Surgical Management Of Lung Cancer

Question 1

Aorto-pulmonary window

Answer 1

Lots of lymph nodes

Question 2

Main three symptoms of lung cancer

Answer 2

Cough, SOB, haemoptysis

Question 3

Phrenic nerve palsy

Answer 3

Causes the diaphragm to be raised

Question 4

History to stage lung cancer

Answer 4

Pain(bony), headaches/neurological symptoms, haematuria

Question 5

Examination to stage lung cancer

Answer 5

Recurrent laryngeal nerve palsy, brachial plexus palsy, supraclavicular LNs, superior vena cava obstruction, soft tissue nodules, chest wall masses, pleural/pericardial effusion, hepatomegaly(big liver)

Question 6

Staging of lung cancer with blood tests

Answer 6

Not used much but possibly anaemia

Question 7

Staging of lung cancer with CXR

Answer 7

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

Question 8

Staging of lung cancer with CT

Answer 8

Gives size of tumour, mediastinal nodes, metastasis, proximity to mediastinal structures, pleural/pericardial effusion, involvement of the diaphragm

Question 9

MRI, bone scans and ECHO for staging lung cancer

Answer 9

MRI- vascular and neurological involvement in pancoast tumour(apex)

Bone scan- chest wall invasion and bony metastasis

ECHO- pericardial effusion

Question 10

Surgical staging of lung cancer

Answer 10

Bronchoscopy or mediastinoscopy

Question 11

Clinical assessment for fitness for surgery

Answer 11

CVS eg smoking, hbp, angina
resp eg asthma, recent URTI, exercise capacity
Psych eg anxiety, mental illness, chronic pain
Other eg pulmonary hypertension, rheumatoid arthritis, immobility

Question 12

Fitness for surgery respiratory function testing

Answer 12

Spirometry, diffusion studies, ABG on air, V/Q scan

Question 13

Fitness for surgery cardiac assessment

Answer 13

ECG, ECHO, CT, ETT, coronary angiogram

Question 14

Reasons for post operative death

Answer 14

ARDS, bronchopneumonia, MI (less space for blood to go through lungs makes heart work harder), pnuemothorax, intrathoracic bleeding

Question 15

Non fatal complications

Answer 15

Post thoracotomy wound pain, empyema, BPF (bronchopleural fistula), wound infection, atrial fibrillation, constipation from drugs

Question 16

Problems with staging lung cancer

Answer 16

Collapsed lobes
Presence of other nodules
Retrosternal thyroid 
Adrenal nodule
No preoperative CT of head

Question 17

Operative mortality

Answer 17

Highest with whole lung, best with lobe

Question 18

Differential diagnosis

Answer 18

Infection eg TB or abscess
Benign tumour
Granulomas
Fibrosis