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Respiratory System > Radiology of Lung Cancer > Flashcards

Radiology of Lung Cancer Flashcards

1
Q

What is the approach to a systematic review of the lungs on a CXR?

A
  1. Name/marker/rotation/penetration
  2. Lines/metal work
  3. Heart
  4. Mediastinum
  5. Lung zones
  6. Bones
  7. Diaphragm
  8. Soft tissue
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2
Q

What to look for in the mediastinum on a CXR?

A

Hilar structures crisply defined
No widening of structure
Central trachea

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3
Q

What to look for in the lungs on a CXR?

A

Compare upper, mid and lower zones
Look between ribs for lung detail
Remember to look “behind” heart

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4
Q

Why might the whole lung look opaque on a CXR?

A

If the tumour blocks a main bronchus, preventing air entering the lung

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5
Q

Why might a lobe of the lung look opaque on a CXR?

A

If the tumour is blocking one of the secondary bronchi

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6
Q

What are the areas that must be carefully reviewed on CXR for lung cancer?

A

Hila
Lung apices
Behind the heart
Behind the diaphragm

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7
Q

What are the important steps to do to prevent misdiagnosing lung cancer?

A

Compare CXR with previous imaging

Confirm lesion is intrapulmonary

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8
Q

What is the step after a chest x-ray if lung cancer is suspected?

A

Carry out CT

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9
Q

What is the CT scan to show after a CXR?

A 
Size
Shape
Atelectasis (collapse)
Border 
Density
Solid or not solid 
Growth 
For dynamic contrast enhancement
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10
Q

What is a pulmonary mass?

A

An opacity in the lung > 3cm with no mediastinal adenopathy (swollen lymph nodes) or atelectasis

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11
Q

What is a pulmonary nodule?

A

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

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12
Q

What is mediastinal adenopathy?

A

Invasion of a cancer in to the mediastinal lymph nodes

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13
Q

What will help distinguish a pulmonary nodule/mass caused by lung cancer from other causes?

A

Age and smoking history

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14
Q

What will help distinguish a pulmonary nodule/mass caused by metastases or from other causes?

A

Previous history of breast, renal, seminoma, sarcoma

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15
Q

What infections may cause a solitary pulmonary nodule/mass?

A

Bacterial, TB or fungal

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16
Q

Give an example of a benign lung neoplasm

A

Carcinoid, hamartoma

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17
Q

What does the T describe in the TNM staging?

A

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

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18
Q

What does the N describe in the TNM staging?

A

Whether the cancer cells have spread into the lymph nodes

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19
Q

What does the M describe in the TNM staging?

A

Any metastases present?

20
Q

What investigation are used to determine T in TNM staging?

A

CT
PET-CT
Bronchoscopy

21
Q

What investigation are used to determine N in TNM staging?

A

CT
PET-CT
Mediastinoscopy
EBUS

22
Q

What investigation are used to determine M in TNM staging?

A

CT
PET-CT
Bone scan

23
Q

Define Tx, T0, Tis

A

Tx - primary tumour cannot be assessed
T0 - no evidence of primary tumour
Tis - carcinoma in situ

24
Q

Describe T1 tumour

A

<= 3cm
Surrounded by lung or visceral pleura
No involvement with main bronchus

25
Q

Size of T1a tumour

A

Minimally invasive adenocarcinoma

<= 1cm

26
Q

Size of T1b tumour

A

< 2cm

27
Q

Size of T1c tumour

A

<= 3cm

28
Q

Describe T2 tumour

A 
> 3cm but under 5 cm
Or one that:
Involves main bronchus 
Invades visceral pleura
Associated with atelectasis or obstructive pneumonitis
29
Q

Size of T2a tumour

A

> 3cm but < 4cm

30
Q

Size of T2b tumour

A

> 4cm but < 5cm

31
Q

Describe T3 tumour

A 
> 5cm but < 7cm 
Or one that directly invades:
-Chest wall 
-Phrenic nerve
-Parietal periardium
32
Q

Describe T4 tumour

A 
> 7cm or invades:
Diaphragm 
Mediastinum 
Heart 
Great vessels 
Trachea
Recurrent laryngeal nerve
Oesophagus
Vertebral body 
Carina
33
Q

What do PET/CT scans do in T staging?

A

Assess chest wall invasion or mediastinal invasion

34
Q

Define N0

A

No lymph nodes

35
Q

Define N1

A

Ipsilateral perobronchial, hilar or intrapulmonary nodes

36
Q

Define N2

A

Ispilateral mediastinal, subcarinal

37
Q

Define N3

A

Contralateral mediastinal, contralateral hilar, scalene or supraclavicular

38
Q

Where are common places for metastases?

A

Cerebral
Skeletal
Adrenal
Liver

39
Q

Define M0

A

No metastases

40
Q

Define M1

A

Distant metastases

41
Q

Define M1a

A

Separate tumour nodule in contralateral lobe

Tumour with pleural or pericardial nodules or malignant pleural or pericardial effusion

42
Q

Define M1b

A

Single distant metastases

43
Q

Define M1c

A

Multiple distant metastases

44
Q

What are the limitation of PET CT

A

All tests have:
False negative results
False positive results
Cost

45
Q

What tests are carried out for tissue diagnosis?

A

Bronchoscopy and EBUS

Percutaneous image guided biopsy

46
Q

What determines stage IV lung cancer?

A

Any T
Any N
M1

Respiratory System (29 decks)

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