Trial Short Case 2 September 2020

Case Summary

58 year old man

Presented for discussion at the Lung Cancer MDT

3 month history of haemoptysis and dyspnoea

Unintentional weight loss 15-20kgs over last year

Background

Ex smoker: Quit 3 years ago. 120 pack year history

Previous heavy alcohol intake. Bottle of spirits every second day. Has stopped 6 weeks ago

Wharf worker. Married.

Nil else

Medications

None

Examination

80kg, 175 cm

HR 72 regular

BP 125/65

JVP not elevated

Nil peripheral oedema

Chest clear to auscultation

No palpable lymphadenopathy

Investigations

Bloods: Hb 128, normal renal and liver function

CT Chest: 10x8.5mm lesion encroaching on the posterosuperior aspect of the right main bronchus, concerning for endobronchial lesion. No other significant pathology identified

CT/PET: 11x9mm PET avid lesion in the right upper lobe bronchus, extending into the right main bronchus. No other sites of avidity.

Bronchoscopy: Visible lesion extending from within the right upper lobe bronchial orifice.

Brushings and biopsy: Squamous Cell Carcinoma

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Questions:

  1. Discuss the stage of this lung cancer, in particular, the possible stages it could be and what would separate one stage from another for this particular patient.

  2. What are the surgical options for this patient? What would specific operative strategies would you involve to minimise the risk of morbidity?

  3. He has a small airleak on cough postoperatively. On day 6 the volume of the airleak on cough increases. Describe your management strategy for this situation.