Diagnosis And Staging Of Lung Cancer Flashcards
Which hilum is higher
Left
Systematic review
Name/marker/rotation/penetration Lines/metal work Heart Mediastinum Lungs (upper middle lower zones) Bones Diaphragm Soft tissues
Hilum in xrays
Should be crisply defined with a central trachea and no widening of Mediastinum
Review areas for chest xray
Hila, lung apices, behind the heart, behind the diaphragm
Pleural effusion
Too much fluid in pleural cavity
Haemoptysis
Coughing up blood
After found something on an xray
Do a CT for size, shape, atelactasis(collapse), border, density, solidity, dynamic contrast enhancement, growth
Nodule vs mass
Mass>3cm≥nodule (opacity with no mediastinal adenomatous or atelactasis)
What cancers metastasise in lungs
Breast, renal, seminoma (testicular), sarcoma
TIA
Almost like a stroke, mini
TNM staging - T
what imaging is used for it
How big it is and how far it’s spread (size and position)
CT
PET-CT
Bronchoscopy
TNM staging - N
Whether it's spread to lymph nodes or not PET-CT Mediastinoscopy CT EBUS (endoscopic bronchial ultrasound)
TNM staging - M
what scans are used
Whether it has metastasised
PET-CT
CT
Bone scan
Functional PET scan
Use 18F FDG (glucose analogue, shows tumours inflammation and infection)
Half body time of FDG glucose
60mins
Tx
Primary tumour cannot be assessed
T0
No evidence of primary tumour
Tis
Carcinoma in situ
T1
≥3cm, surrounded by lung or visceral pleural, no main bronchial involvement
T1a
Less than 1cm
T1b
Less than 2cm
T1c
Less than 3cm
T2
> 3cm, with any of: involve main bronchus, but not carina, invades visceral pleura, associated with atelactasis or obstructive pneumonitis in hilar region
T2a
Between 3 and 4cm
T2b
Between 4 and 5cm
T3
Between 5 and 7cm and invades any of: chest wall, phrenic nerve, parietal pericardium. Or has separate nodules in same lobe as primary
T4
Over 7cm or invades any of: diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body, carina. Or has separate tumour nodules in different ipsilateral lobe
N0
No regional lymph node metastasis
N1
Ipsilateral peribronchial, hilar or intrapulmonary nodes
N2
Ipsilateral mediastinal or subcarinal
N3
Contralateral or scalene or supraclavicular
Common sites of metastasis of lung disease
Cerebral, skeletal, adrenal, liver
M0
No distant metastasis
M1
Distant metastasis
M1a
Separate tumour nodules in contralateral lobe or pleural/pericardial
M1b
Single distant metastasis
M1c
Multiple distant metastasis
Tissue diagnosis
Bronchoscopy and EBUS, percutaneous image/CT/US guided biopsy
