Question 13

What tests can be done to assess respiratory function?

Answer 13

Spirometry, diffusion studies, ABG and V/Q scan

Question 14

What tests can be used to assess cardiac function?

Answer 14

ECG, ECHO, CT scan, ETT and a Coronary angiogram

Question 15

What are the reasons for peri-operative death?

Answer 15

ARDS, bronchopneumonia, MI, PTE, pneumothorax and intrathoracic bleeding

Question 16

What are the non-fatal complications of surgery for lung cancer?

Answer 16

Pain, empyema, BPF, infection, AF, MI, post-op respiratory insufficiency and gastroparesis/constipation

Question 17

What are the commonest problems with staging lung cancer?

Answer 17

Collapse of lobe/lung makes tumour size difficult to assess, presence of a smaller pulmonary nodule, retrosternal thyroid and adrenal nodule