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Resp week 4 > Radiology of lung cancer and staging > Flashcards

Radiology of lung cancer and staging Flashcards

1
Q

What do you need to include in your systematic review of the CHX?

A

The hilar of the lungs and behind the heart
The 3 sections of the lungs (upper/middle/lower)
Behind the diaphragm and the costophrenic angles
Bones
Soft tissue
Lines/metal work

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2
Q

What would blunting of the costophrenic angle mean?

A

Pleural thickening/fluid

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3
Q

What do you look for in the mediastinum

A

That there is equal densities in both sides, no distortion or pulled in either direction

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4
Q

What do you look at when looking at the heart?

A

Behind the heart

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5
Q

Do you need to check behind the diaphragm

A

Yes, because the lungs extend below in front and behind (its a 2d image of 3d thing)

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6
Q

What can cause a hemithorax white out and what can you check for to help with your decision?

A

Large amount of pleural effusion
Pneumonectomy
Complete Lung collapse

you can check for mediastinal shift:
Towards the whiteout could be complete lung collapse or pneuonectomy
Away from mediastinum shift is probably large effusion pushing away the mediastinum from the fluid.

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7
Q

Lobar collapse, what will you see?

A

Everything shifted up, reduced hemithorax volume. Other lobes can be hyper inflated s wider spaces between ribs.

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8
Q

What can an apex tumour be called?

A

Pancost tumour

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9
Q

What are the key points to check?

A

Behind heart and diaphragm,
Lung apices
Hila

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10
Q

What can help spot abnormalities?

A

Comparing with older X Rays

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11
Q

Which hila is usually higher and why?

A

Left Hilum usually little higher than right becasue left main pulmonary artery arches over left main bronchus.

Can be horizontal but right should NEVER be higher than the left!

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12
Q

How do you differentiate Nodule vs Mass?

A 
Nodule = under 3cm 
Mass = greater than 3cm
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13
Q

Other than lung cancer, what can cause nodules?

A

Heratomas or carcinoid (benign lung neoplasm)
Infection bacterial/tuberculosis/fungal
Vascular haematoma, AVMs (Arteriovenous malformations )

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14
Q

What is an AVMs?

A

Arteriovenous malformations, when the artery-vein is shortcutted, leading to higher pressure through the veins and making them more likely to rupture.

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15
Q

What is the first scan used to stage lung cancer?

A

Contrast CT

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16
Q

What do the following letters indicate with regards to staging? T, N , M

A 
T = Tumour, so size of tumour/other structures involved
N = Nodes, no. lymph nodes it has spread to
M = Metastases, so if there have been any metastases away from primary site, eg controlateral lung/elsewhere in the body
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17
Q

Which nodes in lung progression?

A

Hilar lymph nodes, ipsilateral mediastinal lymph nodes/contralateral mediastinal lymph nodes, supraclavicular nodes,

18
Q

What is an EBUS scan? And what cna it be used for?

A

Its a tube with ultrasound and needle that goes down the trachea and using the ultrasound can locate lymph nodes and the needle can then take samples from the nodes. Used to help stage cancer as for how much there has been spread to the lymph nodes.

19
Q

Why is IV contrast CTs better than a standard CT

A

Can see blood flow areas more easily and can help differentiate structures.

20
Q

What is a PET CT

A

Positron Emmision tomography, Uses F18 -FDG labelled glucose analogue and shows areas of increased metabolic uptake

21
Q

Is PET CT specific?

A

No, it will pick up any areas of higher metabolic rates

22
Q

How long after FDG injection should you have a scan?

A

45-60 minutes. Half life = 110 minutes

23
Q

What does Tx mean?

A

That the size of the tumour is unable to be assessed, eg. lost within a collapsed lung.

24
Q

T1 means ?

A

T1 means that the size of the tumour is generally under 3cm:
!a is less than 1cm
1b is under 2cm
1c is under 3cm

25
Q

T2 means?

A

3-5cm
2a = 3-4cm
2b = 4=5cm
OR any tumour that: Involves main bronchus (not carina)
Invades visceral pleura
Is associated with atelectasis (complete/partial collapse of lobe/entire lung) or obstructive pneumonitis that extends to hilar region involving part or all of the lung.

26
Q

T3=

A 
5-7cm
OR directly invades:
Chest wall
Phrenic nerve
Parietal pericardium
OR separate tumour nodules in the same lobe as primary
27
Q

T4

A 
7cm+
OR Invades:
MediastinumDiaphragm
heart
Great vessels
Trachea
Recurrent laryngeal nerve
Eosophagus
Vertebral body
Carina
OR separate tumour nodules in a different ipsilateral lobe
28
Q

N0/N1/N2/N3?

A 
N0 = No lymph node invasion
N1 = Spread to the ipsilateral peribronchial, hila or intrapulmonary lymph nodes
N2 = Spread to the ipsilateral mediasteinal nodes, subcarinal
N3= Contralateral mediastinal/ hilar or scalene or supraclavicular
29
Q

What is classified as non size significant node in CT?

A

Under 1cm, however there is a 13% chance one of them could be malignant if al under 1cm.

30
Q

Does PET uptake mean malignant involvement?

A

Not necessarily! Could just be inflamation/ increased metabolic uptake.

31
Q

M0/M1.M1a/M1b/M1c??

A 
M0 = No metastases
M1 = distant metastases
M1a = metastases within the thorax/chest area eg separate tumour nodules in contralateral lobe or pericardial/pleural nodules or malignant pleural or pericardial effusion
1b = single distant metastases
1c = multiple distant metastases
32
Q

Within a PET scan is it usual to get other avid uptake areas? Eg uraniary bladder?

A

Yes

33
Q

When might you get false negative PET CT

A

If the metastases is v small (eg 5mm nodule unless VERY metabolically active)
if the metastases is very slow growing eg adenocarcinoma spectrum lesions

But PET scans are usually v good at giving acurate negative results.

34
Q

When might you get false positive PET CT?

A

Infection or inflammation that is metabolically active.

35
Q

T1 NO MO

A

Stage 1A, Survival 67%

36
Q

T2 NO MO

A

Stage 1b, 57% chance of survival

37
Q

T1 N1 MO

A

Stage 2a, 55% chance of survival

38
Q

T2 N1 MO/T3 NO MO

A

Stage 2b -39% chance of survival

39
Q

T3 N1 MO/T3 N2 MO

A

Stage 3a -23% chance of survial

40
Q

T4 NO-2 MO/T1-4 N3 MO

A

Stage 3b, 5% chance survival

41
Q

any T any N M1

A

Stage 4 -1% chance of survival

42
Q

How can you get tissue diagnosis?

A

Bronchoscopy and EBUS
Percutaneous image guided biopsy, CT/US guided

  • Mediastinoscopy to sample mediastinal nodes
  • Mediastinotomy for anterior mediastinal nodes
  • VATS (video-assisted thoracoscopic surgery -thoracoscope entered in through ribs)
  • Explorative thoracotomy (opening chest)

Resp week 4 (8 decks)

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