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S2 Respiratory System > Radiology of lung cancer and staging > Flashcards

Radiology of lung cancer and staging Flashcards

1
Q

what should be the systematic review when considering CXR?

A
  • name, marker, rotation, penetration
  • lines /metal work
  • heart
  • mediastinum
  • lungs (zones: upper/ middle/ lower)
  • bones
  • diaphragm
  • soft tissues
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2
Q

what do you look for in CXR when checking the mediastinum?

A
  • trachea should be central
  • no widening of mediastinum
  • hilar vascular structures should be crisply defined
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3
Q

where do you look for in CXR when checking the lungs?

A
  • compare upper, mid and lower zones
  • look between ribs for lung detail
  • remember to look “behind” the heart
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4
Q

what possibly causes a lobar collapse which fails to resolve in 2 to 3 weeks in a smoker of age > 45?

A

central lung cancer

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5
Q

what do lesions in the review areas often indicate?

A

lung cancer

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6
Q

where do you look for in CXR when checking review areas?

A
  • hila
  • lung apices
  • behind the heart
  • behind the diaphragm
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7
Q

what is the angle between the ribs and the diaphragm called?

A

costophrenic angle

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8
Q

what is the typical clinical history for lung cancer?

A

increasing SOB in smoker, history of pulmonary fibrosis, recent haemoptyis

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9
Q

what do you always have to do when examining a patient’s cxr? (HINT: previous cxr)

A

always compare with previous imaging

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10
Q

why would you sometimes complete PA cxr with sagittal view?

A

confirm lesion is intrapulmonary

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11
Q

what is the 2nd step after cxr?

A

CT

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12
Q

what does a CT enable us to tell about a lesion?

A

-evaluate size, shape atelectasis, border, density, solid or non solid, dynamic, contrast enhancement > 25 HU, growth

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13
Q

what is a pulmonary mass?

A

pulmonary mass is an opacity in lung over 3cm with no mediastinal adenopathy or atelectasis

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14
Q

what is a pulmonary nodule?

A

pulmonar nodule is an opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

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15
Q

what might a solitary pulmonary nodule or mass suggest?

A
  • lung cancer (if old and smoking history)
  • metastasis (if previous history of breast, renal, seminoma, sarcoma)
  • benign lung neoplasm (e.g.: carcinoid, hamartoma)
  • infection bacterial, tuberculosis or fungal
  • vascular haematoma, AVM
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16
Q

how do you assess stage of lung cancer?

A
  • clinical history/ examination
  • performance status
  • pulmonary function
  • TNM international system for staging lung cancer
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17
Q

what is TNM staging?

A

T: how big, how far-spread, size, position
N: have cancer cells spread into lymph nodes?
M: presence of distant metastasis?

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18
Q

what analogue is labelled in a FDG PET?

A

labelled glucose analogue 18F-FDG

19
Q

what does Tx mean?

A

primary tumour cannot be assessed

20
Q

what does T0 mean?

A

no evidence of primary tumour

21
Q

what does Tis mean?

A

carcinoma in situ

22
Q

what does T1 mean?

A

tumour <3cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of involvement of the main bronchus

23
Q

what does T1a mean?

A

minimally invasive adenocarcinoma, tumour <1cm in greatest dimension

24
Q

what does T1b mean?

A

tumour <2cm

25
Q

what does T1c mean?

A

tumour <3cm

26
Q

what does T2 mean?

A

tumour >3cm or any tumour with the following features:

  • involves main bronchus but not carina
  • invades visceral pleura
  • associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all the lung
27
Q

what does T2a mean?

A

between 3 and 4cm

28
Q

what does T2b mean?

A

between 4 and 5cm

29
Q

what does T3 mean?

A

between 5 and 7 or one that directly invades any of the following:
- chest wall (including superior sulcus tumours)
- phrenic nerve
- parietal pericardium
or separate tumour nodules in the same lobe as the primary

30
Q

what does T4 mean?

A 
> 7cm or invades any of the following: 
- diaphragm 
- mediastinum
- heart
- great vessels 
- trachea
- recurrent laryngeal nerve
- oesophagus
- vertebral body
- carina 
or separate tumour nodule in a different ipsilateral lobe
31
Q

what does N0 mean?

A

no regional lymph node metastases

32
Q

what does N1 mean?

A

ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

33
Q

what does N2 mean?

A

ipsilateral mediastinal, subcarinal

34
Q

what does N3 mean?

A

contralateral mediastinal, contralateral hilar, scalene or supraclavicular

35
Q

where do pulmonary tumours metastasise?

A

brain, skeleton, adrenal glands, liver

36
Q

what fraction of patients have metastasised lung cancer?

A

1/3

37
Q

what does M0 mean?

A

no distant metastasis

38
Q

what does M1 mean?

A

distant metastasis

39
Q

what does M1a mean?

A
  • separate tumour nodule(s) in a contralateral lobe

- tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion

40
Q

what does M1b mean?

A

single distant metastasis

41
Q

what does M1c mean?

A

multiple distant metastasis

42
Q

how can PET/CT help in staging?

A
  • performs whole body staging in a single study excluding cerebral disease
  • discloses metastases and other pathology not detected by other means (unexpected metastases in 10-20% cases)
  • excludes metastases where structural imaging abnormal
  • non invasive
43
Q

how can you diagnose tissue?

A
  • using bronchoscopy and EBUS
  • percutaneous image guided biopsy, fluoroscopy/CT/US guided
  • mediastinoscopy to sample mediastinal nodes
  • mediastinotomy for anterior mediastinal nodes
  • VATS
  • explorative thoracotomy

S2 Respiratory System (43 decks)

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