Radiology of Lung Cancer and Staging

Question 1

What can an opacity of a chest X-ray indicate?

Answer 1

Pulmonary nodule, mass….

Question 2

What should you note about the mediastinal area?

Answer 2

Hilar vascular structures should be crisply defined

No widening of the mediastinum

Trachea should be central

Question 3

What should you look for when examaning the lungs?

Answer 3

Compare upper, middle and lower zones

Between ribs for lung detail

Behind the heart

Question 4

What type of carcinoma is this?

Answer 4

Peripheral lung carcinoma

Question 5

What type of lung cancer is this?

Suggest a reason why the left lung is collapsed

Answer 5

Central Lung Carcinoma

Collapse of lung, may even be a small tumor, but it is obviously placed in a main airway

Question 6

What type of cancer is this?

Answer 6

Central Lung cancer

Right upper lobe collapse

Question 7

In a chest X ray, what are the systematic review areas?

Answer 7

Hila, lung apices, behind the heart, beind the diaphragm

Question 8

?

Answer 8

Left Hilar Mass

Question 9

?

Answer 9

Right Hilar Mass

Question 10

?

Answer 10

Mass Behind the heart

Question 11

?

Answer 11

Mass of the left costophrenic angle

Question 12

?

Answer 12

RIght apex/Pancoast tumour

Question 13

What clinical history might be indicative of lung cancer?

Answer 13

Increasing SOB, smoker, history of pulmonary fibrosis, recent haemoptysis

Question 14

What is the next step in diagnosis after a chest X ray?

Answer 14

CT

Question 15

What does a CT tell you about a mass/nodule?

Answer 15

Size, shape, border, atelectasis, density, solid vs non-solid

Question 16

What is a pulmonary mass?

Answer 16

An opacity in the lung over 3 cm with no mediastinal adenopathy (enlargement of the lymph nodes) or atelectasis

Question 17

What is a pulmonasry nodule?

Answer 17

An opacity in the lung up to 3cm with no mediastinal adenopathy or alectasis.

Question 18

What can a solitary pulmonary nodule be indicative of?

Answer 18

Lung cancer (likely if the patient is a smoker, old age)

Metastasis- (from breast cancer, renal cancer, seminoma, sarcoma)

Benign lung neoplasm, carcinoid, hamartoma

Infection bacterial, tb or fungal

Vascular haematoma, AVM(arteriovenous malformation)

Question 19

What can recent haemoptysis with previous history of TB as a child indicate?

Answer 19

Growth of fungus

Question 20

What does TIA stand for?

Answer 20

Transient ischaemic attack. Reults in lack of blood and oxygen to the brain (mini-stroke), symptoms are short lived and quickly leave. The word ischaemic means a reduced supply of blood and oxygen to a part of the body

Question 21

What do the letters TNM stand for?

Answer 21

T - Size and position of the tumour

N- Wether cancer has spread to the lymph nodes

M - Metastasis (yes/no?)

Question 22

What are the testing techniques to determine the T? (size and position)

Answer 22

CT

PETCT

Bronchoscopy - uses fibre optic endosope, tells us how close the tumor is to the carina

Question 23

How is N determined?

Answer 23

PET-CT

Mediatinoscopy

CT

EBUS/EUS

Question 24

How is M determined?

Answer 24

PETCT

CT

bone scan

Question 25

What is EBUS?

Answer 25

Endobronchial ultrasound, Allows Doctor's to look at the lungs and take samples from the glands in the mediastinum of the lung using the aid of an ultrasound scan, these glands lie outside the normal breathing tubes (bronchi). Ultrasound probe on the end of a bronchoscope allows the doctor to see the glands in the centre of the chest (mediastinum) and take samples under direct vision. Endobronchial ultrasound-guided transbronchial needle aspiration is done to take samples from the central lymph glands in the centre of your chest (mediastinum) which may be enlarged for a variety of reasons.

Question 26

What is the chemical used by a PET scan?

Answer 26

FDG

Question 27

Who are PET scans offered to?

Answer 27

Patients who are likely to benefit from treatment (surgery or radical chemo or radiotherapy)

Question 28

What are Tx/T0/Tis tumours?

Answer 28

Tx - Primary tumour cannot be assessed T0 - no evidence of primary tumour Tis- carcinoma in situ

Question 29

What are tumours labelled T1?

Answer 29

Tumour is less than 3 cm in its greatest dimension The tumour is surrounded by lung or visceral pleura No involvement with the main bronchus

Question 30

What is a T1 (a,b and c tumour?)

Answer 30

T1a - minimally invasive adenocarcinoma, less than 1 cm in greatest dimension T1b - Tumour less than 2 cm T1c - less than 3 cm

Question 31

What is the classification of a T2 tumour?

Answer 31

A tumour between 3 and 5 cm A tumour which involves the main bronchus, but not the carina A tumour which invades the visceral pleura Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all of the lung.

Question 32

What is a T2a and T2b tumour?

Answer 32

T2a - greater than 3 cm but less than 4cm in greatest dimension T2b is greater than 4 cm but less than 5 cm in its greatest dimension

Question 33

What is a T3 tumour?

Answer 33

Between 5 and 7 cm in length for its greates dimension Or One that directly invades any of the following: - Chest wall (including superior sulcus tumours) - Phrenic nerve - Parietal pericardium or - seperate tumour nodules in the same lobe as the primary

Question 34

What is a T4 tumour?

Answer 34

Greater than 7 cm in length or invades: Diaphragm Mediastinum Heart Great vessels Trachea Recurrent laryngeal nerve Oesophagus Vertebral body Carina Or - seperate tumour nodules in a different ipsilateral lobe

Question 35

What does N0 indicate?

Answer 35

No regional lymph node metastases

Question 36

What does N1 indicate?

Answer 36

Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

Question 37

What does N2 indicate?

Answer 37

Ipsilateral mediastinal, sub carinal

Question 38

What does N3 indicate?

Answer 38

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

Question 39

What are the common places for lung cancer to metastasise?

Answer 39

Cerebral Skeletal Adrenal Liver

Question 40

What does M0 indicate?

Answer 40

No metastasis

Question 41

What does M1 indicate?

Answer 41

Distant metastasis

Question 42

What does M1a indicate?

Answer 42

Separate tumour nodules in a contralateral lobe Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion (condition in which cancer causes an abnormal amount of fluid to collect between the thin layers of tissue (pleura))

Question 43

What does M1b stand for?

Answer 43

Single distant metastasis

Question 44

What does M1c indicate?

Answer 44

Multiple distant metastasis

Question 45

What is the purpose of PET/CT in staging?

Answer 45

Whole body staging in one sitting (excluding cerebral disease) Discloses metastasis and other pathology Excludes metastasis where structural imaging is abnormal Non-invasive

Question 46

What are the limitations of PET CT?

Answer 46

False negative results False positive results Cost

Question 47

How is tissue diagnosis achieved?

Answer 47

Bronchoscopy and EBUS Percutaneous image guided biopsy