Radiology of Lung Cancer and Staging

Question 1

What should you look out for on a chest x-ray?

Answer 1

Name/marker/rotation
Lines/metal work 
Heart 
Mediastinum 
Lungs 
Bones 
Diaphragm 
Soft tissue

Question 2

What has to be checked at the mediastinum?

Answer 2

Hilar vascular structures should be defined
No widening
Trachea should be central

Question 3

What should be checked when looking at the lungs?

Answer 3

Compare the 3 zones
Look between ribs
Look behind the heart

Question 4

Where is it easy to miss lung cancer on an x-ray?

Answer 4

Behind the heart and hila

Question 5

What has to be done when looking at an x-ray?

Answer 5

Compare with previous films
Look at review areas
Check patients clinical history
Confirm lesion is intrapulmonary

Question 6

What are the review areas?

Answer 6

Hila
Lung apices
Behind the heart
Behind the diaphragm

Question 7

What should be done after finding a lesion on an x-ray?

Answer 7

Getting a CT

Question 8

What is a pulmonary nodule or mass?

Answer 8

An opacity in the lung either over 3cm (mass) or under 3cm (nodule) with no mediastinal adenopathy or atelectasis

Question 9

What can a solitary pulmonary nodule or mass indicate?

Answer 9

Lung cancer 
Metastasis 
Benign lung neoplasm 
Infection 
Vascular haematoma

Question 10

Why is a CT useful?

Answer 10

To characterise a lesion

Question 11

How can lung cancer be staged?

Answer 11

Clinical history/examination
Performance status
Pulmonary function
TNM staging

Question 12

When should a PET scan be done?

Answer 12

When a patient is a candidate for radical treatment

Question 13

What does TX mean?

Answer 13

Primary tumour cannot be assessed

Question 14

What does T0 mean?

Answer 14

No evidence of primary tumour

Question 15

What does Tis stand for?

Answer 15

Carcinoma in situ

Question 16

What does T1 indicate?

Answer 16

T1a - minimally invasive adenocarcinoma, smaller or equal to 1cm
T1b - smaller or equal to 2cm
T1c - smaller or equal to 3cm

Question 17

What does T2 indicate?

Answer 17

Involves main bronchus but not carina
Invades visceral pleura 
Associated with atelectasis or obstructive pneumonitis 
T2a - 3 < t < 4cm
T2b - 4 < t < 5cm

Question 18

What does T3 indicate?

Answer 18

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

Question 19

What does T4 indicate?

Answer 19

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

Question 20

What does N0 mean?

Answer 20

No regional lymph node metastases

Question 21

What does N1 mean?

Answer 21

Ipsilateral peribronchial , hilar or intrapulmonary nodes

Question 22

What does N2 mean?

Answer 22

Ipsilateral mediastinal, subcarinal nodes

Question 23

What does N3 mean?

Answer 23

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular nodes

Question 24

What does M0 mean?

Answer 24

No distant metastasis

Question 25

What does M1 mean?

Answer 25

Distant metastasis

Question 26

What does M1a mean?

Answer 26

Separate tumour nodules in a contralateral lobe

Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion

Question 27

What does M1b mean?

Answer 27

Single distant metastasis

Question 28

What does M1c mean?

Answer 28

Multiple distant metastases

Question 29

What is the benefits of PET/CT scans in staging?

Answer 29

Whole body staging in single study
Discloses metastases and other pathology not detected by other means
Non invasive

Question 30

Limitations of PET/CTY scans in staging?

Answer 30

False negatives
False positives
Expensive

Question 31

What tests can be done for tissue diagnosis?

Answer 31

Bronchoscopy 
EBUS 
Percutaneous image guided biopsy 
Mediastinoscopy 
Mediastinotomy 
VATS 
Exploratory thoracotomy