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1st Year Systems > Radiology of Lung Cancer and Staging > Flashcards

Radiology of Lung Cancer and Staging Flashcards

1
Q

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

A

Pulmonary nodule, mass….

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2
Q

What should you note about the mediastinal area?

A

Hilar vascular structures should be crisply defined

No widening of the mediastinum

Trachea should be central

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3
Q

What should you look for when examaning the lungs?

A

Compare upper, middle and lower zones

Between ribs for lung detail

Behind the heart

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4
Q

What type of carcinoma is this?

A

Peripheral lung carcinoma

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5
Q

What type of lung cancer is this?

Suggest a reason why the left lung is collapsed

A

Central Lung Carcinoma

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

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6
Q

What type of cancer is this?

A

Central Lung cancer

Right upper lobe collapse

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7
Q

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

A

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

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8
Q

?

A

Left Hilar Mass

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9
Q

?

A

Right Hilar Mass

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10
Q

?

A

Mass Behind the heart

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11
Q

?

A

Mass of the left costophrenic angle

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12
Q

?

A

RIght apex/Pancoast tumour

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13
Q

What clinical history might be indicative of lung cancer?

A

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

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14
Q

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

A

CT

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15
Q

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

A

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

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16
Q

What is a pulmonary mass?

A

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

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17
Q

What is a pulmonasry nodule?

A

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

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18
Q

What can a solitary pulmonary nodule be indicative of?

A

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)

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19
Q

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

A

Growth of fungus

20
Q

What does TIA stand for?

A

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

21
Q

What do the letters TNM stand for?

A

T - Size and position of the tumour

N- Wether cancer has spread to the lymph nodes

M - Metastasis (yes/no?)

22
Q

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

A

CT

PETCT

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

23
Q

How is N determined?

A

PET-CT

Mediatinoscopy

CT

EBUS/EUS

24
Q

How is M determined?

A

PETCT

CT

bone scan

25
Q

What is EBUS?

A

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.

26
Q

What is the chemical used by a PET scan?

A

FDG

27
Q

Who are PET scans offered to?

A

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

28
Q

What are Tx/T0/Tis tumours?

A

Tx - Primary tumour cannot be assessed

T0 - no evidence of primary tumour

Tis- carcinoma in situ

29
Q

What are tumours labelled T1?

A

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

30
Q

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

A

T1a - minimally invasive adenocarcinoma, less than 1 cm in greatest dimension

T1b - Tumour less than 2 cm

T1c - less than 3 cm

31
Q

What is the classification of a T2 tumour?

A

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.

32
Q

What is a T2a and T2b tumour?

A

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

33
Q

What is a T3 tumour?

A

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

34
Q

What is a T4 tumour?

A

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

35
Q

What does N0 indicate?

A

No regional lymph node metastases

36
Q

What does N1 indicate?

A

Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

37
Q

What does N2 indicate?

A

Ipsilateral mediastinal, sub carinal

38
Q

What does N3 indicate?

A

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

39
Q

What are the common places for lung cancer to metastasise?

A

Cerebral

Skeletal

Adrenal

Liver

40
Q

What does M0 indicate?

A

No metastasis

41
Q

What does M1 indicate?

A

Distant metastasis

42
Q

What does M1a indicate?

A

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))

43
Q

What does M1b stand for?

A

Single distant metastasis

44
Q

What does M1c indicate?

A

Multiple distant metastasis

45
Q

What is the purpose of PET/CT in staging?

A

Whole body staging in one sitting (excluding cerebral disease)

Discloses metastasis and other pathology

Excludes metastasis where structural imaging is abnormal

Non-invasive

46
Q

What are the limitations of PET CT?

A

False negative results

False positive results

Cost

47
Q

How is tissue diagnosis achieved?

A

Bronchoscopy and EBUS

Percutaneous image guided biopsy

1st Year Systems (81 decks)

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