Surgical Management of Lung Cancer

Question 1

What might be included in the history for someone with lung cancer?

Answer 1

Pain, headaches, neurological symptoms including personality change. Haematuria

Question 2

What might you notice during an examination of someone with lung cancer?

Answer 2

Recurrent laryngeal palsy, brachial plexus palsy

SVCO

Supraclavicular lymph nodes, soft tissue nodules, chest wall masses. Pleural/pericardial effusion. Hepatomegaly

Question 3

What is recurrent laryngeal nerve palsy?

Answer 3

Paralysis of the larynx (voice box) caused by damage to the recurrent laryngeal nerve or its parent nerve, the vagus nerve, which originates in the brainstem and runs down to the colon. The recurrent laryngeal nerve supplies the larynx (voice box).

Question 4

What can a chest X-ray indicate?

Answer 4

Pleural effusion
Chest wall invasion
Phrenic nerve palsy
Collapsed lobe or lung

Question 5

What can blood tests indicate?

Answer 5

Anaemia
Abnormal LFTs (liver function tests)
Abnormal bone profile

Question 6

What does a CT scan show you?

Answer 6

The size of the tumour
Mediastinal nodes
Metastatic disease (other parts of the lungs, liver, adrenals or kidneys)
Proximity to mediastinal structures
Pleural/pericardial effusion
Diaphragmatic involvement

Question 7

What other tests besides X-ray, blood tests and CT scans might help a diagnosis?

Answer 7

MRI
Bone Scan
ECHO

Question 8

What is an MRI useful for?

Answer 8

Determining the degree of vascular and neurological involvement in pancoast tumour

Question 9

What is a Bone scan a good test for?

Answer 9

Good test for chest wall invasion and for bony metastases

Question 10

What is an ECHO good for?

Answer 10

Demonstrating the presence or absence of significant pericardial effusion.

Question 11

What are the surgical methods of lung cancer staging?

Answer 11

Bronchoscopy

Mediastinoscopy

Question 12

What considerations would you have to make before operating?

Answer 12

CVS, respiratory, psychology

CVS - Angina, heart problems, High blood pressure, Pulmonary vascular disease, smoking, Stroke, Transient ischemic attack. Carotid bruits (systolic sound), previous coronary artery bypass, angioplasty (stent), heart murmurs

Resp: Barrell chested, (COPD – chest always slightly expanded, COAD (chronic obstructive airway disease), Still smoking, Asthmatic, Recent URTI, On oxygen, Exercise capacity. Previous thoracotomy or ICD (implantable cardioverter – defibrilator)

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

Other: Pulmonary hypertension, permanent tracheostomy, rheumatoid arthritis, immobile patient, cirrhosis

Question 13

What are the respiratory function tests needed to assess fitness for surgery?

Answer 13

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

Question 14

What is ABG?

Answer 14

Arterial blood gas (ABG): The sampling of the blood levels of oxygen and carbon dioxide within the arteries, as opposed to the levels of oxygen and carbon dioxide in venous blood. Typically the acidity, or pH, of the blood is measured simultaneously with the gas levels in ABG sampling.

Question 15

How do you assess someones heart before surgery?

Answer 15

ECG - (electrocardiogram)
ECHO - echocardiography - ultrasound of the heart
CT scan
ETT - (exercise tolerance test, exercise ECG)
Coronary angiogram

Question 16

What must be determined before resection?

Answer 16

Firm diagnosis of malignancy

Question 17

What is the goal in surgical treatment of cancer?

Answer 17

Curative resection, with minimal removal of lung tissue

Question 18

Is resection of the parietal structures possible?

Answer 18

Yes, feasible

Question 19

What is peri-operative death?

Answer 19

Death within 2 weeks of a surgical procedure

Question 20

What are the reasons for peroperative death?

Answer 20

ARDS
Bronchopneumonia
Myocardial Infarction
PTE
Pneumothorax
Intrathoracic bleeding

Question 21

What is ARDS?

Answer 21

Acute respiratory distress syndrome - Condition that leads to low oxygen levels in the blood. Fluid builds up in the air sacs. This prevents the lungs from filling with air and moving enough oxygen into the bloodstream.

Question 22

What does PTE stand for?

Answer 22

Pulmonary thromboembolism

Question 23

What non-fatal complications exist after an operation?

Answer 23

Pain
Empyema
BPF
Wound infection
AF
MI
Post-op respiratory insufficiency
Gastroparesis/constipation.

Question 24

What does BPF stand for?

Answer 24

Bronchopulmonary fistula

Question 25

What does MI stand for?

Answer 25

Myocardial infarction

Question 26

What is gastroparesis?

Answer 26

Spontaneous movement of the muscles (motility) in your stomach does not function normally

Question 27

When is it difficult to assess the size of a tumour?

Answer 27

Because of collapse of a lobe or lung

Question 28

What are the commonest problems with staging of lung cancer?

Answer 28

Presence of another pulmonary nodule
Retrosternal thyroid
Adrenal Nodule - benign tumour in the adrenal gland

Question 29

What is a retrosternal thyroid?

Answer 29

The abnormal location of all or part of the thyroid gland below the breastbone (sternum)

Question 30

Define pneumonectomy

Answer 30

Surgical removal of a lung or part of a lung.

Question 31

When might be confused for cancer?

Answer 31

Tb, lung abscess
Benign tumour - hamartoma
Granuloma 
Fibrosis
Paraffinoma

Question 32

Define hamartoma

Answer 32

Disorganised mass of cells. The cells are the same as those found in the local area, non- malignant. Growth rate is equal to that of the surrounding area

Question 33

Define parrafinoma

Answer 33

Injection of paraffin causing a tumefaction, usually a granuloma