Week 4 - Radiology of Lung Cancer and Staging

Question 1

What situations can cause a white out lung? (3)

Answer 1

large pleural effusion, complete collapse of lung, pneumonectomy

Question 2

What happens to mediastinal structures in case of a collapsed lung?

Answer 2

Volume is decreased on effected side, so mediastinal structures will be pulled into the effected side

Question 3

What happens to mediastinal structures in case of a large pleural effusion?

Answer 3

volume increases on that side so structures move further into normal side on Xray

Question 4

What will you see on an Xray of a collapsed lobe?

Answer 4

hilar structures and hemidiaphragm pulled upwards into space of collapsed lobe. other lobes hyperinflate to compensate, so large dark spaces between ribs on damaged side

Question 5

Which hilum do you expect to find superiorly and why?

Answer 5

left should be above right always - or similar. left pulmonary artery arches over bronchus

Question 6

what is a pulmonary mass vs a pulmonary nodule?

Answer 6

nodule is 3cm and below. mass if above 3cm.

Question 7

What are 5 things that a pulmonary mass/nodule standing alone may be?

Answer 7

• lung tumour,
• metastasis,
• neoplasm ,
• infection,
• vascular hematoma (blood outside vessels)

Question 8

What kind of neoplasm may you find as a mass/nodule on a chest scan?

Answer 8

benign hamartoma (calcium or fat cells) or carcinoid tumour (neuroendocrine system)

Question 9

What kind of infection may you find as a mass/nodule on a chest scan?

Answer 9

TB ghon focus,
bacterial (pneumonia granuloma)
fungal infection (aspergillosis)

Question 10

What is the first step in diagnoses and staging?

Answer 10

lung CT, then Chest Xray and history

Question 11

What is the second step of diagnosis and staging?

Answer 11

Check fitness and pulmonary function

Question 12

For TNM staging, which imaging techniques do we use to diagnose a T stage?

Answer 12

CT, PET CT and bronchoscopy

Question 13

For TNM staging, which imaging technique do we use to diagnose an N stage?

Answer 13

PET CT, mediastinoscopy and EBUS/EUS (ultrasound) for digestive tract and GI area

Question 14

For TNM staging, which scanning techniques do we use to diagnose an M stage?

Answer 14

pet CT, CT, bone scan (uncommon)

Question 15

What is a FDG PET scan?

Answer 15

uses F18 attached to labelled glucose analogue. this is taken up by highly metabolically active cells in the body

Question 16

What are the issues with FDG PET scan?

Answer 16

• attaches to inflammatory processes too - may not mean malignancy always - not specific.
• also always taken up by brain, heart, GI tract and bladder, so cant be used in these areas

Question 17

Why is a PET scan useful?

Answer 17

• Tells us which structures have been invaded by a tumour.
• Identifies hidden metastasis
• CT may sometimes appear normal

Question 18

What are 3 limitations of PET CT scans?

Answer 18

• expensive,
• false positives
• false negatives (if mass too small)

Question 19

What is a VAT’s procedure?

Answer 19

video assisted thoracoscopic surgery. small cut in chest wall and video allows us to see structures inside