Radiology and staging of lung cancer Flashcards
What can an opacity of a chest X-ray indicate ?
Pulmonary nodule, mass….
What should you note about the mediastinal area ?
Hilar vascular structures should be crisply defined
No widening of the mediastinum
Trachea should be central
What should you look for when examining the lungs?
Compare upper, middle and lower zones
Between ribs for lung detail
Behind the heart
What clinical history might be indicative of lung cancer ?
Increasing SOB in smoker
History of pulmonary fibrosis
Recent haemoptysis
TB as a child
What is the next step in diagnosis after a chest X ray ?
CT
What does a CT tell you about a mass/nodule ?
evaluates size, shape, atelectasis, border, density, solid or non-solid, dynamic contrast
What is a pulmonary mass ?
An opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
What is a pulmonary nodule ?
An opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis
What can a solitary pulmonary nodule be indicative of ?
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)
What does TNM stand for ?
T- size/ position of tumour
N- spread to lymph nodes
M- metastases
What are the testing techniques to determine the T? (size and position) ?
CT
PETCT
Bronchoscopy - uses fibre optic endoscope, tells us how close the tumour is to the carina
What are the testing techniques to determine the N ?
PET-CT
Mediastinoscopy
CT
EBUS/EUS
What are the testing techniques to determine the M ?
PET-CT
CT
bone scan
What is the chemical used by a PET scan ?
FDG
Who are PET scans offered to ?
Patients who are likely to benefit from treatment (surgery or radical chemo or radiotherapy)
What are Tx/T0/Tis tumours ?
Tx- primary tumour cannot be assessed
T0- no evidence of primary tumour
Tis- carcinoma in situ
What is a T1 tumour ?
Tumour <3cm
What is a T1a,b, c tumour ?
T1a- minimally invasive adenocarcinoma, < 1cm
T1b- <2cm
T1c- <3cm
What is a T2 tumour ?
Tumour >3cm but <5cm
What is a T2a and T2b tumour ?
T2a- >3cm but <4cm
T2b- >4cm but <5cm
What is a T3 tumour ?
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
What is a T4 tumour ?
Tumour >7cm or invades:
- mediastinum
- diaphragm
- heart and great vessels
- trachea
- recurrent laryngeal nerve
Separate nodule in ipsilateral lobeWhat does N0 indicate ?
No regional lymph node metastases
What does N1 indicate ?
Ipsilateral peribronchial, hilar or intrapulmonary nodes
What does N2 indicate ?
Ipsilateral, mediastinal, subcarinal
What does N3 indicate ?
Contralateral mediastinal, contralateral hilar
What are the common places for lung cancer to metastasise ?
Cerebral
Skeletal
Adrenal
Liver
What does M0 indicate ?
NO direct/ distant metastasis
What does M1 indicate ?
Distant metastasis
What does M1a indicate ?
Seperate tumour in contralateral lobe
Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
What does M1b indicate ?
Single distant metastasis
What does M1c indicate ?
Multiple distant metastasis
What is the purpose of PET/CT in staging ?
Discloses metastases and other pathology
Excludes metastases where structural imaging
Non-invasive
What are the limitations of PET CT ?
False negative results
False positive results
Cost
How is tissue diagnosis achieved ?
Bronchoscopy and EBUS
Percutaneous image guided biopsy, fluoroscopy/CT/US guided
