Radiology of Lung Cancer and Staging Flashcards
What should you look out for on a chest x-ray?
Name/marker/rotation Lines/metal work Heart Mediastinum Lungs Bones Diaphragm Soft tissue
What has to be checked at the mediastinum?
Hilar vascular structures should be defined
No widening
Trachea should be central
What should be checked when looking at the lungs?
Compare the 3 zones
Look between ribs
Look behind the heart
Where is it easy to miss lung cancer on an x-ray?
Behind the heart and hila
What has to be done when looking at an x-ray?
Compare with previous films
Look at review areas
Check patients clinical history
Confirm lesion is intrapulmonary
What are the review areas?
Hila
Lung apices
Behind the heart
Behind the diaphragm
What should be done after finding a lesion on an x-ray?
Getting a CT
What is a pulmonary nodule or mass?
An opacity in the lung either over 3cm (mass) or under 3cm (nodule) with no mediastinal adenopathy or atelectasis
What can a solitary pulmonary nodule or mass indicate?
Lung cancer Metastasis Benign lung neoplasm Infection Vascular haematoma
Why is a CT useful?
To characterise a lesion
How can lung cancer be staged?
Clinical history/examination
Performance status
Pulmonary function
TNM staging
When should a PET scan be done?
When a patient is a candidate for radical treatment
What does TX mean?
Primary tumour cannot be assessed
What does T0 mean?
No evidence of primary tumour
What does Tis stand for?
Carcinoma in situ
What does T1 indicate?
T1a - minimally invasive adenocarcinoma, smaller or equal to 1cm
T1b - smaller or equal to 2cm
T1c - smaller or equal to 3cm
What does T2 indicate?
Involves main bronchus but not carina Invades visceral pleura Associated with atelectasis or obstructive pneumonitis T2a - 3 < t < 4cm T2b - 4 < t < 5cm
What does T3 indicate?
5 < t < 7cm
Or directly invaded the chest wall or the phrenic nerve or the parietal pericardium
Or there are separate tumour nodule(s) in the same lobe as the primary
What does T4 indicate?
Larger than 7cm
Or invades diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body or carina
Or separate tumour nodule(s) in a different ipsilateral lobe
What does N0 mean?
No regional lymph node metastases
What does N1 mean?
Ipsilateral peribronchial , hilar or intrapulmonary nodes
What does N2 mean?
Ipsilateral mediastinal, subcarinal nodes
What does N3 mean?
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular nodes
What does M0 mean?
No distant metastasis
