Podcast
Questions and Answers
What are the main aims of investigating lung cancer?
What are the main aims of investigating lung cancer?
To confirm the diagnosis, establish the histological cell type, and define the extent of the disease.
What does unilateral hilar enlargement on a chest X-ray suggest?
What does unilateral hilar enlargement on a chest X-ray suggest?
It suggests a central tumour or hilar glandular involvement.
What imaging technique should be performed early to detect mediastinal or metastatic spread in lung cancer patients?
What imaging technique should be performed early to detect mediastinal or metastatic spread in lung cancer patients?
CT scan should be performed early.
What procedure can be performed for tumours that are too peripheral for bronchoscopy access?
What procedure can be performed for tumours that are too peripheral for bronchoscopy access?
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Why might a percutaneous needle biopsy be contraindicated in patients with extensive coexisting emphysema?
Why might a percutaneous needle biopsy be contraindicated in patients with extensive coexisting emphysema?
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What does pleural effusion usually indicate in the context of lung cancer?
What does pleural effusion usually indicate in the context of lung cancer?
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What is the preferred investigation for patients with pleural effusions?
What is the preferred investigation for patients with pleural effusions?
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What imaging appearance suggests compression of a bronchus by enlarged lymph glands?
What imaging appearance suggests compression of a bronchus by enlarged lymph glands?
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What can a malignant pericardial effusion cause in imaging studies?
What can a malignant pericardial effusion cause in imaging studies?
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How can bronchoscopy assist in diagnosing a peripheral lung tumour with enlarged lymph nodes?
How can bronchoscopy assist in diagnosing a peripheral lung tumour with enlarged lymph nodes?
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What diagnostic methods are commonly used to confirm the diagnosis of metastatic disease?
What diagnostic methods are commonly used to confirm the diagnosis of metastatic disease?
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Why are patients with small-cell lung cancer usually not suitable for surgical intervention?
Why are patients with small-cell lung cancer usually not suitable for surgical intervention?
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Which imaging technique is primarily used for the early detection of local or distant spread in lung cancer staging?
Which imaging technique is primarily used for the early detection of local or distant spread in lung cancer staging?
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How can enlarged upper mediastinal nodes be sampled for staging purposes?
How can enlarged upper mediastinal nodes be sampled for staging purposes?
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What technique is used to sample nodes in the lower mediastinum?
What technique is used to sample nodes in the lower mediastinum?
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What is the role of combined CT and whole-body FDG-PET in lung cancer management?
What is the role of combined CT and whole-body FDG-PET in lung cancer management?
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Under what circumstances are head CT, radionuclide bone scanning, liver ultrasound, and bone marrow biopsy typically utilized?
Under what circumstances are head CT, radionuclide bone scanning, liver ultrasound, and bone marrow biopsy typically utilized?
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What is the significance of detailed physiological testing in lung cancer treatment planning?
What is the significance of detailed physiological testing in lung cancer treatment planning?
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In the context of lung cancer, why is staging particularly crucial for non-small-cell lung cancer (NSCLC)?
In the context of lung cancer, why is staging particularly crucial for non-small-cell lung cancer (NSCLC)?
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What is the importance of lymph node sampling in the context of metastatic lung cancer?
What is the importance of lymph node sampling in the context of metastatic lung cancer?
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Study Notes
Lung Cancer Investigations
- Aims of investigation: confirm diagnosis, determine cell type, and define disease extent.
Imaging Findings
- Hilar Enlargement: Suggests central tumor or hilar gland involvement on chest X-ray.
- Peripheral Opacity: Irregular, well-circumscribed opacity, possibly with cavitation, can be large on X-ray.
- Lung Collapse: Caused by tumor obstructing a bronchus or lymph node compression.
- Pleural Effusion: Indicates tumor invading the pleural space, or rarely, infection in collapsed lung tissue distal to a tumor.
- Paratracheal Lymphadenopathy: Widens the upper mediastinum.
- Malignant Pericardial Effusion: Enlarges cardiac shadow.
- Raised Hemidiaphragm: Suggests phrenic nerve palsy.
- Osteolytic Rib Destruction: Indicates chest wall invasion or metastasis.
CT Imaging
- Crucial for early detection of mediastinal spread, metastasis, and planning biopsies (e.g., bronchoscopy or percutaneous biopsy).
Biopsy and Histopathology
- Bronchoscopy: Allows direct visualization and sampling of over half of primary lung tumors.
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Peripheral Tumors: Sampled using:
- Bronchoscopic washings and brushings (low yield).
- Percutaneous needle biopsy under CT or ultrasound guidance (higher yield, risk of pneumothorax).
- EBUS-Guided Node Sampling: Diagnoses and stages tumors with enlarged hilar/paratracheal lymph nodes.
- Pleural Effusion: Diagnosed via pleural aspiration and biopsy; thoracoscopy (direct vision) increases yield.
- Metastatic Disease: Diagnosed by needle aspiration/biopsy of affected lymph nodes, skin lesions, liver, or bone marrow.
Staging for Treatment
- Small Cell Lung Cancer: Metastasizes early, usually unsuitable for surgery.
- Non-Small Cell Lung Cancer (NSCLC): Treatment and prognosis determined by disease extent, so staging is crucial.
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Staging Methods:
- CT: Detects local and distant spread.
- EBUS and Mediastinoscopy: Samples upper mediastinal nodes.
- Endoscopic Ultrasound: Samples lower mediastinal nodes.
- CT and FDG-PET: Detects occult, metabolically active metastases.
- Head CT, Bone Scanning, Liver Ultrasound, Bone Marrow Biopsy: Reserved for suspected spread to those sites.
- Physiological Testing: Assesses respiratory and cardiac function for aggressive treatment.
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Description
This quiz explores the various investigations used in diagnosing lung cancer, including imaging findings and biopsy techniques. Learn about the significance of different imaging results such as hilar enlargement and peripheral opacity, as well as the role of CT in detecting metastasis. Understand the implications of these findings for patient management and treatment planning.
