Surgical Management of Lung Cancer

Question 1

What is the assessment of the patient used to determine?

Answer 1

Staging of the lung cancer

Fitness of the patient

Question 2

What needs to be determined to stage lung cancer?

Answer 2

T, N and M status

Question 3

What are common clinical findings in the history for lung cancer?

Answer 3

Pain (especially bone pain)

Headaches or neurological symptoms including personality change

Haematuria (presence of red blood cells in the urine)

Question 4

What is haematouria?

Answer 4

Presence of red blood cells in the urine

Question 5

What is presence of red blood cells in the urine called?

Answer 5

Haematuria

Question 6

What are common clinical findings in the examination with lung cancer?

Answer 6

Recurrent laryngeal nerve palsy

Brachial plexus palsy

Superior vena cava obstruction (SVCO)

Supraclavicular lymph nodes

Soft tissue nodules

Chest wall masses

Pleural/pericardial effusion

Hepatomegaly (enlarged liver)

Question 7

What is hepatomegaly?

Answer 7

Abnormally enlarged liver

Question 8

What is abnormally enlarged liver called?

Answer 8

Hepatomegaly

Question 9

What can chest X-rays be used to determine?

Answer 9

Pleural effusion

Chest wall invasion

Phrenic nerve palsy

Collapsed lobe or lung

Question 10

What is pleural effusion?

Answer 10

Build of of excessive fluid between the pleura

Question 11

What is the build up of excessive fluid between the pleura called?

Answer 11

Pleural effusion

Question 12

What are some tests that are useful for staging cancer other than CT?

Answer 12

MRI

Bone scan

ECHO (echocardiogram)

Question 13

What does ECHO stand for?

Answer 13

Echocardiogram

Question 14

What is an echocardiogram (ECHO)?

Answer 14

Ultrasound scan used to look at the heart and nearby blood vessels

Question 15

What is MRI useful for?

Answer 15

Determine degree of vascular and neurological involvement

Question 16

What test is best for determining the degree of vascular and neurological involvement?

Answer 16

MRI

Question 17

What is bone scan useful for?

Answer 17

Test for chest wall invasion and for bony metastasis

Question 18

What test is best for checking chest wall invasion or bony metastasis?

Answer 18

Bone scan

Question 19

What is an echocardiogram (ECHO) useful for?

Answer 19

Demonstrate presence or absence of significant pericardial effusion

Question 20

What test is best for demonstrating the presence or absence of pericardial effusion?

Answer 20

Echocardiogram (ECHO)

Question 21

What is used for the surgical staging of lung cancer?

Answer 21

Bronchoscopy

Mediastinoscopy

Question 22

What is the fitness for surgery determined by?

Answer 22

Clinical assessment

Question 23

What systems are looked at during the clinical assessment to determine if someone is fit for surgery?

Answer 23

Cardiovascular

Respiratory

Psychological

Other

Question 24

What, in terms of the cardiovascular system, is check when determining fitness for surgery?

Answer 24

Angina

Heart problems

High blood pressure

Diabetes mellitus

Peripheral vascular disease

Smoking

Stroke

Carotid bruits

Heart murmors

Question 25

What is angina?

Answer 25

Chest pain due to not enough blood flow to the heart

Question 26

What is chest pain due to not enough blood flow to the heart called?

Answer 26

Angina

Question 27

What is carotid bruits?

Answer 27

Vascular murmur sound (bruit) heard over the carotid artery

Question 28

What is a vascular murmur sound heard over the carotid artery called?

Answer 28

Carotid bruits

Question 29

What is a heart murmur?

Answer 29

Unusual sound heard between heart beats

Question 30

What is an unusual sound heard between heart beats called?

Answer 30

Heart murmur

Question 31

What, in terms of the respiratory system, is check when determining fitness for surgery?

Answer 31

Barrel-chested COPD Smoking Asthmatic On oxygen Exercise capacity Previous thoractomy

Question 32

What is barrel-chested?

