Radiology of Lung Cancer and Staging Flashcards
When looking at a chest x-ray, what systematic things should you always look at?
Name/marker/rotation/ penetration
Lines/metal work
Heart
Mediastinum
Lungs
Zones (upper/middle/lower)
Bones
Diaphragm
Soft Tissues
What would we expect to see in a chest x-ray regarding the mediastinum?
- Hilar vascular structures should be crisply defined
- No widening of mediastinum
- Trachea should be central
What do you need to pay attention to when looking at the lungs of a chest x-ray?
Look between ribs for lung detail
Remember to look “behind” the heart
Compare zones of the heart
If one of the lungs is completely white in a chest x-ray, what is this called?
Hemithorax
What should we look out for in smokers>45 regarding lung cancer?
Lobar collapse which doesn’t resolve in 2-3 weeks
Lung cancer can be difficult to spot on a chest x-ray so what should we look out for?
Lesions often more subtle- beware of lesions behind the heart and hila
Compare with previous films
Always look at review areas
Which areas of a chest x-ray should be reviewed?
Hila
Lung apices
Behind the heart
Behind the diaphragm
Define pulmonary nodule.
An opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis
Define opacity
Lacking transparency
Define adenopathy
Large or swollen lymph glands
Define atelectasis.
Partial collapse of the lung.
Define pulmonary mass.
Pulmonary mass is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
Give two examples of benign lung neoplasms.
Carcinoid
Hamartoma
In the staging for lung cancer, what two things are usually done first?
History
Chest X-ray
Which type of radiology is useful for staging lung cancer?
CT
Describe what the first part (T) of TMC staging is looking at.
Size and position of the tumour
How big and if it has spread
Describe what the second part (M) of TMC staging is looking at.
Whether or not the cancer has spread to the lymph nodes
Describe what the third part (C) of TMC staging is looking at.
Whether the cancer has spread anywhere else (metastases).
Which investigations can be carried out for stage one (T) of TMC screening?
CT
PET-CT
Bronchoscopy
Which investigations can be carried out for stage two (M) of TMC screening?
PET-CT
CT
Mediastinoscopy
EBUS/EUS
Which investigations can be carried out for stage three (C) of TMC screening?
PET-CT
CT
Bone scan
In the staging of lung cancer, what two parts are important to consider?
Performance status
Pulmonary function
What does FDG stand for?
Fludeoxyglucose (18F)
What is FDG?
Labelled glucose analogue
Radiotracer
What are some of the disadvantages of FDG PET scans?
Expensive
Limited availability in the UK
Describe the classification for a T1 tumour.
Tumour ≤3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of involvement of the main bronchus
Describe the classification of a T2 tumour.
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
Describe the classification of a T3 tumour.
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
Describe the classification of a T4 tumour.
Tumour >7cm
OR
A tumour which invades any of the following-
-diaphragm
-mediastinum
-heart
-great vessels
-trachea
-recurrent laryngeal nerve
-oesophagus
-vertebral body
-carina
In which classification of cancer would there be separate tumour nodule(s) in a different ipsilateral lobe?
T4
What can PET scans be useful for?
Assessing chest wall or mediastinal invasion
In regards the the TMC screening, what does N0 mean?
No regional lymph node metastases
In regards the the TMC screening, what does N1 mean?
Ipsilateral peribronchial , hilar or intrapulmonary nodes including by direct extension
In regards the the TMC screening, what does N2 mean?
Ipsilateral mediastinal or subcarinal nodes
In regards the the TMC screening, what does N3 mean?
Contralateral mediastinal nodes, contralateral hilar, scalene or supraclavicular
How does size of a lymph node relate to the likelihood of it metastasising?
The bigger the lymph node it, the more likely it’ll metastasise.
In regards to TMC screening, what does M0 mean?
No distant metastasis
In regards to TMC screening, what does M1 mean?
Distant metastasis
List some benefits of CT PET
Whole body staging at once
Non invasive
Can diagnose metastases
Discuss some negatives of PET CT scans.
Cost
False negatives
False positives
What type of investigation is carried out if the patient has a central tumour or central node disease?
A bronchoscopy and/or an EBUS
What is mediastinoscopy used for?
Used to sample mediastinal nodes
What is mediastinotomy used for?
Used to sample anterior mediastinal nodes
