The Lung

Question 0

Patient with suspected lung cancer – work up? Factors that limit work up?

Answer 0

1. CXR (compare with old CXR if suspicious lesion)
2. If suggestive, Noninvasive tests – sputum cytology and CT scan
3. If unsuccessful, Bronchoscopy and biopsy (central lesion) or percutaneous biopsy (peripheral lesion)
4. If unsuccessful, Thoracotomy and wedge resection

Probability of cancer, residual pulmonary function, chances that surgery may be curative

Question 1

Coin lesion – chance of being malignant? Not Cancer if?

Answer 1

80% if over age 50 (hired with history of smoking)

Old chest x-ray also shows lesion

Question 2

Lung CT shows noncalcified lesion – probability of cancer?

Answer 2

High

Question 3

Findings that increase chance of lung surgery being curative for cancer

Answer 3

#No metastases to mediastinal or carinal nodes
#Cancer only in one lung
#No metastases to liver

Question 4

Small cell cancer of the lung – when surgery?

Answer 4

Never. Treated with chemotherapy and radiation

Question 5

Difference in surgical management if central lesion versus peripheral vision?

Answer 5

Pneumonectomy versus lobectomy

Question 6

How to determine if someone with lung cancer is a surgical candidate?

Answer 6

#Determine FEV1, fraction that comes from each lung (from VQ scan), and calculate remaining amount after lobectomy/pneumonectomy
#If less than 800 mL, patient is not a surgical candidate (stop doing tests)

Question 7

Metastases that do not rule out surgical removal of lung cancer? Metastases that do?

How to identify nodal metastases?

Answer 7

Hilar metastases

Carinal or mediastinal metastases

CT scan, PET scan, endobronchial ultrasound