Thoracic Oncology Flashcards
What is Tx?
Cancer cells in sputum /bronchial washing’s but not been assessed on imaging /bronchoscopy
What is T0?
No sign of cancer
What is Tis
Carcinoma in situ
Outline T1
<3cm surrounded by lung/ visceral pleura NOT involving main bronchus
T1mi- minimally invasive lung cancer , grown no more than 0.5cm into lung tissue
T1a ≤ 1cm
T1b >1cm to ≤2cm
T1c >2cm to ≤ 3cm
Outline T2
> 3cm to ≤5cm
OR
involvement of main bronchus without carina, regardless of distance from carina
OR
invading visceral pleura
OR
atelectasis
OR
post obstructive pneumonitis extending to hilum
T2a >3cm to ≤4cm
T2b >4cm to ≤ 5 cm
Outline T3
> 5 to ≤7cm
OR
Involving the Chest Wall, Pericardium, Phrenic nerve or satellite nodules in same lobe
Outline T4
> 7cm
OR
involving :Mediastinum, Diaphragm, Heart , Great vessels , Carina, Oesophagus, Trachea , Recurrent laryngeal nerve , spine or separate tumour in different lobe of ipsilateral lung
What is N1?
Ipsilateral peribronchial and /or hilar nodes and intrapulmonary nodes
What is N2?
Ipsilateral mediastinal and/or sub carinal nodes
What is N3?
Contralateral mediastinal or hilar nodes , ipsilateral/contralateral suprclavicular /scalene nodes
What is M1a?
Tumour in the contralateral lung
OR
Pericardial / Pleural Nodule
OR
Pericardial/Pleural Malignant effusion
What is M1b ?
Single extrathoracic Mets including single non regional LN
What is M1c?
Multiple extra-thoracic Mets in one or more organs
What is the incidence of brain Mets at diagnosis of lung cancer ?
10-20%
Who get a CT head with contrast ?
Stage II or Small cell
Who gets MRI brain w contrast ?
Stage 3
What staging does Mets give you?
M1a/M1b - automatically Stage IV A
M1c - automatically Stage IV B
An incidental nodule is picked up on CT , if it’s a harmatoma or typical peri fissural nodule or <5mm what action required ?
None, patient can be discharged
Incidental solid nodule picked up on CT that is 9mm, what are the next steps ?
Calculate Brock score
IF <10% follow up with CT surveillance
IF ≥ 10% then for PET scan with risk assessment using Herder
—Herder <10% CT surveillance
—Herder 10-70% Image guided biopsy or excision biopsy or CT surveillance
— Herder >70% Consider excision or non surgical treatment (+/- image guided biopsy)
Incidental solid 5-6mm nodule picked up on CT what are the next steps as per BTS guidelines ?
Follow up CT one year after baseline
— If stable on basis of 2D diameter value: CT 2 years after baseline . Then calculate VDT categories as per 1 year follow up
— Stable on basis of volumetry : discharge
— VDT >600 days : consider discharge (only if based on volumetry) or ongoing CT surveillance depending on pt preference
— VDT 400-600 days: consider biopsy or further CT surveillance depending on pt preference
- VDT <400 days or clear evidence of growth : further work up and consideration of definitive management
Incidental nodule ≥6mm or ≥80mm3 picked up on CT, talk through next steps
CT 3 months after baseline :
IF VDT ≤ 400 days / clear evidence of growth : further work up and consideration of definitive management
If VDT >400 days : repeat CT at 1 year from baseline and then
— if stable on basis of diameter then repeat CT 2 years from baseline (and VDT as per 1 year)
— if stable on basis of volumetry : discharge
— VDT > 600 days : consider discharge (only if based on volumetry) or ongoing CT surveillance depending on patient preference
— VDT 400-600 days : consider biopsy or further CT surveillance depending on patient preference
- VDT ≤ 400 days : further work up and consider definitive management
What variability in size of nodule is allowed ?
25%
An incidental sub-solid nodule is found on CT , what are the criteria that mean patient can be discharged ?
- Nodule <5mm
- Patient unfit for any treatment
- Nodule stable over 4 years
Incidental finding of sub-solid nodule >5mm , no previous imaging , talk through follow up
Repeat thin section CT at 3 months:
IF resolved : discharge
IF stable: assess risk of malignancy (Brock/ Morphology) patient fitness and preference
— Low risk of malignancy (approx <10%) repeat CT at 1, 2 and 4 years from baseline
— High risk of malignancy (approx >10%) or concerning morphology , discuss options with patient EITHER Thin section CT at 1, 2 and 4 years OR Image guided biopsy OR Favour resection /non surgical treatment
IF growth/altered morphology: favour resection / non surgical treatment