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Respiratory > Radiology of Lung Cancer and Staging > Flashcards

Radiology of Lung Cancer and Staging Flashcards

1
Q

What can an opacity of a chest X-ray indicate?

A

Pulmonary nodule

Mass

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2
Q

What should you note about the mediastinal area?

A

Hilar vascular structures well defined

No widening of mediastinum

Central Trachea

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3
Q

What should you look for when examaning the lungs?

A

Compare zones

Between ribs for lung detail

Behind heart

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4
Q

In a chest X ray, what are the systematic review areas?

A

Hila

Lung apices

Behind heart

Behind diaphragm

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5
Q

What clinical history might be indicative of lung cancer?

A
  • Increasing SOB
  • Smoker
  • History of pulmonary fibrosis
  • Recent haemoptysis
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6
Q

What is the next step in diagnosis after a chest X ray?

A

CT

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7
Q

What does a CT tell you about a mass/nodule?

A
  • Size
  • shape
  • border
  • atelectasis
  • density
  • solid vs non-solid

(atelectasis - partial collapse/incomplete lung inflation)

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8
Q

What is a pulmonary mass?

A

Lung opacity over 3 cm

No mediastinal adenopathy or atelectasis

(adenopathy - enlargement of lymph nodes)

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9
Q

What is a pulmonary nodule?

A

Lung opacity up to 3cm

No mediastinal adenopathy or atelectasis.

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10
Q

What can a solitary pulmonary nodule be indicative of?

A

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)

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11
Q

What does TIA stand for?

A

Transient ischaemic attack

Results in lack of blood and oxygen to brain (mini-stroke)

Symptoms are short and temporary

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12
Q

What do the letters TNM stand for?

A

T - Size and position of tumour

N- nodal involvement

M - Metastasis (yes/no?)

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13
Q

What are the testing techniques to determine the T? (size and position)

A

CT

PET CT

Bronchoscopy - (uses fibre optic endoscope)

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14
Q

How is N determined?

A

PET-CT

Mediastinoscopy

CT

EBUS/EUS

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15
Q

How is M determined?

A

PET CT

CT

bone scan

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16
Q

What is EBUS?

A

Endobronchial ultrasound

17
Q

What is the chemical used by a PET scan?

A

FDG

(Fluorodeoxyglucose)

18
Q

Who are PET scans offered to?

A

Patients likely to benefit from treatment

  • surgery
  • radical chemo
  • radiotherapy
19
Q

What are Tx/T0/Tis tumours?

A

Tx - Primary tumour cannot be assessed

T0 - no evidence of primary tumour

Tis- carcinoma in situ

20
Q

What are tumours labelled T1?

A

T1 ≤ 3cm

No main bronchus inv.

Tumour surrounded by lung or visceral pleura

21
Q

What is a T1 (a,b and c tumour?)

A

T1a - minimally invasive adenocarcinoma, less than 1 cm

T1b - less than 2 cm

T1c - less than 3 cm

22
Q

What is the classification of a T2 tumour?

A
  • 3-5 cm
  • involves main bronchus, not trachea carina
  • invades visceral pleura
  • Associated with atelectasis or obstructive pneumonitis that extends to hilar, involving part/all lung
23
Q

What is a T2a and T2b tumour?

A

T2a - 3-4 cm

T2b - 4-5 cm

24
Q

What is a T3 tumour?

A

5-7 cm

Directly invades:

  • Chest wall (including superior sulcus/pancoast tumours)
  • Phrenic nerve
  • Parietal pericardium

Separate tumour nodules in same lobe as primary

25
Q

What is a T4 tumour?

A

Greater than 7 cm

Separate tumour nodules in diff. ipsilateral lobe

Invades:

  • Oesophagus
  • Trachea
  • Carina
  • Mediastinum
  • Heart
  • Great vessels
  • Recurrent laryngeal nerve
  • Diaphragm
  • Vertebral body
26
Q

What does N0 indicate?

A

No regional lymph node metastases

(LN - Lymph Node)

27
Q

What does N1 indicate?

A

Ipsilateral peribronchial

hilar

intrapulmonary LN

28
Q

What does N2 indicate?

A

Ipsilateral mediastinal

sub carinal

29
Q

What does N3 indicate?

A

Contralateral mediastinal

contralateral hilar

scalene

supraclavicular

30
Q

What are the common places for lung cancer to metastasise?

A

Cerebral

Skeletal

Adrenal

Liver

31
Q

What does M0 indicate?

A

No metastasis

32
Q

What does M1 indicate?

A

Distant metastasis

33
Q

What does M1a indicate?

A

Separate tumour nodule in contralateral lobe

Pleural/pericardial nodule or malignant pleural/pericardial effusion

34
Q

What does M1b stand for?

A

Single distant metastasis

35
Q

What does M1c indicate?

A

Multiple distant metastasis

36
Q

What is the purpose of PET/CT in staging?

A

Whole body staging (excluding cerebral disease)

Discloses metastasis and other pathology

Excludes metastasis where structural imaging is abnormal

Non-invasive

37
Q

What are the limitations of PET CT?

A

False negative results

False positive results

Cost

38
Q

How is tissue diagnosis achieved?

A

Bronchoscopy and EBUS

Percutaneous image guided biopsy

Respiratory (30 decks)

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