Radiology of Lung Cancer

Question 1

What is the definition of a pulmonary mass?

Answer 1

An opacity in lung greater than 3cm with no mediastinal adenopathy or atelectasis.

Question 2

What is the definition of a pulmonary nodule?

Answer 2

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

Question 3

What is the T in cancer staging?

Answer 3

Size and spread of tumour.

Question 4

What is the N in cancer staging?

Answer 4

Whether cancer cells have spread to the lymph nodes.

Question 5

What is the M in cancer staging?

Answer 5

Whether cancer cells have spread elsewhere in the body (metastases)

Question 6

What does TX refer to?

Answer 6

A primary tumour that cannot be assessed.

Question 7

What does T0 refer to?

Answer 7

No evidence of primary tumour.

Question 8

What does Tis refer to?

Answer 8

Carcinoma in situ

Question 9

What is a T1 tumour?

Answer 9

-Tumour ≤3 cm across, surrounded by lung or visceral pleura, without bronchoscopic evidence of involvement of the main bronchus
-T1a minimally invasive adenocarcinoma Tumor <=1 cm in greatest dimension
-T1b Tumor <=2 cm
-T1c<=3 cm

Question 10

What is a T2 tumour?

Answer 10

Tumour between 3 cm and 5 cm or
tumour with any of the following features (T2 tumors with these features are classified T2a if ≤5 cm)
-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
T2a Tumor between 3 cm and 4 cm in greatest dimension
T2b Tumor between 4cm and 5 cm in greatest dimension

Question 11

What’s a T3 tumour?

Answer 11

Between 5 and 7cm or invades chest wall, phrenic nerve or parietal pericardium.
Or a separate tumour nodule in same lobe as the primary.

Question 12

What’s a T4 tumour?

Answer 12

Greater than 7cm or invades Diaphragm
mediastinum
heart
great vessels
trachea
recurrent laryngeal nerve
esophagus
vertebral body
carina

Question 13

What are the classes of N staging in lung cancer?

Answer 13

N0 - no lymph node metastases.
N1 - ipsilateral periobronchial, hilar or intrapulmonary nodes
N2 - ipsilateral mediastinal, subcarinal
N3 - Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

Question 14

What proprtion of patients present with metastases?

Answer 14

1/3
Mainly cerebral, adrenal, skeletal and liver

Question 15

What are the different levels of M staging in lung cancer?

Answer 15

M0 - no distant metastases
M1- distant metastases
M1a - separate tumour nodule in contralateral lobe or tumour with pericardial or pleural nodules or malignant pericardial or pleural effusion.
M1b - single distant metastases
M1c - multiple distant metastases

Question 16

What are some advantages of PET/CT scans?

Answer 16

-whole body staging in a single study
-discloses metastases and other pathology not detected by other means
(unexpected metastases in 10-20%)