Week 4 - Assessment and Surgical Treatment of Lung Cancer

Question 1

What percentage of patients receive surgery and why?

Answer 1

average 10% - most patients have metastasis or not fit for surgery

Question 2

What are some symptoms of a metastasised tumour? (6)

Answer 2

• bone pain,
• larynx issues with voice/bovine cough,
• phrenic nerve issues,
• brachial plexus issues,
• SVCO (neck vein)
• lymph nodes or nodules visible

Question 3

How does a PET scan work?

Answer 3

inject F18 and metabolically active cells glow

Question 4

How does an MRI work and when?

Answer 4

shows soft tissue involvement - in pancoast tumour, shows how much of the brachial plexus is involved

Question 5

What is the use of isotopic bone scan? What happens if metastasis is shown?

Answer 5

shows metastasis to bone using isotope. if its invaded, tumour is inoperable and radiotherapy should be done instead

Question 6

Which patients have an ECHO and why?

Answer 6

type of ultrasound. ALL PATIENTS have it - detects fitness for surgery and if there is a pericardial effusion. if there is, is it malignant or not

Question 7

What is the main purpose of a bronchoscopy?

Answer 7

ensuring the tumour is not at the carina bifurcation and that its at least 2cm away so we can do surgery

Question 8

How is a mediastinoscopy carried out?
Whats the purpose?

Answer 8

small incision above sternum at sternal notch. place telescope in front and adjacent to trachea.

allows you to look at lymph nodes and take biopsies

Question 9

Which metastases are operable? (2)

Answer 9

chest wall invasion may be,
collapsed lung/lobe may be,

Question 10

Which metastases are inoperable? (3)

Answer 10

Pleural effusion, phrenic nerve palsy, bone metastasis

Question 11

What are the signs of bone marrow involvement? (3)

Answer 11

• anaemia,
• abnormal LVT (liver function tests),
• abnormal bone profile (alkaline phosphatase rises)

Question 11

What cardiological factors must be considered for fitness for surgery?

Answer 11

• heart problems,
• angina
• HBP,
• any past surgeries

Question 12

What Respiratory factors must be considered for fitness for surgery?

Answer 12

• smoking,
• asthma,
• COPD,
• recurrent URTI,
• exercise capacity

Question 13

What psychological factors must be considered for fitness for surgery?

Answer 13

anxiety, history of mental illness, chronic pain problems

Question 14

What happens to patients with pulmonary hypertension?

Answer 14

rejected. thin vessels may be damaged during surgery - uncontrollable bleeding and death

Question 15

What happens to patients with cirrhosis?

Answer 15

liver fibrosis and abnormal function. surgery leads to breakdown of many cells, leaving fat soluble debris. bacterial endotoxins are also fat soluble. build-up of these in cirrhosis patients leads to vasodilatation - low blood pressure - circulatory shock. rejected

Question 16

What are the routine lung function tests? (4)

Answer 16

• Spirometry,
• ABG,
• diffusion,
• V/Q scan (how much air and blood gets to each lobe)

Question 17

What is part of the cardiac assessment? (5)

Answer 17

• ECG,
• ECHO,
• CT,
• Coronary angiogram
• ETT (exercise tolerance test)

Question 18

What is the aim of surgery (1) and what must be ensured (2) ?

Answer 18

• ensure it is lung cancer and it is malignant.
• ensure resection of parietal surface is feasible.
• remove minimum amount of lung tisse

Question 19

What are reasons for peri-operative death?

Answer 19

ARDS, borderline lung function tests - bronchopneumonia, pneumothorax, intrathoracic bleeding

Question 20

What are some non-fatal complications following surgery?

Answer 20

• wound pain,
• empyema,
• atrial fibrillation,
• bronchi pleural fistula,
• gastrioparesis/constipation

Question 21

What is a bronchi pleural fistula?

Answer 21

large air space left after lobectomy or pneumonectomy - causes breathlessness as tidal volume dragged into dead space and not lung

Question 22

What do we commonly resect which isn’t lung cancer? (4)

Answer 22

• infection (TB or lung abscess),
• benign tumour (hamartoma),
• granuloma,
• fibrosis