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2. Respiratory Medicine (Lectures) > Radiology of Lung Cancer and Staging > Flashcards

Radiology of Lung Cancer and Staging Flashcards

1
Q

What percentage of patients with lung cancer present with advanced disease?

A

66%

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2
Q

What do you need to check when looking at a chest X-ray?

A

Name/marker/rotation/penetration

Lines/metal work

Heart

Mediastinum

Lung (zones - upper, middle, lower)

Bones

Diaphragm

Soft tissues

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3
Q

What are the first 4 things you should look at in a chest X-ray?

A

Name

Marker

Rotation

Penetration

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4
Q

What are the zones of the lungs in a chest X-ray?

A

Upper

Middle

Lower

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5
Q

What is A?

A

Mediastinum

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6
Q

What are you looking for in the mediastinum?

A

Hilar vascular structures crisply defined

No widening of mediastinum

Trachea should be central

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7
Q

What are you looking for in the lungs?

A

Compare upper, middle and lower zones

Look between ribs for lung detail

Remember to look ‘behind’ the heart

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8
Q

What is this?

A

Peripheral lung carcinoma

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9
Q

What is this?

A

Central lung carcinoma

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10
Q

How should we identify lung cancers on X-rays?

A

Compare with previous films

Always look at review areas

Remember lesions are often more subtle

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11
Q

What are the review areas of a chest X-ray?

A

Hila

Lung apices

Behind the heart

Behind the diaphragm

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12
Q

What is this?

A

Left hilar mass

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13
Q

What is this?

A

Right hilar mass

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14
Q

What is this?

A

Mass behind the heart

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15
Q

What is this?

A

Mass left costophrenic angle

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16
Q

What is this?

A

Right apex tumour

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17
Q

What could the clinical history for lung cancer include?

A

Increasing shortness of breath in smoker

History of pulmonary fibrosis

Recent haemoptysis

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18
Q

What follows taking a history and examining the patient?

A

CT

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19
Q

What should be evaluated using a CT scan?

A

Size

Shape

Atelectasis

Border

Density

Solid or non-solid

Dynamic contrast enhancement >25HU

Growth

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20
Q

What is atelectasis?

A

Collapse of lung resulting in reduced gas exchange

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21
Q

What is the collapse of the lung resulting in reduced gas exchange called?

A

Atelectasis

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22
Q

What is a pulmonary mass?

A

Opacity in the lung over 3cm with no medistinal adenopathy or atelectasis

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23
Q

What is an opacity in the lung over 3cm with no mediastinal adenopathy or atelectasis called?

A

Pulmonary mass

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24
Q

What is a pulmonary nodule?

