Radiology of Lung Cancer and Staging

Question 1

What is the systematic review of a chest X-Ray

Answer 1

• Name/marker/rotation/penetration
• Lines and metal work
• Heart
• Mediastinum
• Lungs: zones (upper/middle/lower)
• Bones
• Diaphragm
• Soft tissues

Question 2

What is a pulmonary mass?

Answer 2

It is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis.

Question 3

What is a pulmonary nodule?

Answer 3

An opacity in lung up to 3cm with ne mediastinal adenopathy or atelectasis.

Question 4

What is PET CT?

Answer 4

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.

Question 5

What is the T stage about?

Answer 5

The size of the tumour.

Question 6

What is TX?

Answer 6

primary tumour cannot be assessed

Question 7

What is T0?

Answer 7

There is no evidence of primary tumour

Question 8

What is Tis?

Answer 8

Carcinoma in situ

Question 9

What is T1?

Answer 9

Tumour <3cm in a greatest dimension surrounded by lung or visceral pleura without bronchoscopic evidence of involvement of the main bronchus.

Question 10

What is T1a?

Answer 10

<= 1cm

Question 11

What is T1b?

Answer 11

<=2cm

Question 12

What is T1c?

Answer 12

<= 3cm

Question 13

What is T2?

Answer 13

Between 3cm and 5cm.

Question 14

What is a T3?

Answer 14

Tumour >5cm but <3cm

Or separate tumor nodule in the same lobe as the primary

Question 15

What is a T4?

Answer 15

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.

Question 16

What is the role of PET/CT and bronchoscopy in T staging

Answer 16

Whole body staging in one sitting (excluding cerebral disease)

Discloses metastasis and other pathology

Excludes metastasis where structural imaging is abnormal

Non-invasive

Question 17

What does N refer to?

Answer 17

The nodal stage

Question 18

What does N0 mean?

Answer 18

No regional lymph node metastases.

Question 19

What does N1 refer to?

Answer 19

Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

Question 20

What does N2 refer to?

Answer 20

Ipsilateral mediastinal, sub carinal

Question 21

What does N3 refer to?

Answer 21

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

Question 22

What is M staging and where does it happen?

Answer 22

Metastases and Cerebral, Skeletal, Adrenal, Liver

Question 23

What is M0?

Answer 23

It is no distant metastases.

Question 24

What is M1?

Answer 24

Distant metastases in the thorax

Question 25

What is M1a metastases?

Answer 25

Separate tumor nodules in a contralateral lobe.

Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion.

Question 26

What is M1b?

Answer 26

Single distant metastases

Question 27

What is M1c?

Answer 27

Multiple distant metastases

Question 28

What are the limitations of PET/CT?

Answer 28

All tests have, false-negative results, false-positive results, cost

Question 29

How do you diagnose tissue in lung cancer?

Answer 29

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

Question 30

What should you note about the mediastinal area?

Answer 30

Hilar vascular structures should be crisply defined

No widening of the mediastinum

Trachea should be central

Question 31

What should you look for when examaning the lungs?

Answer 31

Compare upper, middle and lower zones

Between ribs for lung detail

Behind the heart

Question 32

What clinical history might be indicative of lung cancer?

Answer 32

Increasing SOB, smoker, history of pulmonary fibrosis, recent haemoptysis

Question 33

What is the next step in diagnosis after a chest X ray?

Answer 33

CT

Question 34

What does a CT tell you about a mass/nodule?

Answer 34

Size, shape, border, atelectasis, density, solid vs non-solid

Question 35

What can a solitary pulmonary nodule be indicative of?

Answer 35

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)

Question 36

What does TIA stand for?

Answer 36

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

Question 37

How is N determined?

Answer 37

PET-CT

Mediatinoscopy

CT

EBUS/EUS

Question 38

How is M determined?

Answer 38

PETCT

CT

bone scan

Question 39

What is EBUS?

Answer 39

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.

Question 40

Who are PET scans offered to?

Answer 40

Patients who are likely to benefit from treatment (surgery or radical chemo or radiotherapy)