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Respiratory > Radiology of Lung Cancer and Staging > Flashcards

Radiology of Lung Cancer and Staging Flashcards

1
Q

What percentage of patients with lung cancer present with advanced disease?

A

66%

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2
Q

What do you need to check when looking at a chest X-ray?

A

Name/marker/rotation/penetration

Lines/metal work

Heart

Mediastinum

Lung (zones - upper, middle, lower)

Bones

Diaphragm

Soft tissues

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3
Q

What are the first 4 things you should look at in a chest X-ray?

A

Name

Marker

Rotation

Penetration

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4
Q

What are the zones of the lungs in a chest X-ray?

A

Upper

Middle

Lower

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5
Q

What is A?

A

Mediastinum

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6
Q

What are you looking for in the mediastinum?

A

Hilar vascular structures crisply defined

No widening of mediastinum

Trachea should be central

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7
Q

What are you looking for in the lungs?

A

Compare upper, middle and lower zones

Look between ribs for lung detail

Remember to look ‘behind’ the heart

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8
Q

What is this?

A

Peripheral lung carcinoma

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9
Q

What is this?

A

Central lung carcinoma

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10
Q

How should we identify lung cancers on X-rays?

A

Compare with previous films

Always look at review areas

Remember lesions are often more subtle

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11
Q

What are the review areas of a chest X-ray?

A

Hila

Lung apices

Behind the heart

Behind the diaphragm

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12
Q

What is this?

A

Left hilar mass

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13
Q

What is this?

A

Right hilar mass

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14
Q

What is this?

A

Mass behind the heart

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15
Q

What is this?

A

Mass left costophrenic angle

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16
Q

What is this?

A

Right apex tumour

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17
Q

What could the clinical history for lung cancer include?

A

Increasing shortness of breath in smoker

History of pulmonary fibrosis

Recent haemoptysis

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18
Q

What follows taking a history and examining the patient?

A

CT

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19
Q

What should be evaluated using a CT scan?

A

Size

Shape

Atelectasis

Border

Density

Solid or non-solid

Dynamic contrast enhancement >25HU

Growth

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20
Q

What is atelectasis?

A

Collapse of lung resulting in reduced gas exchange

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21
Q

What is the collapse of the lung resulting in reduced gas exchange called?

A

Atelectasis

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22
Q

What is a pulmonary mass?

A

Opacity in the lung over 3cm with no medistinal adenopathy or atelectasis

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23
Q

What is an opacity in the lung over 3cm with no mediastinal adenopathy or atelectasis called?

A

Pulmonary mass

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24
Q

What is a pulmonary nodule?

A

Opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis

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25
Q

What is an opacity in the lung up to 3cm with no mediastinal adenopathy or atelectasis called?

A

Pulmonary nodule

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26
Q

What is the difference between a pulmonary nodule and a pulmonary mass?

A

Pulmonary mass is over 3cm and pulmonary nodule is up to 3cm

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27
Q

What could a solitary pulmonary nodule or mass be?

A

Lung cancer

Metastasis

Benign lung neoplasm

Infection

Vascular haemotoma

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28
Q

What could suggest a solitary pulmonary nodule or mass is a metastasis?

A

Previous history of breast. renal, seminoma or sarcoma cancer

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29
Q

What are examples of benign lung neoplasms?

A

Carcinoid

Hamartoma

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30
Q

What does the staging of lung cancer take into account?

A

Clinical history/examination

Performance status

Pulmonary function

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31
Q

What system does the staging of lung cancer use?

A

TNM international system for staging lung cancer

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32
Q

What does the TNM international staging of lung cancer consider?

A

Size and position of tumour (T)

Whether cancer cells have spread into the lymph nodes (N)

Whether the tumour has spread anywhere else in the body, metastasis (M)

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33
Q

What is T?

A

Size and position of tumour

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34
Q

What is N?

A

Whether tumour has spread to lymph nodes

35
Q

What is M?

A

Whether the tumour has spread into other parts of the body, metastasis

36
Q

What investigations can be done to determine T?

A

CT

PET-CT

Bronchoscopy

37
Q

What investigations can be done to determine N?

A

PET-CT

Mediastinoscopy

CT

EBUS/EUS (endobronchial ultrasound)

38
Q

What does EBUS stand up for?

A

Endobronchial ultrasound

39
Q

What investigations can be done to determine M?

