Imaging of Lung Cancer

By: Ahmed Mostafa

Tumors of the Lung

•Malignant (NSCLC = Sq.cc 50- Adeno.c 20- Large.c.c10%)

(SCLC 20%)

•Locally malignant

•Mixed tumors (pul. Blastoma** – Carcino/sarcoma)

•Benign

•Metastasis

•HD

Abnormal Hilum

Larger --- Denser ---- loss of concavity

Vascular ----------- Smooth

LN -------------------- Lobulated

Carcinoma --------- Speculated

Abnormal Hilum (Cont.)

Abnormal Hilum (Cont.)

Central Br. Carcinoma•Abnormal hilum ….

•Bronchial obst. Distal changes

•Speculated = Dense streaks rad. From hilum

Growth along Vasc. or Br. CT sheath

•Lymphangitis carcinomatosis (R.N)

(Lymph. Obst Retrograde permeation)

•Cavitation (eccentric – thick wall – Biopsy? – Pn.thx)

•Metastasis

•Diaph. Paralysis = …med. invasion)

•HPAO

Collapse

Consolid.

Air trapping

Bronchocele

Bronchogenic Carcinoma

Bronchogenic Carcinoma (Cont.)

Small C.C: -Aggressive -Sensitive to chemotherapy -Para-malignant $

Bronchogenic Carcinoma (Cont.)

Doubling time

<6 m malignant

>18 m benign

Bronchogenic Carcinoma (Cont.)

Bronchogenic Carcinoma (Cont.)

Bronchogenic Carcinoma (Cont.)

Bronchogenic Carcinoma (Cont.)

Coin shadow

Growth rate

Edge

Calc. ?

Cavitation

Lymphangitis carcinomatosis

Pancoast Tumor

ApicalPleura

Ribs

Symp.chain

Brach. plexus

Broncho-alveolar Carcinoma

Peripheral Type -II pneumocytes, Clara cells,

Br-alv epith, Tote-potent stem cell

Grow along wall of acinus without

destruction preserve

architecture and regional perfusion

Secrete mucin Bronchorrhea

& consolidation-like patches

No br. lesion or adeno-Ca elsewhere

… ? Similar to ad.ca metastasis

ALV CELL CARC LL

Bronchogenic Carcinoma (Cont.)

Bronchogenic Carcinoma (Cont.)

Bronchogenic Carcinoma (Cont.)

Bronchogenic Carcinoma (Cont.)

HPOA

HPOA

T1Solitary pulmonary nodule < 3 cm diameter

T2• Mass> 3 cm• Invasion of visceral pleura• Involves major bronchus> 2 cm from carina• Lobar atelectasis

T3• Any tumor extending into chest wall, diaphragm,mediastinal fat, or pericardium• Whole lung atelectasis• < 2 cm from carina

T4• Any tumor invading heart, great vessels, trachea,esophagus, vertebral body, carina• Malignant pleural effusion• Satellite nodule in ipsilateral tumor lobe

N1Epsilateral hilar

T2Epsilateral mediastinal or midline

T3Contralateral mediastinal or supraclavicular

M0M1

Treatment

• Stage I and 2: Surgery followed by adjuvantchemotherapy in select caseso Radiation therapy or radiofrequency ablation maybe considered for medically non-operable

• Stage 3A: Neoadjuvant chemotherapy and radiationtherapy followed by surgery in select cases• Stage 3B: Chemotherapy and radiation therapy

o Surgery may be performed in select T4NO tumors

• Stage 4: Chemotherapy with palliative radiationtherapy in select caseso Solitary brain metastasis: Resection of brain lesion;followed by resection of primary tumor if possible

Locally Malignant Tumors

Adenoid cystic Ca. Carcinoid

Tr - carina - main br. Major bronchus ice burg – ext.br

Polypoid mass signs of obst…

Asthma-like picture APUD system of Arg

cells 5-HT

Carcinoid $

•Slower growth•Younger age•Not related to smoking

Adenoid Cystic Carcinoma

Adenoid Cystic Carcinoma

Benign TumorsEndo-bronchial

•Adenoma…? Papilloma Fibroma Lipoma ..etc

Pulmonary

Nodule (coin)

Rate of growth

Edge

Calc……..

Cavitation

HamartomaFat inhomog.

Epith.

Cartilage pop-corn calc.

Metastasis• Discrete• Miliary = snow-storm Stomach – thyroid – chorio.Ca

• Canon-ball Renal – seminoma

• Interstitial = ….• Mediastinal LNs

Calc.? Ost-Chond.sarcoma

After ttt

Mucin-sec Tr

Dystrophic

Cavitation + Pn.thx

Chorio-Ca-----Hgic + ARDS & DIC

Metastasis (cont.)

• Miliary = snow-storm Stomach – thyroid – chorio.Ca

Metastasis (cont.)

Hodgkin disease

Start in med. LNs Intra-pul. LNs

Sharp undulating

margins

Peri (br-Vs) & interlobar

lymphatics

NodulesLinear streaksShaggy edge

+ Pl. Eff Merge into patches Cavitate Chylous DD Edema

Hodgkin Disease (Cont.)

Hodgkin Disease (Cont.)

Hodgkin Disease (Cont.)

Lymphoma (Cont.)

Lymphoma (Cont.)

Lymphoma (Cont.)

MRI