Thoracic surgery (week 6)

Question 1

Type of surgery for Lung cancer

Answer 1

Lobectomy / Pneumonectomy

Question 2

Pneumonectomy

Answer 2

Removal of one lung

Question 3

Lobectomy

Answer 3

Removal of one or more lobes (section) of an organ (i.e. lung, liver, brain, thyroid gland)</p>

Question 4

Carcinoma

Answer 4

Cancer that begins in the skin or in tissues that line or cover internal organs

Question 5

Smoking kills ____ New Zealanders every year, which accounts for ___-___% of all deaths from Lung cancer.
___% adults currently smoke in NZ

Answer 5

5,000
92-94%
20%

Question 6

NZ Maori - lung cancer 2.5 - 3 times higher than that in the NZ European population.
True or False?

Answer 6

True

Question 7

Risk of lung cancer halved every 5 yrs quiting. T or F?

Answer 7

True

Question 8

Men who smoke 1 pack a day increases their risk more than 25 times compared with never smokers. T or F?

Answer 8

False … 2 packs a day increase the risk 25 times

Question 9

Signs & Symprtoms of Lung cancer

Answer 9

• Persistent cough
• Sputum
• Haemoptysis … coughing up blood
• Dyspnoea
• Chest pain … diffuse, constant & poorly localised
  (if localised tends to be poor prognosis)
  indicates tumor in the chest wall, pleura,
  pressing on the wall
• Stridor … a whisling soung when breathing
• Wheeze
• Collapse / consolidation / effusion
• Hoarseness … recurrent laryngeal nerve involvement
  (tumor in the laryngeal)
• Bony pain … Metastasis

Question 10

To confirm clinical diagnosis of lung cancr

Answer 10

Currently no routine screening

• Biopsy … the removal of cells or tissues for examination by a pathologist.
• Sputum cytology … take sputum sample; chepest way to exam
• Bronchoscopy … a bronchoscope is a thin, tube-like instrument with a light and a lens for viewing the airways (inside of the trachea, bronchi)
• Thoracoscopy / Mediastinoscopy … confirmers
• PET (positive emition tomography) scanning
• CT / MRI / CXR (chest x-ray)
• Blood profile

Question 11

Lung cancer stages

Answer 11

Stage 1 … No metastasis - survival with surgery up to 75%
Stage 2 … Lymph node involvement - survival 10 - 20%
Stage 3 … Surgery depends upon site, spread - Poor prognosis & survival rates
Stage 4 … Distal metastasis. Inoperatable. Survival 1 yr = 17%, 2 yr = 6%

Question 12

Small cell lung cancer (SCLC) has better prognosis than Large cell lung cancer. T or F?

Answer 12

False
SCLC - without Rx most aggressive clinical course & survival of only 2 -4 months; Metastates common; 4 - 5 fold improvement with chemotherapy; overall 5 yrs survival only approx 5 %

Question 13

What does the monophoic wheeze indicate?

Answer 13

Obstruction or narrowing of the large airway = tumor
(the higher the pitch the greater the obstruction)
=> need to take the whole lung out

Question 14

Preoperative (thoracic surgery) physiotherapy may reduce the development of PPC. T or F?

Answer 14

Yes and No

• PPC occurs irrespective of preop PT education
• Exercise intervention may reduce the development of PPC (Freeney et al, 2011); may increase the Px’s surgery capacity (if the Px on the borderline of

Question 15

whtat does “VATS” stands for?

Answer 15

Video assisted thoracic surgery

to view the inside of the chest cavity after making only very small incisions

Question 16

Physiotherapy managemetn post thoracic surgery

Answer 16

• Respiratory care
• shoulder and thoracic cage function
• Early mobilisation … reduce PPC risk; increase respiratory fitness

Question 17

Incidence of PPC after thoracic surgery

Answer 17

4 - 36% (Reeve et al, 2010)

Question 18

<p>Post-operative (open thoracotomy) PT is more effective than usual care. T or F?</p>

Answer 18

<p>False According to (Reeve et al, 2009) there was no difference between the PT treatment group and the control group. Low incidence of PPC. However, the usual care involved: early position changes, early mobilisation, frequent pain assessment..., and PT group had: DBE, coughing exercise, assistance with ambulation, progressive shoulder &amp; thoracic cage mobility programme in addition to usual care... so In conclusion, DBE is not necessary in addition to &quot;Early mobilisation&quot;!! done.</p>

Question 19

A post-operative PT (shoulder exercise programme) improves?

Answer 19

pain & shoulder function, but doesn’t improve ROM, strength

Question 20

IS (incentive spirometry) reduces the development of PPC. T or F?

Answer 20

False

No documented benefit in reduction of PPC

Question 21

PPCs specific to thoracic surgery

Answer 21

• Pneumonia, chest infection
• Persistant air leaks
• Empyema … a collection of pus in a body cavity
• Recurrent laryngeal damage
• Broncho pleural fistula … ab abnormal opening between two organs
• Wound infection
• Post thoracic pain
• Surgical emphysema

Question 22

TENS treatment is effective when used alone in severe post-thoracotomy pain. T or F?

Answer 22

False
It is ineffective when used alone in severe post-thoracotomy pain but useful as an adjunct tto other medications in moderate post-thoracotomy pain and very effective as the sole pain-control treatment in patients with mild post-thoracotomy pain

Question 23

the criteria for thoracic surgery

Answer 23

-FEV1 > 2L
-FEV1/FVC > 50%
-VO2peak >15ml/kg
(if it doesn’t meet theses, no surgery; not fit enough to do surgery)

Question 24

90% of thoracic surgical prosedures are

Answer 24

lung cancer