Specialty Area: Thoracic Surgery

Description of Specialty: Surgery of heart and lungs.

1. Diagnosis: Lung Cancer

Questions that should be asked:

1. Are there different kinds of lung cancer?
2. Do they require different diagnostic work-up and different treatments?
3. Aside from history and physical examinations, what tests are proposed?
4. What is a CT scan and why do I need one?
5. What is a MRI scan and why is it needed?
6. What is a PET scan and why do I need it?
7. In what way will the results of the scans change the proposed further diagnostic steps and treatment?
8. Why do I need a needle biopsy?
9. What is a mediastinscopy, what are the risks associated with it and what are the chances that doing it will change further treatment?
10. Will a mediastinoscopy be done at the same time as a lung operation?
11. Who do you propose operate for my lung cancer?
12. Are there other possible effective treatments, such as radiation, that might apply to my case?
13. What are the risks of combining surgery and radiation?
14. If an operation is needed, how much of my lung will need to be removed?
15. What is a sleeve resection and how much experience do you have with this procedure?
16. If surgery is required, who will do the operation and if a team is used, who will do each procedure?
17. What are the risks for surgery given my age and health problems and how incapacitated will I be after the operation?
18. What are the common problems during recovery?
19. Do you video thoracoscopy and can my operation be done this way?
20. Will you see me periodically after surgery?
21. What happens if I have a recurrence?
22. How often should I have a chest x-ray after surgery and will x-rays hurt me?

2. Diagnosis: Emphysema

Questions that should be asked:

1. What does emphysema do to my lungs?
2. If I do nothing, what are my prospects?
3. What kinds of treatment is available for emphysema?
4. What is lung volume reduction surgery and am I a candidate?
5. What preparations do I need to undergo before LVRS, will I need oxygen after the operation and what results can be expected in my case?
6. Are you in one of the centers designated by Medicare for this still investigational procedure?
7. Can and should my operation be done by videothoracoscopy?
8. What type of incision will be used and does a midline incision hurt more than one along the ribs?
9. What are my chances of survival with a lung transplant and how would the operation be performed?
10. How many transplants have you performed and how good are your results?
11. What medicines would I have to take after a transplant and how dangerous are these medications?
12. What is obliterative bronchiolitis, what are my chances of getting it and what will it do to me if I get it?

3. Diagnosis: Hiatal Hernia

Questions that should be asked:

1. What is a hiatal hernia and how bad is my case?
2. Has it affected my esophagus and did I have stricture of the esophagus?
3. Can my hernia be fixed by abdominal surgery or by laparoscopic surgery?
4. Is my esophagus shortened?
5. Why are tests of esophageal function needed and what will be their impact on treatment?
6. What kind of surgery is proposed in my case and what are the risks?
7. Will I be able to eat reasonably normal after my operation and if I cannot, what kinds of problems might I have?
8. Is this an elective operation and could it be treated medically?

4. Diagnosis: Esophageal Cancer

Questions that should be asked:

1. If I am having trouble swallowing, do I have cancer of the esophagus?
2. What tests are needed to determine if I have cancer and is there more than one kind of cancer?
3. Where is my cancer situated and will this influence the treatment?
4. Can you tell if it is limited to the esophagus or if it already affects other tissues?
5. What are my treatment options and what are the advantages and disadvantaged of each kind?
6. Should I get radiation treatment either before, after or instead of an operation?
7. What kind of operation is proposed, what are the risks and will It need to be done through the chest, neck or abdomen?
8. How will be swallowing be affected by the surgery and will my voice be alright?
9. What are my chanced for a permanent cure and what would be done if I have a recurrence?

5. Diagnosis: Mediastinal Tumors

Questions that should be asked:

1. What is the mediastinum?
2. What is the thymus gland?
3. Is there a tumor and what do you think it is?
4. Is it malignant and can you tell from the x-rays and scans whether or not it is?
5. Do I need a needle biopsy or will I need an open biopsy?
6. What is the best treatment in my case?
7. Are there alternatives such as radiation or chemotherapy and would I possibly need these even if I have surgery?
8. If I have myasthenia gravis, will it get better if I have an operation on my thymus and what are my chances for a complete cure?

6. Diagnosis: Chest Wall Tumors

Questions that should be asked:

1. If I have a lump on my chest wall , what is it and how will you find out?
2. What kinds of x-rays or scans do I need and will they tell you if the growth is malignant?
3. Do I need a needle biopsy?
4. Do I need an operation and what kind of operation is needed?
5. If you have to remove some ribs, how will the hole be repaired?
6. Will I have a soft spot on my chest, will I have extended pain, will I be deformed, will I lose feeling in my chest wall and will my breast be numb?
7. What are the chances for additional treatment in the future?

7. Diagnosis: Common diagnostic procedures

Questions that should be asked:

1. What is a bronchoscopic examination, what are the risks, what information is sought during this procedure, will I be put to sleep, who will give the anesthetic and how soon would I know the results?
2. What is an esophagoscopy, what kinds of instruments (rigid or flexible) will be used, why is it proposed, what are the risks, will a anethetic be needed?
3. What is a needle biopsy of the lung or other areas of the chest, how is it performed, when is it performed, what are the risks and will the result of the biopsy influence or change further treatment?
4. What is a thoracentesis, why is it needed, what are the commonest complications and who performs the procedure- a surgeon or someone else?
5. What is a chest tube, why is it needed, who will place it, will a local or general anesthetic be used how long will the tube remain, what medications will be needed and what risks are involved with all of this?

Martin Bergmann. M.D. Clinical Associate Professor Department of Medicine Washington University School of Medicine St. Louis, MO