Radiology of Lung Cancer and Staging Flashcards
What is the systematic review of a chest X-Ray
- Name/marker/rotation/penetration
- Lines and metal work
- Heart
- Mediastinum
- Lungs: zones (upper/middle/lower)
- Bones
- Diaphragm
- Soft tissues
What is a pulmonary mass?
It is 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 ne mediastinal adenopathy or atelectasis.
What is PET CT?
Metabolic assessment of the patient and the disease and it uses a label glucose analog FDG which is attached to Fluorine 18 and its taken up by cells that are metabolically active.
What is the T stage about?
The size of the tumour.
What is TX?
primary tumour cannot be assessed
What is T0?
There is no evidence of primary tumour
What is Tis?
Carcinoma in situ
What is T1?
Tumour <3cm in a greatest dimension surrounded by lung or visceral pleura without bronchoscopic evidence of involvement of the main bronchus.
What is T1a?
<= 1cm
What is T1b?
<=2cm
What is T1c?
<= 3cm
What is T2?
Between 3cm and 5cm.
What is a T3?
Tumour >5cm but <3cm
Or separate tumor nodule in the same lobe as the primary
What is a T4?
Any tumour >7cm or invades any of the following: Diaphragm, heart, great vessels, tracheaa, recurrent laryngeal nerve, esophagus, vertebral body, carina or separate tumour nodule in a different ipsilateral lobe.
What is the role of PET/CT and bronchoscopy in T staging
Whole body staging in one sitting (excluding cerebral disease)
Discloses metastasis and other pathology
Excludes metastasis where structural imaging is abnormal
Non-invasive
What does N refer to?
The nodal stage
What does N0 mean?
No regional lymph node metastases.
What does N1 refer to?
Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension
What does N2 refer to?
Ipsilateral mediastinal, sub carinal
What does N3 refer to?
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
What is M staging and where does it happen?
Metastases and Cerebral, Skeletal, Adrenal, Liver
What is M0?
It is no distant metastases.
What is M1?
Distant metastases in the thorax
What is M1a metastases?
Separate tumor nodules in a contralateral lobe.
Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion.
What is M1b?
Single distant metastases
What is M1c?
Multiple distant metastases
What are the limitations of PET/CT?
All tests have, false-negative results, false-positive results, cost
How do you diagnose tissue in lung cancer?
Bronchoscopy and EBUS (central tumor or nodal disease)
- Percutaneous image-guided biopsy, fluoroscopy/CT/US-guided
- Mediastinoscopy to sample mediastinal nodes
- Mediastinotomy for anterior mediastinal nodes
- VATS
- Explorative thoracotomy
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 examaning 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, smoker, history of pulmonary fibrosis, recent haemoptysis
What is the next step in diagnosis after a chest X ray?
CT
What does a CT tell you about a mass/nodule?
Size, shape, border, atelectasis, density, solid vs non-solid
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 TIA stand for?
Transient ischaemic attack. Reults in lack of blood and oxygen to the brain (mini-stroke), symptoms are short lived and quickly leave. The word ischaemic means a reduced supply of blood and oxygen to a part of the body
How is N determined?
PET-CT
Mediatinoscopy
CT
EBUS/EUS
How is M determined?
PETCT
CT
bone scan
What is EBUS?
Endobronchial ultrasound, Allows Doctor’s to look at the lungs and take samples from the glands in the mediastinum of the lung using the aid of an ultrasound scan, these glands lie outside the normal breathing tubes (bronchi). Ultrasound probe on the end of a bronchoscope allows the doctor to see the glands in the centre of the chest (mediastinum) and take samples under direct vision. Endobronchial ultrasound-guided transbronchial needle aspiration is done to take samples from the central lymph glands in the centre of your chest (mediastinum) which may be enlarged for a variety of reasons.
Who are PET scans offered to?
Patients who are likely to benefit from treatment (surgery or radical chemo or radiotherapy)
