19. Radiology of Lung Cancer and Staging

Question 1

What is the the systematic reviews that should be followed for a chest x-ray/

Answer 1

Name/marker/rotation/ penetration
Lines/metal work
Heart 
Mediastinum
Lungs
Zones (upper/middle/lower)
Bones
Diaphragm
Soft Tissues

Question 2

What should be observed about the mediating?

Answer 2

Hilar vascular structures should be crisply defined
No widening of mediastinum
Trachea should be central

Question 3

What should be observed about the lungs?

Answer 3

Compare upper, mid and lower zones
Look between ribs for lung detail
Remember to look “behind” the heart

Question 4

What should be observed when looking for lung cancer?

Answer 4

Lesions often more subtle
Beware of lesions behind the heart and hila
Compare with previous films
Always look at review areas

Question 5

What should be observed about the review areas?

Answer 5

Hila
Lung apices
Behind the heart
Behind the diaphragm

Question 6

What is a pulmonary nodule/mass?

Answer 6

Pulmonary mass is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
Pulmonary nodule is an opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

Question 7

What is a solitary pulmonary nodule or pulmonary mass indicative of?

Answer 7

Lung cancer
- nb. Age,smoking history
Metastasis
- nb. Previous history breast, renal, seminoma, sarcoma
Benign lung neoplasm eg.carcinoid, hamartoma
Infection bacterial ,tuberculosis or fungal
Vascular haematoma, AVM

Question 8

What is the TNM staging?

Answer 8

T - How big it is and how far it has spread/size and position of the tumour
N - Whether cancer cells have spread into the lymph nodes
M - Whether the tumour has spread anywhere else in the body i.e. metastases