Lung cancer radiology Flashcards
what is the order for the systematic review of the lungs in a chest x ray?
- name/ marker/ rotation (gap between clavicles and spinous processes)/ penetration
- lines/metal work
- heart
- mediastinum
- lungs
- upper zone
- middle zone
- lower zone - bones
- diaphragm
- soft tissues
when looking at the mediastinum in a chest x-ray what is normal?
- hilar vascular structures should be crisply defined
- no widening of mediastinum
- trachea is central
when looking at the lungs in a chest x-ray what is normal?
- compare upper, middle and lower zones to check they are consistent and normal
- look between ribs for lung detail
- look “behind” heart
why might the whole lung appear opaque in lung cancer?
if the tumour blocks a main bronchus, preventing air entering the lung
why might a lobe of a lung appear opaque in lung cancer?
if the cancer is blocking one of the secondary bronchi
what are the areas that must be carefully reviewed for lung cancer?
Hila
lung apices
behind the heart
behind the diaphragm
what are the important steps to do to prevent misdiagnosing lung cancer?
- always compare with previous imaging
- confirm lesion is intrapulmonary
what is the step after a chest x-ray if lung cancer is suspected?
CT scan
what is a CT scan used to do after a chest xray?
evaluate:
- size
- shape
- atelectasis (collapsed lung, alveoli collapse, not pneumothorax)
- border
- density
- solid or non-solid
- growth
- for dynamic contrast enhancement
what is a pulmonary mass?
an opacity in lung over 3cm with no mediastinal adenopathy (enlargement of the mediastinal lymph nodes) or atelectasis
what is a pulmonary nodule?
an opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis
what is mediastinal adenopathy?
invasion of a cancer in to the mediastinal lymph nodes
what are the possible diagnoses for a solitary pulmonary nodule or mass?
- lung cancer
- metastasis
- benign lung neoplasm
- infection
- vascular haematoma
what will help distinguish a pulmonary nodule/mass caused by lung cancer from other causes?
age and smoking history
what will help distinguish a pulmonary nodule/mass caused by metastasis from other causes?
previous history of breast, renal, seminoma, sarcoma
give an example of a benign lung neoplasm?
carcinoid hamartoma
what infections may cause a solitary pulmonary nodule/mass?
tuberculosis or fungal infection
what is the T part of the TNM staging system for cancer?
how big it is and how far it spread/ size and position of the tumour
what is the N part of the TNM staging system for cancer?
whether cancer cells have spread into the lymph nodes
what is the M part of the TNM staging system for cancer?
whether the tumour has spread anywhere else in the body ie metastases
what investigations are used to determine the T stage of lung cancer?
CT
PET-CT
bronchoscopy
what investigations are used to determine the N stage of lung cancer?
PET-CT
mediastinoscopy
CT
EBUS/EUS
what is EBUS?
endobronchiol ultrasound, A special endoscope fitted with an ultrasound processor and a fine-gauge aspiration needle is guided through the patient’s trachea
what investigations are used to determine the m stage of lung cancer?
PET-CT
CT
bone scan
what does TX mean in the TNM cancer staging system?
primary tumour cannot be assessed
what does T0 mean in the TNM cancer staging system?
no evidence of primary tumour
what does Tis mean in the TNM cancer staging system?
carcinoma in situ
what does a T1 cancer look like?
tumour ≤3cm in greatest diameter, surrounded by lung or visceral pleura, no bronchoscopic evidence of involvement of the main bronchus
what is a T1a tumour?
minimally invasive adenocarcinoma ≤1cm
what is a T1b tumour?
minimally invasive adenocarcinoma ≤2cm
what is a T1c tumour?
minimally invasive adenocarcinoma ≤3cm
what is a T2 tumour?
a tumour >3cm but <5cm
which features make a tumour a T2a tumour?
any one of:
- Involves main bronchus, but not carina
- Invades visceral pleura
- Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all the lung
what size is a T2a tumour?
> 3 cm but <4cm
what size is a T2b tumour?
> 4cm but <5cm
what are the features of a T3 tumour?
tumour >5cm but <7cm or one that directly invades any of the following:
chest wall
phrenic nerve
parietal pericardium
or seperate tumour nodule(s) in the same lobe as the primary
what is a T4 tumour?
a tumour that is >7cm or invades any of the following: Diaphragm mediastinum heart great vessels trachea recurrent laryngeal nerve esophagus vertebral body carina
or has seperate nodule(s) in a different ipsilateral lobe
what does N0 mean?
no regional lymph node metastases
what does N1 mean?
ipsilateral peribronchial, hilar or intrapulmonary nodes including direct extension (local invasion)
what does N2 mean?
N2 Ipsilateral mediastinal, subcarinal
what does N3 mean?
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
what does M0 mean?
no distance metastasis
what does M1a mean?
- separate tumour nodule in a contralateral lobe
- tumour with peural or pericardial nodulels or malignant pleural or pericardial effusion
what does M1b mean?
single distant metastasis
what does M1c mean?
multiple distant metastases
what is a the function of PET/CT scanning in staging?
very useful tool as it performs whole body staging in a single study excluding cerebral disease
what are the limitations of PET CT?
all tests have false negative or false positive results
costly
what are the tissue diagnosis techniques?
- Bronchoscopy and EBUS
- Percutaneous image guided biopsy ,fluoroscopy/CT/US guided
- Mediastinoscopy to sample mediastinal nodes
- Mediastinotomy for anterior mediastinal nodes
- VATS (Video-assisted thoracoscopic surgery)
- explorative thoracotomy
