surgical management of lung cancer

Question 1

what are two factors when assessing the patient?

Answer 1

staging of the lung cancer

fitness of the patient

Question 2

in staging of lung cancer, by taking the history what should be in it to help you undertand if it is lung cancer and what stage?

Answer 2

pain, esp bony pain
headaches or neurological symptoms including personality change
haematuria

Question 3

what kind of testing would you use to check:
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung

Answer 3

CXR (chest x ray)

Question 4

what would you be looking at if you are doing blood tests?

Answer 4

Anaemia
Abnormal LFTs
Abnormal bone profile

Question 5

when looking at CT scan what would you be looking for?

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

what other tests can you do to see the stage of lung cancer?

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

what surgical testing would you use for determining the stage of lung cancer?

Answer 7

Bronchoscopy

Mediastinoscopy

Question 8

what are the questions you would ask yourself when determining a patient fit for surgery in the CVS

Answer 8

Angina? 
Heart problems?
 HBP, DM, PVD, Smoking, Stroke/TIA, Carotid bruits?,
 Prev CABG/angioplasty. 
Heart murmurs?

Question 9

what are the questions you would ask yourself when determining a patient fit for surgery in the resp

Answer 9

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

Question 10

what are the questions you would ask yourself when determining a patient fit for surgery in the Psych

Answer 10

PH of mental illness, severe anxiety, social background, chronic pain problems

Question 11

what are the respiratory function testing to test fitness for surgery?

Answer 11

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

Question 12

what are the cardiovascular function testing to test fitness for surgery?

Answer 12

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

Question 13

what are the aims of surgical treatment of the lung cancer?

Answer 13

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 14

what are the reasons for peri-operative death?

Answer 14

ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding

Question 15

what are non-fatal complications of surgery for lung cancer?

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 of lung cancer?

Answer 16

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

Question 17

what is the operative mortality for pneumonectomy

Answer 17

8-12%

Question 18

what is the operative mortality for lobectomy

Answer 18

3-5%

Question 19

what is the operative mortality for wedge resection?

Answer 19

2-3%

Question 20

what is the operative mortality for open-close thoractomy

Answer 20

5%

Question 21

what is the percentage of 5 year survival postop with T1N0?

Answer 21

70%

Question 22

what is the percentage of 5 year survival postop with T2N0

Answer 22

60%

Question 23

what is the percentage of 5 year survival postop with T3N0?

Answer 23

50%

Question 24

what is the percentage of 5 year survival postop with T1N1?T2N1?

Answer 24

40%

Question 25

what is the percentage of 5 year survival postop with any N2

Answer 25

16%

Question 26

what is the percentage of 5 year survival postop with chance of second primary?

Answer 26

5%

Question 27

what does T stand for

Answer 27

size of tumour and location

Question 28

what does N mean?

Answer 28

he number of nearby lymph nodes that have cancer

Question 29

what does M mean?

Answer 29

whether the cancer has metastasized

Question 30

what type of staging is lung cancer staging?

Answer 30

TNM

Question 31

where does cancer typically spread to?

Answer 31

bones, liver, brain (can change personality) adrenals

Question 32

where about is the cancer in the lung?

Answer 32

the very top of the lung

Question 33

what happens if the cancer has taken over brachial plexus?

Answer 33

shooting sore pain down arm

Question 34

are pleural effusion opperable

Answer 34

no

Question 35

what is pleural effusion

Answer 35

excess fluid that accumulates in the pleural cavity

Question 36

do you opperate if the phrenic nerve has been affected?

Answer 36

no

Question 37

wheres the first place that lung cancer spreads to?

Answer 37

lymph nodes

Question 38

what testing would you use to see if the cancer has spread esp to lymph?

Answer 38

PET scan

Question 39

why would you do a bronchoscopy

Answer 39

allows us to plan the opertion if you can see where the tumour lies?