Radiology of Lung Cancer Flashcards
What is the approach to a systematic review of the lungs on a CXR?
- Name/marker/rotation/penetration
- Lines/metal work
- Heart
- Mediastinum
- Lung zones
- Bones
- Diaphragm
- Soft tissue
What to look for in the mediastinum on a CXR?
Hilar structures crisply defined
No widening of structure
Central trachea
What to look for in the lungs on a CXR?
Compare upper, mid and lower zones
Look between ribs for lung detail
Remember to look “behind” heart
Why might the whole lung look opaque on a CXR?
If the tumour blocks a main bronchus, preventing air entering the lung
Why might a lobe of the lung look opaque on a CXR?
If the tumour is blocking one of the secondary bronchi
What are the areas that must be carefully reviewed on CXR for lung cancer?
Hila
Lung apices
Behind the heart
Behind the diaphragm
What are the important steps to do to prevent misdiagnosing lung cancer?
Compare CXR with previous imaging
Confirm lesion is intrapulmonary
What is the step after a chest x-ray if lung cancer is suspected?
Carry out CT
What is the CT scan to show after a CXR?
Size Shape Atelectasis (collapse) Border Density Solid or not solid Growth For dynamic contrast enhancement
What is a pulmonary mass?
An opacity in the lung > 3cm with no mediastinal adenopathy (swollen 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 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 metastases or from other causes?
Previous history of breast, renal, seminoma, sarcoma
What infections may cause a solitary pulmonary nodule/mass?
Bacterial, TB or fungal
Give an example of a benign lung neoplasm
Carcinoid, hamartoma
What does the T describe in the TNM staging?
How big it is and how far it has spread / size and position of the tumour
What does the N describe in the TNM staging?
Whether the cancer cells have spread into the lymph nodes
What does the M describe in the TNM staging?
Any metastases present?
What investigation are used to determine T in TNM staging?
CT
PET-CT
Bronchoscopy
What investigation are used to determine N in TNM staging?
CT
PET-CT
Mediastinoscopy
EBUS
What investigation are used to determine M in TNM staging?
CT
PET-CT
Bone scan
Define Tx, T0, Tis
Tx - primary tumour cannot be assessed
T0 - no evidence of primary tumour
Tis - carcinoma in situ
Describe T1 tumour
<= 3cm
Surrounded by lung or visceral pleura
No involvement with main bronchus
Size of T1a tumour
Minimally invasive adenocarcinoma
<= 1cm
Size of T1b tumour
< 2cm
Size of T1c tumour
<= 3cm
Describe T2 tumour
> 3cm but under 5 cm Or one that: Involves main bronchus Invades visceral pleura Associated with atelectasis or obstructive pneumonitis
Size of T2a tumour
> 3cm but < 4cm
Size of T2b tumour
> 4cm but < 5cm
Describe T3 tumour
> 5cm but < 7cm Or one that directly invades: -Chest wall -Phrenic nerve -Parietal periardium
Describe T4 tumour
> 7cm or invades: Diaphragm Mediastinum Heart Great vessels Trachea Recurrent laryngeal nerve Oesophagus Vertebral body Carina
What do PET/CT scans do in T staging?
Assess chest wall invasion or mediastinal invasion
Define N0
No lymph nodes
Define N1
Ipsilateral perobronchial, hilar or intrapulmonary nodes
Define N2
Ispilateral mediastinal, subcarinal
Define N3
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
Where are common places for metastases?
Cerebral
Skeletal
Adrenal
Liver
Define M0
No metastases
Define M1
Distant metastases
Define M1a
Separate tumour nodule in contralateral lobe
Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
Define M1b
Single distant metastases
Define M1c
Multiple distant metastases
What are the limitation of PET CT
All tests have:
False negative results
False positive results
Cost
What tests are carried out for tissue diagnosis?
Bronchoscopy and EBUS
Percutaneous image guided biopsy
What determines stage IV lung cancer?
Any T
Any N
M1
