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Systems: Resp. WK > 20. Radiology of Lung Cancer +Staging > Flashcards

20. Radiology of Lung Cancer +Staging Flashcards

1
Q

Majority of patients diagnosed with lung cancer will die within what time period?

A

Within one year

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2
Q

How many patients present with advanced form of lung cancer? (in fractions)

A

2/3

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3
Q

What structures to look for in a chest x ray?

A
  • name/marker/rotation/penetration
  • lines/metal work
  • heart
  • mediastinum
  • lungs (zones: upper, middle, lower)
  • bones
  • diaphragm
  • soft tissues
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4
Q

Where are tumours/cancer most likely found in the chest?

A

In the mediastinum

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5
Q

What should hilar vascular structures look like?

A

should be crisply defined

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6
Q

What should the mediastnium look like on a chest x ray?

A

no widening of mediastinum

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7
Q

What should the trachea look like on a chest x ray?

A

should be central

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8
Q

What area in a chest x ray is easily missed and should be looked at in detail?

A

behind the heart (where tumours like to hide)

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9
Q

Where are lesions in the chest often found? (2)

A
  • behind heart

- behind hila

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10
Q

What are the 4 main review areas?

A
  1. hila
  2. lung apices
  3. behind the heart
  4. behind the diaphragm
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11
Q

What diagnostic technique is used after a chest x ray?

A

CT scan

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12
Q

What does CT scan evaluate?

A
  • size and shape
  • ateletasis (collapse)
  • border
  • density
  • solid/non-solid
  • dynamic contrast enhancement >25 HU
  • growth
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13
Q

What is a pulmonary mass defined as?

A

An opacity in lung OVER 3cm with no mediastinal adenopathy (enlargement of lymph nodes) or atelectasis (collapse)

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14
Q

What is a pulmonary nodule defined as?

A

An opacity in lung UP TO 3cm with no mediastinal adenopathy (enlargement of lymph nodes) or atelectasis (collapse)

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15
Q

What are possible causes of solitary (single) pulmonary nodules or pulmonary mass?

A
  1. lung cancer
  2. metastasis (previous history; breast, renal, seminoma, sarcoma)
  3. benign lung neoplasm (e.g. carcinoid, hemartoma)
  4. infection; bacterial, TB or fungal
  5. Vascular haematoma, AVM (arteriovenous malformation)
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16
Q

What patients are only put through treatment/ surgery?

A

Patients who have high chances of cure/ recovery

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17
Q

What system is used for staging of lung cancer?

A

TNM system (tumour size and position of primary tumour, lymph node spread, metastasis)

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18
Q

What is taken into account for staging of lung cancer? (3)

A
  1. clinical history/examination
  2. performance status
  3. pulmonary function
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19
Q

What 3 diagnostic methods are used to identify T staging of lung cancer?

A
  1. CT
    2 PET-CT
  2. bronchoscopy
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20
Q

What 4 diagnostic methods are used to identify N staging of lung cancer?

A
  1. PET-CT
  2. mediastinoscopy
  3. CT
  4. EBUS/ EUS (endobronchial ultrasound, endoscopic ultrasound)
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21
Q

What 3 diagnostic methods are used to identify M staging of lung cancer?

A
  1. PET-CT
  2. CT
  3. bone scan
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22
Q

What does EBUS/EUS involve?

A
  • sampling nodes from the mediastinum (biopsies taken for testing)
  • invasive procedure
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23
Q

What does PET tell us about the tumour?

A

its activity (of the tumour) and activity of the nodes

24
Q

What does CT tell us specifically about the tumour?

A

what vascular structures it’s invading

25
Q

What analogue is used for a FDG PET (functional imaging) scan which is taken up by the tumour?

A

labelled glucose analogue 18F- FDG ( fludeoxyglucose) which is a nuclear medicine analogue

26
Q

Why is FDG PET scan less frequently used than other diagnostic machines?

A
  • expensive
  • limited availability in the UK
  • only started being used for lung cancer staging in 94
27
Q

What patients are mainly offered FDG PET scans?

A
  • patients who will directly benefit from it and will be considered for curative treatment (chemotherapy and radiotherapy)
28
Q

What is the half body time in PET scan?

A

60 mins post injection (370MBq)

29
Q

What system is used when we can’t assume what size the tumour is?

