Clinical Features & Staging of Lung Cancer

Question 1

What are the clinical features we use when staging a lung cancer that would show in a history?

Answer 1

History:

• Any pain, (notably bony)
• Headaches or neurological symptoms.
• Haematuria (RBCs in urine)

Question 2

When staging what clinical features would we use from an examination?

Answer 2

• Palsy of Recurrent Laryngeal Nerve or Brachial Plexus
• Superior Vena Cava Obstruction
• Supraclavicular Lymph Node enlargement
• Any soft tissue or chest wall masses
• Hepatomegaly
• Pleural/Pericardial effusion

Question 3

What would show up on a CXR to help us stage a lung cancer?

Answer 3

For starters its size.
But also:
 - Pleural Effusion
- Chest wall invasion
- Phrenic Nerve Palsy
- Collapse

Question 4

How would phrenic nerve palsy appear on a CXR?

Answer 4

One or both side of the diaphragm would be crazy high up.

If the left is higher than the right or the right higher than the left by an unusual amount.

Question 5

What blood tests help us stage lung cancer and why?

Answer 5

For Anaemia - Would show ventilation is significantly reduced
Abnormal LFTs - Could show metastatic tumours in liver
Abnormal Bone profile - Could show metastatic tumours in bone

Question 6

How would an MRI help in staging?

Answer 6

Shows vascular/neurological involvement with a pancoast tumour

Question 7

How would a bone scan help with staging?

Answer 7

Shows bony metastasis & chest wall invasion

Question 8

How would an ECHO help with staging?

Answer 8

Shows significant pericardial effusion

Question 9

What surgical investigations help with staging?

Answer 9

Bronchoscopy & Mediastinoscopy

To have a look at the tumour and sometimes the lymph nodes.

Question 10

How do we assess a patients fitness for surgery?

Answer 10

Check their for any potentially dangerous or risky Cardio/Resp. problems
Assess their psychological readiness
Assess their respiratory function
Assess their cardiac function

Question 11

How do we assess a patients respiratory function before surgery?

Answer 11

Arterial blood gasses
Diffusion study to check for alveolar function.
Spirometry
Fractionated V/Q scan

Question 12

What is the use of a fractionated V/Q scan before surgery?

Answer 12

OFten we wont want to remove a section of lung if the patient is close to having breathing problems.
However if a V/Q scan can show that section of lung isn’t actually ventilated or perfused (due to the tumour) then we can safely remove it.

Question 13

How would we assess a patient’s cardiac function prior to surgery?

Answer 13

Exercise Tolerance Testing (ETT)
ECHO
Coronary Angiogram
ECG

Question 14

What are some reasons for peri-operative death with lung cancer ops?

Answer 14

• Acute Respiratory Distress Syndrome (ARDS)
• Bronchopneumonia
• MI
• Pneumothorax
• Intrathoracic Bleeding

Question 15

What are some non-fatal complications of lung cancer ops?

Answer 15

Wound pain
Empyema
Wound infection
MI
Post-op respiratory Insufficiency

Question 16

What are some problems with staging of lung cancer?

Answer 16

Collapse makes tumour size hard to spot

Other nodules in the lungs or adrenals.

Question 17

What might look like lung cancer but isnt?

Answer 17

Certain infections (TB, Lung abscess)
Benign Tumour
Granuloma
Fibrosis
Other - e.g. paraffinoma