Lung Cancer Investigations Overview

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Questions and Answers

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?

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?

CT scan should be performed early.

What procedure can be performed for tumours that are too peripheral for bronchoscopy access?

<p>Percutaneous needle biopsy under CT guidance can be performed.</p> Signup and view all the answers

Why might a percutaneous needle biopsy be contraindicated in patients with extensive coexisting emphysema?

<p>There is a risk of iatrogenic pneumothorax.</p> Signup and view all the answers

What does pleural effusion usually indicate in the context of lung cancer?

<p>It usually indicates tumour invasion of the pleural space.</p> Signup and view all the answers

What is the preferred investigation for patients with pleural effusions?

<p>Pleural aspiration and biopsy is the preferred investigation.</p> Signup and view all the answers

What imaging appearance suggests compression of a bronchus by enlarged lymph glands?

<p>Lung, lobe or segmental collapse suggests this compression.</p> Signup and view all the answers

What can a malignant pericardial effusion cause in imaging studies?

<p>It may cause enlargement of the cardiac shadow.</p> Signup and view all the answers

How can bronchoscopy assist in diagnosing a peripheral lung tumour with enlarged lymph nodes?

<p>Bronchoscopy with EBUS-guided node sampling can allow both diagnosis and staging.</p> Signup and view all the answers

What diagnostic methods are commonly used to confirm the diagnosis of metastatic disease?

<p>Needle aspiration or biopsy of affected lymph nodes, skin lesions, liver, or bone marrow.</p> Signup and view all the answers

Why are patients with small-cell lung cancer usually not suitable for surgical intervention?

<p>Small-cell lung cancer has a propensity for early metastasis, making surgical options impractical.</p> Signup and view all the answers

Which imaging technique is primarily used for the early detection of local or distant spread in lung cancer staging?

<p>CT (Computed Tomography) is used for this purpose.</p> Signup and view all the answers

How can enlarged upper mediastinal nodes be sampled for staging purposes?

<p>They may be sampled using an EBUS-equipped bronchoscope or through mediastinoscopy.</p> Signup and view all the answers

What technique is used to sample nodes in the lower mediastinum?

<p>Endoscopic ultrasound is used to sample nodes through the oesophageal wall.</p> Signup and view all the answers

What is the role of combined CT and whole-body FDG-PET in lung cancer management?

<p>They are used to detect occult but metabolically active metastases.</p> Signup and view all the answers

Under what circumstances are head CT, radionuclide bone scanning, liver ultrasound, and bone marrow biopsy typically utilized?

<p>They are reserved for patients with clinical, hematological, or biochemical evidence of tumor spread.</p> Signup and view all the answers

What is the significance of detailed physiological testing in lung cancer treatment planning?

<p>It assesses whether respiratory and cardiac function are sufficient for aggressive treatment.</p> Signup and view all the answers

In the context of lung cancer, why is staging particularly crucial for non-small-cell lung cancer (NSCLC)?

<p>Staging determines treatment options and prognosis based on disease extent.</p> Signup and view all the answers

What is the importance of lymph node sampling in the context of metastatic lung cancer?

<p>It helps in accurately staging the disease and guiding treatment decisions.</p> Signup and view all the answers

Flashcards

Cancer Staging

The process of determining the extent and spread of cancer within the body.

Metastasis

The spread of cancer cells from their original site to other parts of the body.

Small-Cell Lung Cancer (SCLC)

A type of lung cancer that tends to spread rapidly and is not usually treatable with surgery.

Non-Small-Cell Lung Cancer (NSCLC)

A type of lung cancer that can be treated with surgery, depending on the stage.

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CT Scan

A medical imaging test that uses X-rays to create detailed images of the inside of the body.

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Mediastinoscopy

A medical procedure that allows doctors to sample and examine lymph nodes in the chest.

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EBUS (Endobronchial Ultrasound)

A type of bronchoscope (a thin, flexible tube) that uses ultrasound to help doctors visualize and sample lymph nodes in the chest.

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FDG-PET Scan

A medical imaging test that uses a radioactive tracer to detect areas of increased metabolic activity, which can indicate cancer cells.

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Liver Ultrasound

A medical procedure that uses ultrasound to examine organs and tissues in the abdomen, including the liver.

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Physiological Testing

A test that evaluates the function of the heart and lungs to determine if a patient can tolerate aggressive cancer treatment.

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CT Scan (Computed Tomography)

Imaging technique used to detect lung cancer and assess its spread. It provides detailed images of the lungs and surrounding structures, including lymph nodes.

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Bronchoscopy

A procedure that uses a thin, flexible tube with a camera to view the inside of the airways. It can be used to take biopsies of lung tissue.

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Staging of Lung Cancer

The extent to which cancer has spread from its original site to other parts of the body. It is determined by staging, which is based on tumor size, location, and spread to lymph nodes and distant organs.

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Lung Biopsy

A procedure where a small sample of tissue is removed from the lung and examined under a microscope. This helps identify the type of lung cancer and its characteristics.

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Bronchogenic Carcinoma

A type of lung cancer that originates in the cells lining the airways, known as bronchi. It is commonly found in smokers.

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Percutaneous Needle Biopsy

A procedure that uses a needle to obtain a tissue sample from a suspicious area in the lung. It is usually guided by CT or ultrasound imaging.

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Endobronchial Ultrasound (EBUS)

A specific type of bronchoscopy that uses ultrasound to visualize lymph nodes in the chest. It allows for targeted biopsy of these nodes for staging.

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Pleural Aspiration

A procedure to remove fluid from the pleural space, the area between the lungs and the chest wall. It can be used to diagnose lung cancer or other conditions affecting the pleura.

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Thoracoscopy

A surgical procedure that allows for direct visualization of the pleural space. It is used to perform biopsies and other procedures, offering a clearer view compared to traditional methods.

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Pleural Effusion

The presence of fluid in the pleural space, often associated with lung cancer or other lung diseases.

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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.
  • 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.
  • 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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