A

PET-CT

CT

Bone scan

40
Q

What is the most common tracer used?

A

FDG (flourodeoxyglucose)

41
Q

What does FDG stand for?

A

Flourodeoxyglucose

42
Q

What is often used for the staging of lung cancer?

A

Flourodeoxyglucose PET

43
Q

What can be said about the availability and cost of FDG PET?

A

Expensive

Limited availability in the UK

44
Q

What is the labelled glucose analogue used in FDG-PET?

45
Q

What is the half body time of 18F-FDG?

A

60 minutes

46
Q

What does TX mean?

A

Primary tumour cannot be assessed

47
Q

What does T0 mean?

A

No evidence of primary tumour

48
Q

What does Tis mean?

A

Carcinoma in situ (has not spread to surrounding tissue, group of abnormal cells in the place where they formed)

49
Q

What is carcinoma in situ?

A

Group of abnormal cells which are still where they were formed, have not spread to nearby tissue

50
Q

What is T1?

A

Less than or equal to 3cm in diameter

Surrounded by lung or visceral pleura

Without bronchoscopic evidence of involvement of the main bronchus

51
Q

What is T1a?

A

Less than or equal to 1cm

52
Q

What is T1b?

A

Less than or equal to 2cm

53
Q

What is T1c?

A

Less than or equal to 3cm

54
Q

What are the sub classes of T1?

A

T1a

T1b

T1c

55
Q

What is T2?

A

More than 3cm but less than 5cm

56
Q

What are the different classes of T2?

57
Q

What is T2a?

A

More than 3cm but less than 4cm

58
Q

What is T2b?

A

More than 4cm but less than 5cm

59
Q

When are tumours classified as T2a although they are less than 3cm?

A

Invades main bronchus

Invades visceral pleura

Associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all of the lung

60
Q

What is T3?

A

More than 5cm but less than 7cm

61
Q

When are tumours classified as T3 althouh they are less than 5cm?

A

Invades any of:

Chest wall

Phrenic nerve

Parietal pericardium

or has seperate tumour nodules in the same lobe as primary

62
Q

What is T4?

A

More than 7cm

63
Q

When is a tumour T4 although it is less than 7cm?

A

Invades any of:

Diaphragm

Mediastinum

Heart

Great vessels

Trachea

Recurrent laryngeal nerve

Oesophagus

Vertebral body

Carina

or seperate tumour nodules in a different ipsilateral lobe

64
Q

What does N staging range from?

65
Q

What is N0?

A

No regional lymph node involvement

66
Q

What is N1?

A

Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

67
Q

What is N2?

A

Ipsilateral mediastinal, subcarinal

68
Q

What is N3?

A

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

69
Q

How does the number of lymph nodes change with size?

A

There are many small lymph nodes and few large ones

70
Q

How does the prevalence of metastasis change with the size of lymph nodes?

A

Large lymph nodes are more likely to have metastasis

71
Q

What percentage of patients present with metastasis?

72
Q

What are common metastasis?

A

Cerebral

Skeletal

Adrenal

Liver

73
Q

What does M staging range from?

74
Q

What is M0?

A

No distant metastasis

75
Q

What is M1?

A

Distant metastasis

76
Q

What are the different classes of M1?

A

M1a

M1b

M1c

77
Q

What is M1a?

A

Seperate tumour nodes in a contralateral lobe, tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion

78
Q

What is M1b?

A

Single distant metastasis

79
Q

What is M1c?

A

Multiple distant metastasis

80
Q

What are some of the advantages of PET/CT scanning in staging?

A

Performs whole body staging in single study excluding cerebral disease

Discloses metastasis and other pathology no detected by other means

Excludes metastasis where structural imaging abnormal

Non invasive

81
Q

What are some limitations of CT/PET?

A

All tests have false positives and false negatives

Cost

82
Q

How does 5 year survival change with staging?

A

As staging increases survival decreases

83
Q

What are some examples of tissue diagnosis methods?

A

Bronchoscopy with endobronchial ultrasound

Percutaneous image guided biopsy, flouroscopy/CT/US guided

Mediastinoscopy (sample mediastinal nodes)

Mediastinotomy (anterior mediastinal nodes)

Video assisted thoracoscopic surgery (VATS)

Explorative thoracotomy

Respiratory (37 decks)

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