Answer 32

Broad deep chest

Question 33

What is a broad deep chest called?

Answer 33

Barrel-chested

Question 34

What psychologically is checked when determining fitness for surgery?

Answer 34

Past history of mental illness Severe anxiety Social background Chronic pain problems

Question 35

What additional things will be checked when determining fitness for surgery?

Answer 35

Pulmonary hypertension Permanent tracheostomy Rheutamoid artheritis Immobile patient Cirrhosis

Question 36

What is cirrhosis?

Answer 36

Condition where the liver does not function properly due to long term damage

Question 37

What is a condition where the liver does not function properly due to long term damage?

Answer 37

Cirrhosis

Question 38

What is respiratory function testing determined by?

Answer 38

Spirometry Diffusion studies Arterial blood gasses on air V/Q scan

Question 39

What is cardiac assessment determined by?

Answer 39

Electrocardiogram (ECG) Echocardiogram (ECHO) CT scan Exercise tolerance test (ETT) Coronary angiogram

Question 40

What does ETT stand up for?

Answer 40

Exercise tolerance test

Question 41

In terms of operating, what should you do if you are in doubt?

Answer 41

Do not operate

Question 42

What is the goal for the surgical treatment of lung cancer?

Answer 42

Curative resection

Question 43

What firm diagnosis is highly desirably before lung resection?

Answer 43

Malignancy

Question 44

What are the aims of surgical treatment of lung cancer?

Answer 44

Curative resection Remove minimal amount of lung tissue Resection of parietal structure is feasible

Question 45

What does peri-operative deaths mean?

Answer 45

During operation

Question 46

What are some reasons for peri-operative deaths?

Answer 46

Acute respiratory distress syndrome (ARDS) Bronchopneumonia Myocardial infarction Pulmonary thromboendarectomy (PTE) Pneumothorax Intrathoracic bleeding

Question 47

What does ARDS stand for?

Answer 47

Acute respiratory distress syndrome

Question 48

What is acute respiratory distress syndrome (ARDS)?

Answer 48

The lungs cannot provide the bodies vital organs with enough oxygen

Question 49

What is myocardial infarction?

Answer 49

Heart attack

Question 50

What is the medical name for a heart attack?

Answer 50

Myocardial infarction

Question 51

What does PTE stand for?

Answer 51

Pulmonary thromboendarectomy

Question 52

What is a pulmonary thromboendarectomy (PTE)?

Answer 52

Operation that removes thrombus from pulmonary arteries

Question 53

What is the operation that removes thrombus from the pulmonary arteries called?

Answer 53

Pulmonary thromboendarectomy (PTE)

Question 54

What are some non-fatal surgical complications?

Answer 54

Post thoracotomy wound pain Empyema Wound infection Atrial fibrillation Myocardial infarction Post-op respiratory insufficiency Gastroparesis/constipation

Question 55

What is atrial fibrillation?

Answer 55

Irregular and often abnormally fast heart rate

Question 56

What is an irregular and often abnormally fast heart rate called?

Answer 56

Atrial fibrillation

Question 57

What are some common problems with the staging of lung cancer?

Answer 57

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

Question 58

What is the operative mortality of the most dangerous procedure?

Answer 58

5-10%

Question 59

What is the operative mortality of a pneumonectomy?

Answer 59

5-10%

Question 60

What is the operative mortality of a lobectomy?

Answer 60

3-5%

Question 61

What is the operative mortality of a wedge resection?

Answer 61

2-3%

Question 62

What is the operative mortality of a open/close thoracotomy?

Answer 62

5%

Question 63

What is the chance of a second primary within 5 years of the operation?

Answer 63

5%

Question 64

What is the 5 year survival, post-operatively, of T1/2/3 and N\<2?

Answer 64

Between 40-70%

Question 65

What is the 5 year survical, post operatively, of any N2?

Answer 65

16%