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respiratory system year 1 > radiology of lung cancer (diagnosis and staging) > Flashcards

radiology of lung cancer (diagnosis and staging) Flashcards

1
Q

steps of systematic review of CXR

A

name, marker, rotation, penetration

lines, metal work

heart

mediastinum

lungs - upper, middle and lower zones

bones

diaphragm

soft tissues

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2
Q

where do the lungs sit in relation to the diaphragm

A

they sit in front and behind the diaphragm and hemi-diaphragm?

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3
Q

review of mediastinum on CXR

A

hilar vascular structures should be crisply defined, compare height and difference between L and R

no widening of mediastinum

trachea should be central

look behind the heart

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4
Q

review of lungs on CXR

A

compare upper, mid and lower zones

look between ribs for lung detail

remeber to look behind the heart

compare L and R

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5
Q

what is the abnormality in this CXR

A

mass in the R lung

possible cavity of infection

  • peripheral lung carcinoma
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6
Q

what is the abnormality in this CXR

A

whiteout of the L semi thorax

could be - total collapse of the lung, pneumonectomy, large pleural effusion

  • central lung carcinoma which has lead to collapse, potential effusion also

if there is a concern about a central tumour which has caused collapse, a chest and abdominal CT would be done

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7
Q

what is the abnormality in this CXR

A

right upper lobe collapse

movement of the hilum

hyper-inflation of the lung - darker colour

BEWARE the lobar collapse which fails to resolve in 2-3wks in a smoker of age>45

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8
Q

what would be seen on a CXR if the lower of middle lobe collapses

A

lower - double heart border (triangle on both sides)

middle - loss of clear heart border

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9
Q

features of lung cancer on CXR

A

lesions often more subtle

beware of lesions behind the heart and hila

compare with previous films and always look at review areas

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10
Q

what are the review areas on a CXR

A

hila

lung apices

behind the heart

behind the diaphragm

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11
Q

what is the abnormality in this CXR

A

left middle zone abnormality

abnormality of the hilum - bulky

left hilar mass

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12
Q

what is the abnormality on this CXR

A

abnormality on the R

normal hilum position

rounded structure which is denser than the other side

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13
Q

what is the abnormality on this CXR

A

left lower zone abnormality

opacity behind the heart

cardiac area should be homogenous in density

mass behind the heart

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14
Q

what is the abnormality on this CXR

A

mass left costophrenic angle

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15
Q

what is the abnormality on this CXR

A

much denser on the R around apex

right apical/pancoast tumour

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16
Q

what is the abnormality on this CXR

A

tumour on R base

lacy like obacity (fibrosis) predominant in mid/lower zones and peripheries

clinical hx: increasing SOB in smoker, hx of pulmonary fibrosis, recent haemoptysis

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17
Q

what are the steps to take following a mass on CXR

A

always compare with previous imaging

confirm lesion is intrapulmonary

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

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18
Q

what is the abnormality on this CXR

A

rounded uniform opacity

previous breast cancer, mastectomy and then implant

look for evidence of metastasis

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19
Q

define pulmonary mass

A

an opacity in lung >3cm with no mediastinal adenopathy or atelectasis

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20
Q

define pulmonary nodule

A

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

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21
Q

potential diagnosis for solitary pulmonary nodule or mass

A

lung cancer (age, smoking hx)

metastasis (prev hx of breast, renal, seminoma, sarcoma)

benign lung neoplasm e.g. carcinoid, hamartoma

infection (bacterial, TB, fungal)

vascular haematoma, AVM

multiple nodules/masses are much more likely to be mets

22
Q

if an opacity is longstanding and unchanging is it likley to be malignant?

