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Respiratory System DO > Radiology of Lung Cancer And Staging > Flashcards

Radiology of Lung Cancer And Staging Flashcards

1
Q

When doing a systemic review of a chest X-Ray, list the order in which items should be viewed

A 
Name/marker/rotation/ penetration
Lines/metal work
Heart 
Mediastinum
Lungs [Zones (upper/middle/lower)]
Bones
Diaphragm
Soft Tissues
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2
Q

How defined should the hilar vascular be in the mediastimum when viewing an X-Ray

A

Crisply defined

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3
Q

Name 2 normal features of an X-Ray of the mediastinum

A

No widening of the mediastinum

Trachea should be central

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4
Q

Where can some of the tumours be located in the mediastinum

A

Centrally

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5
Q

What zones of the lung should be compared in an X-Ray

A

Upper, Middle and Lower

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6
Q

When observing an X-Ray of the lung, what details should be looked for

A

Details should be looked for:
Between the ribs and heart
Always look ‘behind’ the heart

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7
Q

How will lesions show on a chest X-Ray and where could they be

A

They are subtler

Could behind the heart and hila

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8
Q

What should a patients chest X-Rays be compared with

A

Previous films

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9
Q

What are the main review areas of a chest X-Ray

A

Hila
Lung apices
Behind the heart
Behind the diaphragm

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10
Q

What will a patient with a Pancoast tumour present with

A

Arm pain/weakness
Horner’s syndrome
Invasion of brachial plexus

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11
Q

What is the next step after confirming that a lesion is intrapulmonary

A

CT

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12
Q

What will a CT scan allow the evaluation of

A 
Size
Shape atelectasis
Border
Density
Solid or non-solid
Dynamic contrast enhancement >25 HU
Growth
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13
Q

What is a pulmonary mass

A

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

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14
Q

What is a pulmonary nodule

A

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

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15
Q

What can comparing previous films to each other help determine

A

What has changes

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16
Q

What is lung cancer staging dependent on

A

Clinical history/examination
Performance status (e.g. fitness, independence etc.)
Pulmonary function
TNM International system – tumour, nodes and metastases

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17
Q

What does the T in TNM staging question

A

How big is the tumour, how far has it spread/size and position of the tumour

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18
Q

What does the N in TNM staging question

A

Whether cancer cells have spread into the lymph nodes

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19
Q

What does the M in TNM staging question

A

Whether the tumour has spread anywhere else in the body (metastases)

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20
Q

What type of imaging is used for T in TNM staging

A

CT
PET-CT
Bronchoscopy

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21
Q

What type of imaging is used for N in TNM staging

A

PER-CT
Mediastinoscopy
CT
EBUS/EUS

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22
Q

What type of imaging is used for M in TNM staging

A

PET-CT
CT
Bone scan

23
Q

What type of technique does FDG PET use

A

Nuclear medicine

24
Q

Since when has FDG PET been used clinically for cancer staging

A

1994

25
Q

What does FDG PET use

A

Labelled glucose analogue (18F-FDG)

26
Q

What is the half body time of 18FDG post injection

A

60 minutes

27
Q

Where does 18FDG accumulate

A

Tumours and Nodes

28
Q

What does Tx mean

A

A primary tumour that cannot be assessed

29
Q

What does T0 mean

A

No evidence of primary tumour

30
Q

What does Tis mean

A

Carcinoma in situ

31
Q

What is a T1 tumour

A

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

32
Q

What is a T1a tumour

A

A minimally invasive adenocarcinoma, the tumour is less than or equal to 1com at its greatest dimension

33
Q

What is a T1b tumour

A

A tumour less than or equal to 2cm

34
Q

What is a T1c tumour

A

A tumour less than or equal to 3 cm

35
Q

What is a T2 tumour

A

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
36
Q

What is a T2a tumour

A

Tumor over 3 cm but less than 4 cm in greatest dimension

37
Q

What is a T2b tumour

A

Tumor over 4cm but less than 5 cm in greatest dimension

38
Q

What is a T3 tumour

A

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

39
Q

What else can a T3 tumour be

A

Separate tumor nodule(s) in the same lobe as the primary

40
Q

What is a T4 tumour

A 
Tumours are tumours over 7cm or invading any of the following:
\+	Diaphragm
\+	Mediastinum
\+	Heart 
\+	Great vessels
\+	Trachea 
\+	Recurrent laryngeal nerve
\+	Esophagus 
\+	Vertebral body
\+	Carina
41
Q

What else can a T4 tumour be

A

Separate tumor nodule(s) in a different ipsilateral lobe

42
Q

What does PET/CT allows you to assess

A

Chest wall

Mediastinal invasion

43
Q

What kind of metastases has occurred in N0

A

No regional lymph node metastases

44
Q

What kind of metastases has occurred in N1

A

Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

45
Q

What kind of metastases has occurred in N2

A

Ipsilateral mediastinal, subcarinal

46
Q

What kind of metastases has occurred in N3

A

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

47
Q

How many patients tend to present with metastasis

A

1/3

48
Q

What type of metastases are common

A

Cerebral
Skeletal
Adrenal
Liver

49
Q

What is a M0 metastases

A

No distant metastases

50
Q

What is a M1 metastases

A

Distant metastasis

51
Q

What is a M1a metastases

A

Separate tumour nodule(s) in a contralateral lobe

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

52
Q

What is a M1b metastases

A

Single distant metastasis

53
Q

What is a M1c metastases

A

Multiple distant metastases

Respiratory System DO (33 decks)

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