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Systems: Respiratory AB > Radiology of Lung Cancer and Staging > Flashcards

Radiology of Lung Cancer and Staging Flashcards

1
Q

How many lung cancer patients present with advanced disease?

A

2/3

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2
Q

What is the first investigation carried out in the diagnosis of lung cancer?

A

Chest X-ray

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3
Q

What is the systematic approach to X-rays?

A
  • Name/marker/rotation/penetration
  • Lines/metal work
  • Heart
  • Mediastinum
  • Lungs -zones (upper, middle, lower)
  • Bones
  • Diaphragm
  • Soft tissue
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4
Q

How should the mediastinum look on an X-ray?

A
  • Hilar vascular structures should be crisply defined
  • No widening of mediastinum
  • Trachea should be central
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5
Q

What should be examined in relation to the lungs on an X-ray

A
  • Compare upper, mid and lower areas
  • Look between ribs for lung detail
  • Remember to look behind the heart
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6
Q

What can a small tumour within a main airway cause?

A

A collapse of the peripheral lung

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7
Q

What should doctors be aware of?

A

Lobar collapse which fails to resolve in 2 to 3 weeks in a smoker of age >45

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8
Q

What should you be aware of with lesions?

A
  • They are often more subtle than tumours
  • Beware of lesions behind the heart and hila
  • Compare with previous films
  • Always look at review areas
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9
Q

What areas are considered review areas?

A
  • Hila
  • Lung apices
  • Behind the heart
  • Behind the diaphragm
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10
Q

After confirming a lesion is intrapulmonary what is the nest test to run?

A

CT scan

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11
Q

What are you looking for with a CT?

A

Evaluate

  • Size
  • Shape
  • Atelectasis
  • Border
  • Density
  • Solid vs non solid
  • Dynamic contrast enhancement >25 HU
  • Growth
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12
Q

Pulmonary mass

A

An opacity in lung over 3cm with no mediastinal adenopathy or atelectasis

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13
Q

Pulmonary nodule

A

An opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

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14
Q

What can pulmonary masses/nodules in the lung mean?

A
  • Lung cancer
  • Metastasis
  • Benign lung neoplasm
  • Infection bacterial, tuberculosis or fungal
  • Vascular haematoma
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15
Q

When diagnosing based on scans what should you bear in mind?

A
  • Clinical history

- Compare with previous films

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16
Q

What is CT useful for?

A

To characterise

17
Q

What is considered in the of staging lung cancer?

A
  • Clinical history/examination
  • Performance status
  • Pulmonary function
  • TMN International system for staging of Lung Cancer
18
Q

What does TNM stand for?

A
  • T: Tumour
  • N: Nodes
  • M: Metastases
19
Q

TNM staging: Tumour

A
  • How big it is and how far has it spread

- Size and position of tumour

20
Q

TNM staging: Nodes

A

-Whether cancer cells have spread into the lymph nodes

21
Q

TNM staging: Metastasis

A

-Whether the tumour has spread anywhere else in the body

22
Q

What tests are used in evaluating T?

A
  • CT
  • PET-CT
  • Bronchoscopy
23
Q

What tests are used in evaluating N?

A
  • PET-CT
  • Mediastinoscopy
  • CT
  • EBUS/EUS
24
Q

What tests are used in evaluating M?

A
  • PET-CT
  • CT
  • Bone scan
25
Q

What is FDG PET?

A
  • Functional imaging
  • Nuclear medicine technique
  • Clinical use for lung cancer staging from 1994
  • Labelled glucose analogue 18F-FDG
  • Expensive
  • Limited availability in the UK
26
Q

TX

A

Primary tumour cannot be assessed

27
Q

T0

A

No evidence of primary tumour

28
Q

Tis

A

Carcinoma in situ

29
Q

What is PET/CT used for in T staging?

A

Assessing chest wall or mediastinal invasion

30
Q

How many patients present with metastases?

A

1/3

31
Q

What are common sites of metastasis?

A
  • Cerebral
  • Skeletal
  • Adrenal
  • Liver
32
Q

What role does PET/CT play in staging?

A
  • Performs whole body staging in single study excluding cerebral disease
  • Discloses metastases and other pathology not detected by other means
  • Excludes metastases where structural imaging abnormal
  • Non invasive
33
Q

What are limitations o PET CT?

A
  • Expensive
  • Can produce false negatives
  • Can produce false positives
34
Q

What tests can be performed for tissue diagnosis?

A
  • Bronchoscopy and EBUS
  • Percutaneous image guided biopsy, fluoroscopy/CT/US guided
  • Mediastinoscopy to sample mediastinal nodes
  • Mediastinotomy for anterior mediastinal nodes
  • VATS
  • Explorative thoracotomy

Systems: Respiratory AB (39 decks)

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