Diagnosis and Staging of Lung Cancer Flashcards
What is the systematic review of chest x-ray?
Lines/metal work, heart, mediastinum, lungs (zones),, bones, diaphragm and soft tissues
What do we need to look for in the mediastinum?
Hilar vascular structures should be crisply defined
No widening of the mediastinum
Trachea should be central
How should you look at lungs on chest x-ray?
\compare upper, mid and lower zones
Look between the ribs for lung detail
Remember to look ‘behind’ the heart
What is the sign of right upper lobe collapse in chest x-ray?
Horizontal fissure is pulled up along with hila and hemi-diaphragm
There is also reduced volume on the right
Why should we be aware of lobar collapse in smokers?
Can fail to resolve in smoker of age of above 45
Where can abnormalities hide in chest x-rays?
Can hide in apices, behind the heart, hemidiaphragm and hila
Compare with previous films and always look in review areas
What are the review areas in CXR?
Hila, lung apices, behind the heart and behind the diaphragm
What is included in the clinical history of lung cancer/
Increasing shortness of breath in smoker, history of pulmonary fibrosis and recent haemoptysis
What does the CT evaluate?
Size, shape atelectasis, border, density, solid or not solid, dynamic contrast enhancement and growth
What is a pulmonary mass?
Is an opacity in the lung over 3cm with no mediastinal adenopathy or atelectasis
What does atelectasis mean?
Lung collapse
What is a pulmonary nodule?
Is an opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis
What can be a pulmonary mass or nodule?
Lung cancer, metastasis, benign lung neoplasm, infection bacterial, TB or fungal and vascular haematoma, AVM
What is a hamartoma?
Benign lung tumour
Can show signs of calcification
What is pulmonary AVM?
Abnormal connections between a pulmonary artery and a pulmonary vein
Can cause paradoxical emboli that can lead to strokes or TIAs (transient ischaemic attack)
What contributes to the staging of lung cancer?
Clinical history/examination
Performance status
Pulmonary function
TNM international system
Explain TNM staging
T - size and position of tumour
N - whether cancer cells have spread to lymph nodes
M - metastases
What investigations are used to determine T?
CT, PET-CT and bronchoscopy
What investigations are used to determine N?
PET-CT, mediastinoscopy, CT and EBUS/EUS
What investigations are used to determine M?
PET-CT, CT and bone scan
Explain PET scan
Functional imaging, labelled glucose analogue used, 18F - FDG
FDG taken up by metabolically active cells
It is not specific to diagnosis of malignancy
What does T0 mean?
No evidence of primary tumour
What does Tis mean?
Carcinoma in situ
What scan is good for showing structures involved for T staging?
PET-CT scan
What does N0 mean?
No regional lymph node metastases
Describe PET scan and N staging
PET uptake does not equate to a malignant environment
Reactive nodes can also be metabolically active - infection
What metastases are common for lung cancer?
Cerebral, skeletal, adrenal and liver
What does M0 and M1 mean?
M0 - no distant metastases
M1 - distant metastases
What are the positives of using PET-CT in staging?
Whole body staging in single study excluding cerebral
Discloses metastases and other pathology
Excludes metastases where imaging is abnormal
Non-invasive
What are the limitations of PET-CT?
Tests can have false negative or false positives
False positives can be infection or inflammation
False negative can be a malignancy with low metabolic rate
What investigations are used for tissue diagnosis?
Bronchoscopy and EBUS
Percutaneous image guided biopsy, fluoroscopy/CT/US guided
What investigation is used to sample mediastinal nodes?
Mediastinoscopy
Mediastinotomy for anterior mediastinal nodes