A

Opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis

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25
What is an opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis called?
Pulmonary nodule
26
What is the difference between a pulmonary nodule and a pulmonary mass?
Pulmonary mass is over 3cm and pulmonary nodule is up to 3cm
27
What could a solitary pulmonary nodule or mass be?
Lung cancer Metastasis Benign lung neoplasm Infection Vascular haemotoma
28
What could suggest a solitary pulmonary nodule or mass is a metastasis?
Previous history of breast. renal, seminoma or sarcoma cancer
29
What are examples of benign lung neoplasms?
Carcinoid Hamartoma
30
What does the staging of lung cancer take into account?
Clinical history/examination Performance status Pulmonary function
31
What system does the staging of lung cancer use?
TNM international system for staging lung cancer
32
What does the TNM international staging of lung cancer consider?
Size and position of tumour (T) Whether cancer cells have spread into the lymph nodes (N) Whether the tumour has spread anywhere else in the body, metastasis (M)
33
What is T?
Size and position of tumour
34
What is N?
Whether tumour has spread to lymph nodes
35
What is M?
Whether the tumour has spread into other parts of the body, metastasis
36
What investigations can be done to determine T?
CT PET-CT Bronchoscopy
37
What investigations can be done to determine N?
PET-CT Mediastinoscopy CT EBUS/EUS (endobronchial ultrasound)
38
What does EBUS stand up for?
Endobronchial ultrasound
39
What investigations can be done to determine M?
PET-CT CT Bone scan
40
What is the most common tracer used?
FDG (flourodeoxyglucose)
41
What does FDG stand for?
Flourodeoxyglucose
42
What is often used for the staging of lung cancer?
Flourodeoxyglucose PET
43
What can be said about the availability and cost of FDG PET?
Expensive Limited availability in the UK
44
What is the labelled glucose analogue used in FDG-PET?
18F-FDG
45
What is the half body time of 18F-FDG?
60 minutes
46
What does TX mean?
Primary tumour cannot be assessed
47
What does T0 mean?
No evidence of primary tumour
48
What does Tis mean?
Carcinoma in situ (has not spread to surrounding tissue, group of abnormal cells in the place where they formed)
49
What is carcinoma in situ?
Group of abnormal cells which are still where they were formed, have not spread to nearby tissue
50
What is T1?
Less than or equal to 3cm in diameter Surrounded by lung or visceral pleura Without bronchoscopic evidence of involvement of the main bronchus
51
What is T1a?
Less than or equal to 1cm
52
What is T1b?
Less than or equal to 2cm
53
What is T1c?
Less than or equal to 3cm
54
What are the sub classes of T1?
T1a T1b T1c
55
What is T2?
More than 3cm but less than 5cm
56
What are the different classes of T2?
T2a T2b
57
What is T2a?
More than 3cm but less than 4cm
58
What is T2b?
More than 4cm but less than 5cm
59
When are tumours classified as T2a although they are less than 3cm?
Invades main bronchus Invades visceral pleura Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all of the lung
60
What is T3?
More than 5cm but less than 7cm
61
When are tumours classified as T3 althouh they are less than 5cm?
Invades any of: Chest wall Phrenic nerve Parietal pericardium or has seperate tumour nodules in the same lobe as primary
62
What is T4?
More than 7cm
63
When is a tumour T4 although it is less than 7cm?
Invades any of: Diaphragm Mediastinum Heart Great vessels Trachea Recurrent laryngeal nerve Oesophagus Vertebral body Carina or seperate tumour nodules in a different ipsilateral lobe
64
What does N staging range from?
N0 to N3
65
What is N0?
No regional lymph node involvement
66
What is N1?
Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension
67
What is N2?
Ipsilateral mediastinal, subcarinal
68
What is N3?
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
69
How does the number of lymph nodes change with size?
There are many small lymph nodes and few large ones
70
How does the prevalence of metastasis change with the size of lymph nodes?
Large lymph nodes are more likely to have metastasis
71
What percentage of patients present with metastasis?
33%
72
What are common metastasis?
Cerebral Skeletal Adrenal Liver
73
What does M staging range from?
M0 to M1
74
What is M0?
No distant metastasis
75
What is M1?
Distant metastasis
76
What are the different classes of M1?
M1a M1b M1c
77
What is M1a?
Seperate tumour nodes in a contralateral lobe, tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
78
What is M1b?
Single distant metastasis
79
What is M1c?
Multiple distant metastasis
80
What are some of the advantages of PET/CT scanning in staging?
Performs whole body staging in single study excluding cerebral disease Discloses metastasis and other pathology no detected by other means Excludes metastasis where structural imaging abnormal Non invasive
81
What are some limitations of CT/PET?
All tests have false positives and false negatives Cost
82
How does 5 year survival change with staging?
As staging increases survival decreases
83
What are some examples of tissue diagnosis methods?
Bronchoscopy with endobronchial ultrasound Percutaneous image guided biopsy, flouroscopy/CT/US guided Mediastinoscopy (sample mediastinal nodes) Mediastinotomy (anterior mediastinal nodes) Video assisted thoracoscopic surgery (VATS) Explorative thoracotomy

2. Respiratory Medicine (Lectures) (50 decks)

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