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Year 1- Respiratory > Radiology of Lung Cancer and Staging > Flashcards

Radiology of Lung Cancer and Staging Flashcards

1
Q

When looking at a chest x-ray, what systematic things should you always look at?

A

Name/marker/rotation/ penetration

Lines/metal work

Heart

Mediastinum

Lungs
Zones (upper/middle/lower)

Bones

Diaphragm

Soft Tissues

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2
Q

What would we expect to see in a chest x-ray regarding the mediastinum?

A
  1. Hilar vascular structures should be crisply defined
  2. No widening of mediastinum
  3. Trachea should be central
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3
Q

What do you need to pay attention to when looking at the lungs of a chest x-ray?

A

Look between ribs for lung detail
Remember to look “behind” the heart
Compare zones of the heart

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4
Q

If one of the lungs is completely white in a chest x-ray, what is this called?

A

Hemithorax

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5
Q

What should we look out for in smokers>45 regarding lung cancer?

A

Lobar collapse which doesn’t resolve in 2-3 weeks

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6
Q

Lung cancer can be difficult to spot on a chest x-ray so what should we look out for?

A

Lesions often more subtle- beware of lesions behind the heart and hila
Compare with previous films
Always look at review areas

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7
Q

Which areas of a chest x-ray should be reviewed?

A

Hila
Lung apices
Behind the heart
Behind the diaphragm

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8
Q

Define pulmonary nodule.

A

An opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

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9
Q

Define opacity

A

Lacking transparency

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10
Q

Define adenopathy

A

Large or swollen lymph glands

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11
Q

Define atelectasis.

A

Partial collapse of the lung.

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12
Q

Define pulmonary mass.

A

Pulmonary mass is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis

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13
Q

Give two examples of benign lung neoplasms.

A

Carcinoid
Hamartoma

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14
Q

In the staging for lung cancer, what two things are usually done first?

A

History
Chest X-ray

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15
Q

Which type of radiology is useful for staging lung cancer?

A

CT

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16
Q

Describe what the first part (T) of TMC staging is looking at.

A

Size and position of the tumour
How big and if it has spread

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17
Q

Describe what the second part (M) of TMC staging is looking at.

A

Whether or not the cancer has spread to the lymph nodes

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18
Q

Describe what the third part (C) of TMC staging is looking at.

A

Whether the cancer has spread anywhere else (metastases).

19
Q

Which investigations can be carried out for stage one (T) of TMC screening?

A

CT
PET-CT
Bronchoscopy

20
Q

Which investigations can be carried out for stage two (M) of TMC screening?

A

PET-CT
CT
Mediastinoscopy
EBUS/EUS

21
Q

Which investigations can be carried out for stage three (C) of TMC screening?

A

PET-CT
CT
Bone scan

22
Q

In the staging of lung cancer, what two parts are important to consider?

A

Performance status
Pulmonary function

23
Q

What does FDG stand for?

A

Fludeoxyglucose (18F)

24
Q

What is FDG?

A

Labelled glucose analogue
Radiotracer

25
Q

What are some of the disadvantages of FDG PET scans?

A

Expensive
Limited availability in the UK

26
Q

Describe the classification for a T1 tumour.

A

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

27
Q

Describe the classification of a T2 tumour.

A

Tumour >3 cm but 5 cm
OR
A tumour with any of the following:
-Involves main bronchus, but not carina
-Invades visceral pleura
-Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all the lung

28
Q

Describe the classification of a T3 tumour.

A

Tumour >5 cm but <7cm
OR

A tumour which invades any of the following-
-chest wall (including superior sulcus tumors)
-phrenic nerve
-parietal pericardium
-separate tumour nodule(s) in the same lobe as the primary

29
Q

Describe the classification of a T4 tumour.

A

Tumour >7cm
OR

A tumour which invades any of the following-
-diaphragm
-mediastinum
-heart
-great vessels
-trachea
-recurrent laryngeal nerve
-oesophagus
-vertebral body
-carina

30
Q

In which classification of cancer would there be separate tumour nodule(s) in a different ipsilateral lobe?

A

T4

31
Q

What can PET scans be useful for?

A

Assessing chest wall or mediastinal invasion

32
Q

In regards the the TMC screening, what does N0 mean?

A

No regional lymph node metastases

33
Q

In regards the the TMC screening, what does N1 mean?

A

Ipsilateral peribronchial , hilar or intrapulmonary nodes including by direct extension

34
Q

In regards the the TMC screening, what does N2 mean?

A

Ipsilateral mediastinal or subcarinal nodes

35
Q

In regards the the TMC screening, what does N3 mean?

A

Contralateral mediastinal nodes, contralateral hilar, scalene or supraclavicular

36
Q

How does size of a lymph node relate to the likelihood of it metastasising?

A

The bigger the lymph node it, the more likely it’ll metastasise.

37
Q

In regards to TMC screening, what does M0 mean?

A

No distant metastasis

38
Q

In regards to TMC screening, what does M1 mean?

A

Distant metastasis

39
Q

List some benefits of CT PET

A

Whole body staging at once
Non invasive
Can diagnose metastases

40
Q

Discuss some negatives of PET CT scans.

A

Cost
False negatives
False positives

41
Q

What type of investigation is carried out if the patient has a central tumour or central node disease?

A

A bronchoscopy and/or an EBUS

42
Q

What is mediastinoscopy used for?

A

Used to sample mediastinal nodes

43
Q

What is mediastinotomy used for?

A

Used to sample anterior mediastinal nodes

Year 1- Respiratory (36 decks)

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