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 should be crisply defined
No widening of the mediastinum
Trachea should be central
What should you look for when examaning the lungs?
Compare upper, middle and lower zones
Between ribs for lung detail
Behind the heart
What type of carcinoma is this?
Peripheral lung carcinoma
What type of lung cancer is this?
Suggest a reason why the left lung is collapsed
Central Lung Carcinoma
Collapse of lung, may even be a small tumor, but it is obviously placed in a main airway
What type of cancer is this?
Central Lung cancer
Right upper lobe collapse
In a chest X ray, what are the systematic review areas?
Hila, lung apices, behind the heart, beind the diaphragm
?
Left Hilar Mass
?
Right Hilar Mass
?
Mass Behind the heart
?
Mass of the left costophrenic angle
?
RIght apex/Pancoast tumour
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
What is a pulmonary mass?
An opacity in the lung over 3 cm with no mediastinal adenopathy (enlargement of the lymph nodes) or atelectasis
What is a pulmonasry nodule?
An opacity in the lung up to 3cm with no mediastinal adenopathy or alectasis.
What can a solitary pulmonary nodule be indicative of?
Lung cancer (likely if the patient is a smoker, 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 can recent haemoptysis with previous history of TB as a child indicate?
Growth of fungus
What does TIA stand for?
Transient ischaemic attack. Reults in lack of blood and oxygen to the brain (mini-stroke), symptoms are short lived and quickly leave. The word ischaemic means a reduced supply of blood and oxygen to a part of the body
What do the letters TNM stand for?
T - Size and position of the tumour
N- Wether cancer has spread to the lymph nodes
M - Metastasis (yes/no?)
What are the testing techniques to determine the T? (size and position)
CT
PETCT
Bronchoscopy - uses fibre optic endosope, tells us how close the tumor is to the carina
How is N determined?
PET-CT
Mediatinoscopy
CT
EBUS/EUS
How is M determined?
PETCT
CT
bone scan
What is EBUS?
Endobronchial ultrasound, Allows Doctor’s to look at the lungs and take samples from the glands in the mediastinum of the lung using the aid of an ultrasound scan, these glands lie outside the normal breathing tubes (bronchi). Ultrasound probe on the end of a bronchoscope allows the doctor to see the glands in the centre of the chest (mediastinum) and take samples under direct vision. Endobronchial ultrasound-guided transbronchial needle aspiration is done to take samples from the central lymph glands in the centre of your chest (mediastinum) which may be enlarged for a variety of reasons.
What is the chemical used by a PET scan?
FDG
Who are PET scans offered to?
Patients who are 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?
Tumour is less than 3 cm in its greatest dimension
The tumour is surrounded by lung or visceral pleura
No involvement with the main bronchus
What is a T1 (a,b and c tumour?)
T1a - minimally invasive adenocarcinoma, less than 1 cm in greatest dimension
T1b - Tumour less than 2 cm
T1c - less than 3 cm
What is the classification of a T2 tumour?
A tumour between 3 and 5 cm
A tumour which involves the main bronchus, but not the carina
A tumour which invades the visceral pleura
Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all of the lung.
What is a T2a and T2b tumour?
T2a - greater than 3 cm but less than 4cm in greatest dimension
T2b is greater than 4 cm but less than 5 cm in its greatest dimension
What is a T3 tumour?
Between 5 and 7 cm in length for its greates dimension
Or
One that directly invades any of the following:
- Chest wall (including superior sulcus tumours)
- Phrenic nerve
- Parietal pericardium
or - seperate tumour nodules in the same lobe as the primary
What is a T4 tumour?
Greater than 7 cm in length or invades:
Diaphragm
Mediastinum
Heart
Great vessels
Trachea
Recurrent laryngeal nerve
Oesophagus
Vertebral body
Carina
Or - seperate tumour nodules in a different ipsilateral lobe
What does N0 indicate?
No regional lymph node metastases
What does N1 indicate?
Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension
What does N2 indicate?
Ipsilateral mediastinal, sub carinal
What does N3 indicate?
Contralateral mediastinal, contralateral hilar, scalene or 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 nodules in a contralateral lobe
Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion (condition in which cancer causes an abnormal amount of fluid to collect between the thin layers of tissue (pleura))
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 in one sitting (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