A

much less likely to be malignant

take note of clinical hx and compare to prev films

23
Q

changes to lungs from TB

A

generally leads to scarring and calcifications in the upper zones

hila can be pulled up as a result of scarring

increased density can be a sign of infection

24
Q

steps for staging lung cancer

A

clincal hx/examination

performance status

pulmonary function

TNM international system for staging lung cancer - tumour, nodes, mets, higher stage = poorer prognosis

25
Q

TNM staging

A

T = how big is it, how far has it spread, is it infiltrating any additional structures (T1-4)

N = have cancer cells spread into the lymph nodes (N1-3)

M - whether the tumour has spread anywhere else in the body (M1A-C)

26
Q

how is the T in TNM staged

A

CT, PET, bronchoscopy

27
Q

how is the N in TNM staged

A

PET, mediastinoscopy (confirms malignancy in nodes), CT, EBUS/EUS

CT isn’t as useful for notes

PET will show the metabolic activity - useful for small nodes

28
Q

how is the M in TNM staged

A

PET, CT, bone scan

29
Q

FDG PET scan

A

functional imaging

used in lung cancer staging

labelled glucose analogue

expensive

limited availability in UK

30
Q

PET scan

A

metabolic hot spots are matched to anatomical location

very metabolically active areas aren’t necessarily cancer, can also be infection

31
Q

Tx/T0/Tis

A

Tx = 1y tumour cannot be assessed

T0 = no evidence of 1y tumour

Tis = carcinoma in situ

32
Q

T1

A

tumous = 3cm in greatest dimension

surrounded by lung or visceral pleura

without bronchoscopic evidence of involvement of the main bronchus

T1a - minimally invasive adenocarcinoma tumous, = 1cm in greatest dimesion

T1b - = 2cm

T1c - = 3cm

33
Q

T2

A

tumour >3cm but <5cm or tumour with any of the following features:

(T2 tumours with these features are classified T2a if = 5cm)

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

T2a - >3cm but <4cm in greatest dimension

T2b - >4cm but <5cm in greatest dimension

34
Q

T3

A

tumour >5cm but <7cm or one that directly invades any of the following:

  • chest wall (including superior sulcus tumours)
  • phrenic nerve
  • parietal pericardium

or separate tumour nodule(s) in the same lobe as the 1y

35
Q

T4

A

tumour >7cm or invades any of the following:

  • diaphragm
  • mediastinum
  • heart
  • great vessels
  • trachea
  • recurrent laryngeal nerve
  • oesophagus
  • vertebral body
  • carina

separate tumour nodule(s) in a different ipsilateral lobe

36
Q

how is PET/CT used in T staging

A

assessing chest wall or mediastinal invasion

37
Q

N0

A

no regional lymph node metastasis

38
Q

N1

A

ipsilateral peribronchal, hilar or intrapulmonary nodes including by direct extension

39
Q

N2

A

ipsilateral mediastinal, subcarinal

40
Q

N3

A

contralateral mediastinal, contralateral, hilar, scalene or supraclavicular

41
Q

what proportion of patients present with mets

A

1/3

42
Q

what are the scommon sites of mets in lung cancer

A

cerebral

skeletal

adrenal

liver

43
Q

M0

A

no distant mets

44
Q

M1 - distant mets

M1a (metastatic disease in thorax):

separate tumour nodule(s) in a contralateral lobe

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

M1b - single distant mets

M1c - multiple distant mets

A
45
Q

PET/CT in staging

A

performs whole body staging in a single study excluding cerebral disease (brain is normally metabolically active)

discloses mets and other pathology not deteceted by other means (unexpected mets in 10-20%)

excludes mets where structural imaging abnormal

non-invasive

46
Q

how should cerebral disease be investigated

A

head CT w/ contrast

47
Q

limitations of PET CT

A

all tests have false -ve and +ve results

cost

48
Q

stage I cancer

A

T1 N0 M0

T2 N0 M0

49
Q

stage II cancer

A

T1 N1 M0

T2 N1 M0

T3 N0 M0

50
Q

Stage III cancer

A

T3 N1 M0

T3 N2 M0

T4 N0-2 M0

T1-4 N3 M0

51
Q

Stage IV cancer

A

any T any N M1

1% 5YS

52
Q

Tissue diagnosis

A

bronchoscopy and EBUS

percutaneous image guided biopsy,CT/US guided

mediastinoscopy - sample mediastinal nodes

mediastinotomy for anterior mediastinal nodes

VATS

explorative thoracotomy

respiratory system year 1 (25 decks)

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