Radiology of lung cancer

Question 1

Staging

Answer 1

1-Clinical history/examination
2-Performance status
3-Pulmonary function
4-TNM

Question 2

Areas to look at

Answer 2

Mediastinum : 
-Hilar vasculature should be defined
-Trachea should be central
-Should be no widening 
Lungs:
-Compare zones 
-Behind the heart 
Lesions:
-Behind the heart
-Compare films 
Lung apices 
Behind diaphragm

Question 3

What to evaluate when looking at tumours?

Answer 3

• Size
• Surrounding areas and growth
• Density
• Solidity
• Atelectasis: internal density

Question 4

Tumour staging in TNM

Answer 4

T1- smaller than 3 cm
-No invasion of visceral pleura
-surrounds the lung
-no evidence of main bronchus invasion  
T2- between 3 and 5 cm
-invasion of main bronchus
-invades visceral pleura 
-Obstructive pneumonitis  
T3- between 5 and 7 cm
-invades chest wall/parietal pericardium
-Nodule in same wall 
T4-greater than 7 cm 
-Invades structures such as the parietal pleura, diaphragm, heart, trachea, oesophagus

Question 5

PET scans

Answer 5

• need radiopharmacy: labels glucose analogue with F18
• need radiochemistry: makes sure it can be injected into patients
• Whole body scan
• Non-invasive
• Expensive
• Few places in the country where it can be done
• False positives