Surgical management of lung cancer

Question 1

What is the most common spread place of cancer?

Answer 1

Other lung is most common

Can also spread to adrenal gland,liver, brain or bone

Question 2

What is the history of lung cancer?

Answer 2

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

Question 3

What is the examination of lung cancer?

Answer 3

Recurrent laryngeal nerve palsy, brachial plexus palsy, SVCO, supraclavicular LNs, soft tissue nodules, Chest wall masses. Pleural/pericardial effusion. Hepatomegaly.

Question 4

What are the two classifications of lung cancers

Answer 4

Small cell carcinoma and non small cell carcinoma

Question 5

Which classification more likely treated with surgery?

Answer 5

Non small cell carcinoma

Question 6

What staging is involved in chest Xray?

Answer 6

May be able to see: 
Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung

Question 7

What are examples of blood tests for testing lung cancer?

Answer 7

Anaemia
Abnormal LFTs
Abnormal bone profile

Question 8

What can Ct scan show for lung cancer?

Answer 8

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

Question 9

What is the main reason for getting PET?

Answer 9

PET used mainly to see Nodule activity within mediastinum

Question 10

Why do MRI for lung cancer?

Answer 10

Useful in determining the degree of vascular and neurological involvement in Pancoast tumour.

Question 11

Why do bone scan for lung cancer?

Answer 11

Good test for chest wall invasion and for bony metastases

Question 12

Why do ECHO?

Answer 12

Will demonstrate presence or absence of significant pericardial effusion and how well ventricle is functioning and ventricle strain

Question 13

What are the two surgical investigation methods?

Answer 13

Bronchoscopy and mediastinoscopy

Question 14

What are things to look out for in the CVS when assessing for fitness?

Answer 14

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

Question 15

What are things to look out for in the Resp when assessing for fitness?

Answer 15

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

Question 16

What are things to look out for in the psych when assessing for fitness?

Answer 16

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

Question 17

What are other things to look out when assessing for fitness?

Answer 17

Pulmonary hypertension, permanent tracheostomy, rheumatoid arthritis, the immobile patient. Cirrhosis, h/o radiotherapy to chest

Question 18

What are examples of respiratory function testing?

Answer 18

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

Question 19

What does cardiac assessment involve?

Answer 19

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

Question 20

What are reasons for preoperative death?

Answer 20

ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding

Question 21

What are some non fatal complications after lung cancer surgery?

Answer 21

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

Question 22

What are the operative mortality for pneumonectomy?

Answer 22

5-10%