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Respiratory block > Radiology and staging of lung cancer > Flashcards

Radiology and staging of lung cancer Flashcards

1
Q

What can an opacity of a chest X-ray indicate ?

A

Pulmonary nodule, mass….

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2
Q

What should you note about the mediastinal area ?

A

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

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3
Q

What should you look for when examining the lungs?

A

Compare upper, middle and lower zones
Between ribs for lung detail
Behind the heart

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4
Q

What clinical history might be indicative of lung cancer ?

A

Increasing SOB in smoker
History of pulmonary fibrosis
Recent haemoptysis
TB as a child

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5
Q

What is the next step in diagnosis after a chest X ray ?

A

CT

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6
Q

What does a CT tell you about a mass/nodule ?

A

evaluates size, shape, atelectasis, border, density, solid or non-solid, dynamic contrast

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7
Q

What is a pulmonary mass ?

A

An opacity in lung over 3cm with no mediastinal adenopathy or atelectasis

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8
Q

What is a pulmonary nodule ?

A

An opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

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9
Q

What can a solitary pulmonary nodule be indicative of ?

A

Lung cancer (likely if the patient is a smoker, old age)
Metastasis- (from breast cancer, renal cancer, seminoma, sarcoma)
Benign lung neoplasm, carcinoid, hamartoma
Infection bacterial, TB or fungal
Vascular haematoma, AVM(arteriovenous malformation)

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10
Q

What does TNM stand for ?

A

T- size/ position of tumour
N- spread to lymph nodes
M- metastases

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11
Q

What are the testing techniques to determine the T? (size and position) ?

A

CT
PETCT
Bronchoscopy - uses fibre optic endoscope, tells us how close the tumour is to the carina

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12
Q

What are the testing techniques to determine the N ?

A

PET-CT
Mediastinoscopy
CT
EBUS/EUS

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13
Q

What are the testing techniques to determine the M ?

A

PET-CT
CT
bone scan

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14
Q

What is the chemical used by a PET scan ?

A

FDG

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15
Q

Who are PET scans offered to ?

A

Patients who are likely to benefit from treatment (surgery or radical chemo or radiotherapy)

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16
Q

What are Tx/T0/Tis tumours ?

A

Tx- primary tumour cannot be assessed
T0- no evidence of primary tumour
Tis- carcinoma in situ

17
Q

What is a T1 tumour ?

A

Tumour <3cm

18
Q

What is a T1a,b, c tumour ?

A

T1a- minimally invasive adenocarcinoma, < 1cm
T1b- <2cm
T1c- <3cm

19
Q

What is a T2 tumour ?

A

Tumour >3cm but <5cm

20
Q

What is a T2a and T2b tumour ?

A

T2a- >3cm but <4cm

T2b- >4cm but <5cm

21
Q

What is a T3 tumour ?

A

Tumour >5cm but <7cm or one that directly invades:
- chest wall
- phrenic nerve
- parietal pericardium
Or separate tumour nodules in the same lobe as the primary

22
Q

What is a T4 tumour ?

A 
Tumour >7cm or invades:
    - mediastinum
    - diaphragm
    - heart and great vessels 
    - trachea 
    - recurrent laryngeal nerve 
Separate nodule in ipsilateral lobe
23
Q

What does N0 indicate ?

A

No regional lymph node metastases

24
Q

What does N1 indicate ?

A

Ipsilateral peribronchial, hilar or intrapulmonary nodes

25
Q

What does N2 indicate ?

A

Ipsilateral, mediastinal, subcarinal

26
Q

What does N3 indicate ?

A

Contralateral mediastinal, contralateral hilar

27
Q

What are the common places for lung cancer to metastasise ?

A

Cerebral
Skeletal
Adrenal
Liver

28
Q

What does M0 indicate ?

A

NO direct/ distant metastasis

29
Q

What does M1 indicate ?

A

Distant metastasis

30
Q

What does M1a indicate ?

A

Seperate tumour in contralateral lobe

Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion

31
Q

What does M1b indicate ?

A

Single distant metastasis

32
Q

What does M1c indicate ?

A

Multiple distant metastasis

33
Q

What is the purpose of PET/CT in staging ?

A

Discloses metastases and other pathology
Excludes metastases where structural imaging
Non-invasive

34
Q

What are the limitations of PET CT ?

A

False negative results
False positive results
Cost

35
Q

How is tissue diagnosis achieved ?

A

Bronchoscopy and EBUS

Percutaneous image guided biopsy, fluoroscopy/CT/US guided

Respiratory block (38 decks)

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