A

TX staging (Tx, T0, Tis)

30
Q

What does Tx stage mean?

A

primary tumour cannot be assessed/measured

31
Q

What does T0 stage mean?

A

no evidence of primary tumour (cannot be found)

32
Q

What does Tis stage mean?

A

carcinoma in situ; CIS (group of abnormal cells forming a neoplasm but not always certain cancer, it varies)

33
Q

General stages of cancer are used using the combination of the TNM system, what are the 5 less detailed-stages? (which combine aspects of TNM)

A
  • stage 0 (abnormal cells, no spread, CIS, not cancer but may become cancer)
  • stage 1
  • stage 2
  • stage 3
  • stage 4 (biggest spread)
34
Q

What information is ESSENTIAL in determining cancer stage? (6)

A
  • size of tumour
  • cancer spread to nearby lymph nodes
  • cancer spread to distant body sites
  • where tumour is located in the body
  • cell type
  • tumour grade (how likely to the tumour is to spread further+how they look)
35
Q

What is T1 tumour?

A
  • tumour <3 cm in greatest dimension
  • surrounded by parietal/lung and visceral pleura
  • without bronchoscopic evidence of involvement of main bronchus
36
Q

What does T1a, T1b, T1c refer to?

A

T1a <= 1cm in greatest dimention
T1b<=2cm
T1c<= 3cm

37
Q

What is T1a highly likely to be? (what type of tumour)

A

minimally invasive adenocarcinoma

38
Q

What is T2 tumour?

A
  • tumour between 3-5cm
    -involves main bronchus but not carina
    -invades visceral pleura
  • associated with atelectasis (collapse) or obstructive pneumonitis that extends to the hilar region involving part or all the lung
    (T2a is between 3-4cm and T2b is between 4-5cm)
39
Q

What is a T3 tumour?

A
  • Tumour between 5-7cm
  • Tumour which directly invades: chest wall (including superior sulcus tumours), phrenic nerve and parietal pericardium
  • Or separate tumour nodule in the same lobe as the primary
40
Q

What is a T4 tumour?

A
  • tumour >7cm
  • tumour invades: diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body and carine
  • separate tumour nodule (s) in a different ipsilateral lobe
  • extensive involvement in brachial plexus and mediastinal structures
41
Q

What scan is used to recognise nodes which are involved in tumour growth?

A

PET scan

42
Q

What do N0 mean?

A

No regional lymph node metastasis

43
Q

What does N1 means?

A

Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

44
Q

What does N2 mean?

A

Ipsilateral mediastinal, subcarinal

45
Q

What does N3 mean?

A

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

46
Q

What fraction of patients present with metastasis of lung cancer?

A

1/3

47
Q

What are the 4 most common metastasis regions in the body of lung cancer?

A
  1. cerebral (brain)
  2. skeletal
  3. adrenal
  4. liver
48
Q

What does M0 mean?

A

No distant metastasis

49
Q

What does M1 mean?

A

distant metastasis

50
Q

What does M1a mean?

A
  • separate tumour nodular in a contralateral lobe

- tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion

51
Q

What does M1b mean?

A

Single distant metastases

52
Q

What does M1c mean?

A

Multiple distant metastases

53
Q

What are main advantages of PET/CT?

A
  • performs WHOLE body staging in a single study excluding cerebral disease
  • discloses metastases and pathology not detected by other means (unexpected mets in 10-20%)
  • non-invasive
  • excluded mets where structural imaging is abnormal
54
Q

What are main limitations of PET/CT?

A
  • false negative results
  • false positive results
  • very expensive cost
55
Q

What is the T1m N0, M0 approximate survival percentage and what happens to it as more T, N and M are increasing?

A

~67% and decreasing with rising TNM values

56
Q

What are the main methods for tissue diagnosis? (2)

A
  1. bronchoscopy and EBUS

2. percutaneous image guided biopsy( fluoroscopy/CT/US guide)

57
Q

What are the less common methods of tissue diagnosis`?

A
  • mediastinoscopy to sample mediastinal nodes
  • mediastinotomy for anterior mediastinal nodes
  • VATS; video assisted thoracoscopic surgery
  • explorative thoracotomy

Systems: Resp. WK (40 decks)

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