Radiology of lung cancer and staging Flashcards
what should be the systematic review when considering CXR?
- name, marker, rotation, penetration
- lines /metal work
- heart
- mediastinum
- lungs (zones: upper/ middle/ lower)
- bones
- diaphragm
- soft tissues
what do you look for in CXR when checking the mediastinum?
- trachea should be central
- no widening of mediastinum
- hilar vascular structures should be crisply defined
where do you look for in CXR when checking the lungs?
- compare upper, mid and lower zones
- look between ribs for lung detail
- remember to look “behind” the heart
what possibly causes a lobar collapse which fails to resolve in 2 to 3 weeks in a smoker of age > 45?
central lung cancer
what do lesions in the review areas often indicate?
lung cancer
where do you look for in CXR when checking review areas?
- hila
- lung apices
- behind the heart
- behind the diaphragm
what is the angle between the ribs and the diaphragm called?
costophrenic angle
what is the typical clinical history for lung cancer?
increasing SOB in smoker, history of pulmonary fibrosis, recent haemoptyis
what do you always have to do when examining a patient’s cxr? (HINT: previous cxr)
always compare with previous imaging
why would you sometimes complete PA cxr with sagittal view?
confirm lesion is intrapulmonary
what is the 2nd step after cxr?
CT
what does a CT enable us to tell about a lesion?
-evaluate size, shape atelectasis, border, density, solid or non solid, dynamic, contrast enhancement > 25 HU, growth
what is a pulmonary mass?
pulmonary mass is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
what is a pulmonary nodule?
pulmonar nodule is an opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis
what might a solitary pulmonary nodule or mass suggest?
- lung cancer (if old and smoking history)
- metastasis (if previous history of breast, renal, seminoma, sarcoma)
- benign lung neoplasm (e.g.: carcinoid, hamartoma)
- infection bacterial, tuberculosis or fungal
- vascular haematoma, AVM
how do you assess stage of lung cancer?
- clinical history/ examination
- performance status
- pulmonary function
- TNM international system for staging lung cancer
what is TNM staging?
T: how big, how far-spread, size, position
N: have cancer cells spread into lymph nodes?
M: presence of distant metastasis?
what analogue is labelled in a FDG PET?
labelled glucose analogue 18F-FDG
what does Tx mean?
primary tumour cannot be assessed
what does T0 mean?
no evidence of primary tumour
what does Tis mean?
carcinoma in situ
what does T1 mean?
tumour <3cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of involvement of the main bronchus
what does T1a mean?
minimally invasive adenocarcinoma, tumour <1cm in greatest dimension
what does T1b mean?
tumour <2cm
