Staging Of Lung Cancer Flashcards
How do you differentiate between a pulmonary mass and a pulmonary node?
A mass is > 3cm
A node is < or equal to 3cm
Both with no mediastinal adenoma they or atelectasis
If you find a met on a chest X ray, what do you have to think about when assessing?
Wether it is a node or not because some infections such as bacterial, TB and fungal infections show as lesions.
It may also be atrial valve malformations of vascular haematoma.
If there are a few lesions then is it mets from a primary tumour such as the breast, renal or a sarcoma?
Or is the lesion the primary tumour?
What 4 stages have to be assessed when staging cancer?
Clinical history/examination
Performance status
Pulmonary function
TNM system
What imaging techniques are used for the 3 parts for the TNM staging system?
T = bronchoscopy, CT, PET-CT N = CT, PET-CT, mediastinoscopy, endobronchial ultra sound / endoscopic ultrasound M = CT, PET-CT, bone scan
What specific type of PET scan may be used for testing staging?
FDG PET. It contains labelled glucose analogue which attaches to the metabolically active tumours which makes them stand out on the scan.
What does TX, T0 and Tins stand for in T staging?
TX - tumour cannot be assessed
T0 - no evidence of primary tumour
Tins - carcinoma in situ
Describe how tumours are assessed using the TNS staging system.
T1 = < 3cm T2 = > 3cm T3 = > 5cm T4 = < 7cm
State the node classifications in the TNM system for staging cancer.
N0 = no regional lymph node metastasis
N1 , N2 and N3
State the metastasis classification for the staging of lung cancer.
M0 = no distinct metastasis
M1 = distinct metastasis
M1a (separate mets), M1b (single distant met) and M1c (multiple distant mets)
Give examples of non surgical tests that can be carried out for the tissue diagnosis for lung cancer.
Bronchoscopy , endobronchial ultra sound
Percutaneous image guided biopsy
Fluoroscopy/ CT / ultrasounded guided biopsy
Give examples of surgical procedures used for the tissue diagnosis of lung cancer.
Mediastinoscopy to sample mediastinal nodes
Mediastinotomy to sample anterior mediastinal nodes
Exploration thoractomy
Video assisted thoractomy surgery (VATS)
what is a tumour like which scores a T4 in the T from TNM staging?
Tumor >7cm with invasion of the heart, carina and great vessels. it also have nodes in the ipsilateral node
what is a tumour like which scores a T3 in the T from TNM staging?
Tumor >7cm with invasion of the mediastinum, pleura, pericardium, diaphragm and chest wall. There are also nodes in the same lobe.
where are nodes found which score a N3 in the TNM staging?
nodes in the contralateral lobe or ipsilateral supraclavicular or scalene nodes.
