Radiology of lung cancer and staging Flashcards
What does your survival rate depend on in the diagnosis of lung cancer
Availability for surgery
Early diagnosis
In a chest ray what parts are visible and checked
Name/marker/rotation/ penetration
Lines/metal work
Heart
Mediastinum
Lungs
Zones (upper/middle/lower)
Bones
Diaphragm
Soft Tissues
What clinical features should you look out for in the mediastinum in a chest x ray
Hilar vascular structures should be crisply defined
No widening of mediastinum
Trachea should be central
Where is the special review areas in a chest x ray of the lungs
Hila
Lung apices
Behind the heart
Behind the diaphragm
What is a hillier mass, what does it usually indicate
abnormality in one or both of the hilar lymph nodes in the lungs, usually indicating bronchogenic carcinoma
Where is a pancost tumour located
a tumor of the pulmonary apex
What is the a similarity and difference between a pulmonary nodule and pulmonary mass
both have no enlargement of mediastinal lymph nodes
But a pulmonary mass is greater than 3cm, where a pulmonary nodule is up to 3cm
Define atelectasis
partial collapse or incomplete inflation of the lung
No all pulmonary masses or nodules can be deemed lung cancer what are the other possibilities
Metastasis
Benign lung neoplasm
Infection, bacterial, TB, fungal
Vascular haematoma
What effect do small tumour within a main area have
they have a dramatic effect
In diagnosing lung cancer with radiology what information do you need to gather
Clinical history
Compare with previous films
What diagnosis technique is particularly good in characterising lesions
CT
What does T stand for in TNM staging
How big it is and how far has it spread /Size and position of the tumour
What does N stand for in TNM staging
Whether cancer cells have spread into the lymph nodes
What does M stand for in TNM staging
Whether the tumour has spread anywhere else in the body ie metastases
What diagnostic techniques can assess T
CT
PET
Bronchoscopy
What is the diagnostic techniques to assess N
PET - CT
mediastinoscopy
EBUS/EUS - tissue diagnosis
What is the diagnostic techniques to assess M
PET - CT
Bone scan
What is a mediastinoscopy
procedure used to examine the mediastinum, good in examining lymph nodes
What is a PET scan labeled with and why is this useful
glucose analogue FDG
This is recognised by tumours as glucose which takes lots of it - failt to metabolise and accumulate it - shows up on PET scan where tumours are located
What is the disadvantage to a PET scan
Expensive
Limited
exclude cerebral diseases - brains absorbs to much glucose
What does TX stand for
Primary tumour cannot be assessed
What does T0 stand for
no evidence of primary tumour
What does Tis stand for
carcimona in situ - group of abnormal cells with the potentially to be cancerous
What is the tumour growth sizes for T1 staging
Tumour growth below 3cm
T1a- 1cm
T1b-2cm
T1c-3cm
Does T1 evolve the main bronchus
No
What is the tumour growth for T2a/b Lung cancer
T2a- 3-4cm
T2b - 4-5cm
What does T2 stage of lung cancer invade
Involves main bronchus, but not carina
Invades visceral pleura
At the phase of T2 Lung cancer what can occur
- Atelectasis - partial collapse or incomplete inflation of the lung
- obstructive pneumonitis that extends to the hilar region involving part or all the lung
What is the characteristics of T3 lung cancer
tumour growth 5-7cm span
or separate tumor nodule(s) in the same lobe as the primary
What structures are invaded in T3 lung cancer
chest wall (including superior sulcus tumors)
phrenic nerve
parietal pericardium
What is the characteristic of T4 lung cancer
tumour growth above 7cm
Separate tumour nodules on different ipsilateral lobes
Where does T4 stage of lung cancer invade
Diaphragm mediastinum heart great vessels trachea recurrent laryngeal nerve esophagus vertebral body carina
What is PET and CT scan checking for in T staging
assessing chest wall
and
mediastinal invasion
What does N0 stand for in lung cancer staging
No regional lymph node metastases
What does N1 stand for in lung cancer staging
Ipsilateral peribronchial , hilar or intrapulmonary nodes including by direct extension (same side)
What does N2 stand for in lung cancer staging
Ipsilateral mediastinal, subcarinal (same side)
What does N3 stand for in lung cancer staging
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular (both sides)
What has greater infect in increasing Metastases the number of lymph nodes or the size
The size of the lymph nodes
Above which size will the lymph nodes give 100% metastases
> 4cm
Where is lung cancer most likely to metastasis
Cerebral
Skeletal
Adrenal
liver
How much patients present with metastasis
1/3
What does the M0 in lung cancer staging present
No distant metastasis
What does the M1 in lung cancer staging present
Distant metastasis
What does the M1a in lung cancer staging present
Separate tumour nodule(s) in a contralateral lobe
Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
(to the lungs and the heart)
What does the M1b in lung cancer staging present
single distant metastasis
What does the M1c in lung cancer staging present
multiple distant metastases
What is the benefit of PET-CT scan
non invasive
discloses metastases and other pathology not detected by other means
performs whole body staging in a single
What is stage 1A
T1 N0 M0 (67% survival)
What is stage 1B
T2 N0 M0 (57% survival)
What is stage 11A
T1 N1 M0 (55% survival)
What is stage 11B
T2 N1 MO/T3 NO MO (39% survival)
What is stage 111A
T3 N1 MO/T3 N2 MO (23% survival)
What is stage 111B
T4 NO-2 MO/T1-4 N3 MO (5% survival)
What is stage IV
any T any N M1
What is the survival rate at stage IV
1%
