Radiology of Lung Cancer And Staging

Question 1

When doing a systemic review of a chest X-Ray, list the order in which items should be viewed

Answer 1

Name/marker/rotation/ penetration
Lines/metal work
Heart 
Mediastinum
Lungs [Zones (upper/middle/lower)]
Bones
Diaphragm
Soft Tissues

Question 2

How defined should the hilar vascular be in the mediastimum when viewing an X-Ray

Answer 2

Crisply defined

Question 3

Name 2 normal features of an X-Ray of the mediastinum

Answer 3

No widening of the mediastinum

Trachea should be central

Question 4

Where can some of the tumours be located in the mediastinum

Answer 4

Centrally

Question 5

What zones of the lung should be compared in an X-Ray

Answer 5

Upper, Middle and Lower

Question 6

When observing an X-Ray of the lung, what details should be looked for

Answer 6

Details should be looked for:
Between the ribs and heart
Always look ‘behind’ the heart

Question 7

How will lesions show on a chest X-Ray and where could they be

Answer 7

They are subtler

Could behind the heart and hila

Question 8

What should a patients chest X-Rays be compared with

Answer 8

Previous films

Question 9

What are the main review areas of a chest X-Ray

Answer 9

Hila
Lung apices
Behind the heart
Behind the diaphragm

Question 10

What will a patient with a Pancoast tumour present with

Answer 10

Arm pain/weakness
Horner’s syndrome
Invasion of brachial plexus

Question 11

What is the next step after confirming that a lesion is intrapulmonary

Answer 11

CT

Question 12

What will a CT scan allow the evaluation of

Answer 12

Size
Shape atelectasis
Border
Density
Solid or non-solid
Dynamic contrast enhancement >25 HU
Growth

Question 13

What is a pulmonary mass

Answer 13

An opacity in lung over 3cm with no mediastinal adenopathy or atelectasis

Question 14

What is a pulmonary nodule

Answer 14

An opacity in lung up to 3cm with no mediastinal adenopathy or atelectasis

Question 15

What can comparing previous films to each other help determine

Answer 15

What has changes

Question 16

What is lung cancer staging dependent on

Answer 16

Clinical history/examination
Performance status (e.g. fitness, independence etc.)
Pulmonary function
TNM International system – tumour, nodes and metastases

Question 17

What does the T in TNM staging question

Answer 17

How big is the tumour, how far has it spread/size and position of the tumour

Question 18

What does the N in TNM staging question

Answer 18

Whether cancer cells have spread into the lymph nodes

Question 19

What does the M in TNM staging question

Answer 19

Whether the tumour has spread anywhere else in the body (metastases)

Question 20

What type of imaging is used for T in TNM staging

Answer 20

CT
PET-CT
Bronchoscopy

Question 21

What type of imaging is used for N in TNM staging

Answer 21

PER-CT
Mediastinoscopy
CT
EBUS/EUS

Question 22

What type of imaging is used for M in TNM staging

Answer 22

PET-CT
CT
Bone scan

Question 23

What type of technique does FDG PET use

Answer 23

Nuclear medicine

Question 24

Since when has FDG PET been used clinically for cancer staging

Answer 24

1994

Question 25

What does FDG PET use

Answer 25

Labelled glucose analogue (18F-FDG)

Question 26

What is the half body time of 18FDG post injection

Answer 26

60 minutes

Question 27

Where does 18FDG accumulate

Answer 27

Tumours and Nodes

Question 28

What does Tx mean

Answer 28

A primary tumour that cannot be assessed

Question 29

What does T0 mean

Answer 29

No evidence of primary tumour

Question 30

What does Tis mean

Answer 30

Carcinoma in situ

Question 31

What is a T1 tumour

Answer 31

When the tumour is 3cm or below at its greatest dimension, surrounded by the lung or visceral pleura without bronchoscopic evidence of involvement of the main bronchus

Question 32

What is a T1a tumour

Answer 32

A minimally invasive adenocarcinoma, the tumour is less than or equal to 1com at its greatest dimension

Question 33

What is a T1b tumour

Answer 33

A tumour less than or equal to 2cm

Question 34

What is a T1c tumour

Answer 34

A tumour less than or equal to 3 cm

Question 35

What is a T2 tumour

Answer 35

A tumour which is over 3cm but smaller than 5cm or a tumour which: - 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

Question 36

What is a T2a tumour

Answer 36

Tumor over 3 cm but less than 4 cm in greatest dimension

Question 37

What is a T2b tumour

Answer 37

Tumor over 4cm but less than 5 cm in greatest dimension

Question 38

What is a T3 tumour

Answer 38

Tumors are over 5cm but under 7cm or one that directly invades any one of the following: – chest wall (including superior sulcus tumors) – phrenic nerve – parietal pericardium

Question 39

What else can a T3 tumour be

Answer 39

Separate tumor nodule(s) in the same lobe as the primary

Question 40

What is a T4 tumour

Answer 40

``` Tumours are tumours over 7cm or invading any of the following: + Diaphragm + Mediastinum + Heart + Great vessels + Trachea + Recurrent laryngeal nerve + Esophagus + Vertebral body + Carina ```

Question 41

What else can a T4 tumour be

Answer 41

Separate tumor nodule(s) in a different ipsilateral lobe

Question 42

What does PET/CT allows you to assess

Answer 42

Chest wall | Mediastinal invasion

Question 43

What kind of metastases has occurred in N0

Answer 43

No regional lymph node metastases

Question 44

What kind of metastases has occurred in N1

Answer 44

Ipsilateral peribronchial, hilar or intrapulmonary nodes including by direct extension

Question 45

What kind of metastases has occurred in N2

Answer 45

Ipsilateral mediastinal, subcarinal

Question 46

What kind of metastases has occurred in N3

Answer 46

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

Question 47

How many patients tend to present with metastasis

Answer 47

1/3

Question 48

What type of metastases are common

Answer 48

Cerebral Skeletal Adrenal Liver

Question 49

What is a M0 metastases

Answer 49

No distant metastases

Question 50

What is a M1 metastases

Answer 50

Distant metastasis

Question 51

What is a M1a metastases

Answer 51

Separate tumour nodule(s) in a contralateral lobe | Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion

Question 52

What is a M1b metastases

Answer 52

Single distant metastasis

Question 53

What is a M1c metastases

Answer 53

Multiple distant metastases