Radiology of Lung Cancer And Staging Flashcards
When doing a systemic review of a chest X-Ray, list the order in which items should be viewed
Name/marker/rotation/ penetration Lines/metal work Heart Mediastinum Lungs [Zones (upper/middle/lower)] Bones Diaphragm Soft Tissues
How defined should the hilar vascular be in the mediastimum when viewing an X-Ray
Crisply defined
Name 2 normal features of an X-Ray of the mediastinum
No widening of the mediastinum
Trachea should be central
Where can some of the tumours be located in the mediastinum
Centrally
What zones of the lung should be compared in an X-Ray
Upper, Middle and Lower
When observing an X-Ray of the lung, what details should be looked for
Details should be looked for:
Between the ribs and heart
Always look ‘behind’ the heart
How will lesions show on a chest X-Ray and where could they be
They are subtler
Could behind the heart and hila
What should a patients chest X-Rays be compared with
Previous films
What are the main review areas of a chest X-Ray
Hila
Lung apices
Behind the heart
Behind the diaphragm
What will a patient with a Pancoast tumour present with
Arm pain/weakness
Horner’s syndrome
Invasion of brachial plexus
What is the next step after confirming that a lesion is intrapulmonary
CT
What will a CT scan allow the evaluation of
Size Shape atelectasis Border Density Solid or non-solid Dynamic contrast enhancement >25 HU Growth
What is a pulmonary mass
An opacity in lung over 3cm with no mediastinal adenopathy or atelectasis
What is a pulmonary nodule
An opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis
What can comparing previous films to each other help determine
What has changes
What is lung cancer staging dependent on
Clinical history/examination
Performance status (e.g. fitness, independence etc.)
Pulmonary function
TNM International system – tumour, nodes and metastases
What does the T in TNM staging question
How big is the tumour, how far has it spread/size and position of the tumour
What does the N in TNM staging question
Whether cancer cells have spread into the lymph nodes
What does the M in TNM staging question
Whether the tumour has spread anywhere else in the body (metastases)
What type of imaging is used for T in TNM staging
CT
PET-CT
Bronchoscopy
What type of imaging is used for N in TNM staging
PER-CT
Mediastinoscopy
CT
EBUS/EUS
What type of imaging is used for M in TNM staging
PET-CT
CT
Bone scan
What type of technique does FDG PET use
Nuclear medicine
Since when has FDG PET been used clinically for cancer staging
1994
What does FDG PET use
Labelled glucose analogue (18F-FDG)
What is the half body time of 18FDG post injection
60 minutes
Where does 18FDG accumulate
Tumours and Nodes
What does Tx mean
A primary tumour that cannot be assessed
What does T0 mean
No evidence of primary tumour
What does Tis mean
Carcinoma in situ
What is a T1 tumour
When the tumour is 3cm or below at its greatest dimension, surrounded by the lung or visceral pleura without bronchoscopic evidence of involvement of the main bronchus
What is a T1a tumour
A minimally invasive adenocarcinoma, the tumour is less than or equal to 1com at its greatest dimension
What is a T1b tumour
A tumour less than or equal to 2cm
What is a T1c tumour
A tumour less than or equal to 3 cm
What is a T2 tumour
A tumour which is over 3cm but smaller than 5cm or a tumour which:
- Involves main bronchus, but not carina
- Invades visceral pleura
- Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all the lung
What is a T2a tumour
Tumor over 3 cm but less than 4 cm in greatest dimension
What is a T2b tumour
Tumor over 4cm but less than 5 cm in greatest dimension
What is a T3 tumour
Tumors are over 5cm but under 7cm or one that directly invades any one of the following:
– chest wall (including superior sulcus tumors)
– phrenic nerve
– parietal pericardium
What else can a T3 tumour be
Separate tumor nodule(s) in the same lobe as the primary
What is a T4 tumour
Tumours are tumours over 7cm or invading any of the following: \+ Diaphragm \+ Mediastinum \+ Heart \+ Great vessels \+ Trachea \+ Recurrent laryngeal nerve \+ Esophagus \+ Vertebral body \+ Carina
What else can a T4 tumour be
Separate tumor nodule(s) in a different ipsilateral lobe
What does PET/CT allows you to assess
Chest wall
Mediastinal invasion
What kind of metastases has occurred in N0
No regional lymph node metastases
What kind of metastases has occurred in N1
Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension
What kind of metastases has occurred in N2
Ipsilateral mediastinal, subcarinal
What kind of metastases has occurred in N3
Contralateral mediastinal, contralateral hilar, scalene or supraclavicular
How many patients tend to present with metastasis
1/3
What type of metastases are common
Cerebral
Skeletal
Adrenal
Liver
What is a M0 metastases
No distant metastases
What is a M1 metastases
Distant metastasis
What is a M1a metastases
Separate tumour nodule(s) in a contralateral lobe
Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion
What is a M1b metastases
Single distant metastasis
What is a M1c metastases
Multiple distant metastases