Radiology of Lung Cancer and Staging Flashcards
What can an opacity of a chest X-ray indicate?
Pulmonary nodule
Mass
What should you note about the mediastinal area?
Hilar vascular structures well defined
No widening of mediastinum
Central Trachea
What should you look for when examaning the lungs?
Compare zones
Between ribs for lung detail
Behind heart
In a chest X ray, what are the systematic review areas?
Hila
Lung apices
Behind heart
Behind diaphragm
What clinical history might be indicative of lung cancer?
- Increasing SOB
- Smoker
- History of pulmonary fibrosis
- Recent haemoptysis
What is the next step in diagnosis after a chest X ray?
CT
What does a CT tell you about a mass/nodule?
- Size
- shape
- border
- atelectasis
- density
- solid vs non-solid
(atelectasis - partial collapse/incomplete lung inflation)
What is a pulmonary mass?
Lung opacity over 3 cm
No mediastinal adenopathy (enlargement lymph nodes) or atelectasis
What is a pulmonasry nodule?
Lung opacity up to 3cm with no mediastinal adenopathy or atelectasis.
What can a solitary pulmonary nodule be indicative of?
Lung cancer - (likely if patient smokes, 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)
What does TIA stand for?
Transient ischaemic attack
Reults in lack of blood and oxygen to brain (mini-stroke)
Symptoms are short and temporary
What do the letters TNM stand for?
T - Size and position of tumour
N- nodal involvement
M - Metastasis (yes/no?)
What are the testing techniques to determine the T? (size and position)
CT
PETCT
Bronchoscopy - (uses fibre optic endosope)
How is N determined?
PET-CT
Mediatinoscopy
CT
EBUS/EUS
How is M determined?
PETCT
CT
bone scan
What is EBUS?
Endobronchial ultrasound
What is the chemical used by a PET scan?
FDG
Who are PET scans offered to?
Patients likely to benefit from treatment (surgery or radical chemo or radiotherapy)
What are Tx/T0/Tis tumours?
Tx - Primary tumour cannot be assessed
T0 - no evidence of primary tumour
Tis- carcinoma in situ
What are tumours labelled T1?
T1 ≤ 3cm no main bronchus inv.
Tumour surrounded by lung or visceral pleura
What is a T1 (a,b and c tumour?)
T1a - minimally invasive adenocarcinoma, less than 1 cm
T1b - less than 2 cm
T1c - less than 3 cm
What is the classification of a T2 tumour?
- 3 and 5 cm
- involves main bronchus, not trachea carina
- invades visceral pleura
- Associated with atelectasis or obstructive pneumonitis that extends to hilar, involving part/all lung
What is a T2a and T2b tumour?
T2a - >3 cm, less than 4cm
T2b - >4 cm, less than 5 cm
What is a T3 tumour?
5 - 7 cm
Directly invades:
- Chest wall (including superior sulcus tumours)
- Phrenic nerve
- Parietal pericardium
Separate tumour nodules in same lobe as primary
What is a T4 tumour?
Greater than 7 cm
Invades:
- Diaphragm
- Mediastinum
- Heart
- Great vessels
- Trachea
- Recurrent laryngeal nerve
- Oesophagus
- Vertebral body
- Carina
Separate tumour nodules in different ipsilateral lobe
What does N0 indicate?
No regional lymph node metastases
(LN - Lymph Node)
What does N1 indicate?
Ipsilateral peribronchial
hilar
intrapulmonary LN
What does N2 indicate?
Ipsilateral mediastinal
sub carinal
What does N3 indicate?
Contralateral mediastinal
contralateral hilar
scalene
supraclavicular
What are the common places for lung cancer to metastasise?
Cerebral
Skeletal
Adrenal
Liver
What does M0 indicate?
No metastasis
What does M1 indicate?
Distant metastasis
What does M1a indicate?
Separate tumour nodule in contralateral lobe
Pleural/pericardial nodule or malignant pleural/pericardial effusion
What does M1b stand for?
Single distant metastasis
What does M1c indicate?
Multiple distant metastasis
What is the purpose of PET/CT in staging?
Whole body staging (excluding cerebral disease)
Discloses metastasis and other pathology
Excludes metastasis where structural imaging is abnormal
Non-invasive
What are the limitations of PET CT?
False negative results
False positive results
Cost
How is tissue diagnosis achieved?
Bronchoscopy and EBUS
Percutaneous image guided biopsy
