Staging of Small Cell Lung Cancer Pretreatment staging for patients with SCLC includes the initial general lung cancer evaluation with chest and abdominal CT scans (because of the high frequency of hepatic and adrenal involvement) as well as fiberoptic bronchoscopy with washings and biopsies to determine the tumor extent before therapy; brain CT scan (10% of patients have metastases); and radionuclide scans (bone) if symptoms or other findings suggest disease involvement in these areas.
Clinical Manifestations Lung cancer gives rise to signs and symptoms caused by local tumor growth, invasion or obstruction of adjacent structures, growth in regional nodes through lymphatic spread, growth in distant metastatic sites after hematogenous dissemination, and remote effects of tumor products (paraneoplastic syndromes) (Chaps. 96 and 97).
Although 5–15% of patients with lung cancer are identified while they are asymptomatic, usually as a result of a routine chest radiograph or through the use of screening CT scans, most patients present with some sign or symptom.
Chest radiographs and CT scans are needed to evaluate tumor size and nodal involvement; old radiographs are useful for comparison. CT scans of the thorax and upper abdomen are of use in the preoperative staging of NSCLC to detect mediastinal nodes and pleural extension and occult abdominal disease (e.g., liver, adrenal), and in planning curative radiation therapy. However, mediastinal nodal involvement should be documented histologically if the findings will influence therapeutic decisions.
Superior Sulcus or Pancoast Tumors Non-small cell carcinomas of the superior pulmonary sulcus producing Pancoast's syndrome appear to behave differently than lung cancers at other sites and are usually treated with combined radiotherapy and surgery. Patients with these carcinomas should have the usual preoperative staging procedures, including mediastinoscopy and CT and PET scans, to determine tumor extent and a neurologic examination (and sometimes nerve conduction studies) to document involvement or impingement of nerves in the region.
Small Cell Lung Cancer
A simple two-stage system is used. In this system, limited-stage disease (seen in about 30% of all patients with SCLC) is defined as disease confined to one hemithorax and regional lymph nodes (including mediastinal, contralateral hilar, and usually ipsilateral supraclavicular nodes), while extensive-stage disease (seen in about 70% of patients) is defined as disease exceeding those boundaries. Clinical studies such as physical examination, x-rays, CT and bone scans, and bone marrow examination are used in staging.
In September 2003, the National Institutes of Health (NIH) presented to the American
people the goals of the NIH for medical research in the 21st century. Dr. Elias Zerhouni,
who became director of the NIH in May 2002, had been Associate Dean for Research at
Johns Hopkins School of Medicine before going to the NIH as the fi rst radiologist
to head that agency. He had been trained in nuclear medicine while a resident in radiology
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Radiation Oncology cung cấp cho các bạn kiến thức về ngành y đề tài: " Reproducibility of target volumes generated using uncoached 4-dimensional CT scans for peripheral lung cancer...
Cô y tá trong khu Ngoại chẩn của tôi có nguời mẹ 61 tuổi. Bà mẹ cách đây 3 tháng than đau ở sau lưng truyền xuống mông và hai đùi phía sau. BS toàn khoa cuả bà đoán có lẽ là sciatica và cho NSAID (non steroidal antiinflammatory drug)(BS này là BS ja dình cuả bệnh nhân). Vì đau không thuyên jảm, và nhức dến nỗi không ngủ duợc, cô con gái dưa mẹ dến một BS ja dình khác, y sĩ này cho chụp MRI xuơng sống (MRI of the lumbosacral spines) và làm CAT scan bụng...
I examined the structure of the cryofractured book lung of Phidippus audax with a scanning electron microscope. Each book lung is essentially a stack of flattened air-sacs, or lamellae, which project anteriorly into the lateral hemolymph space of the anterior opisthosoma. Each lamella is roughly triangular in shape. Hemolymph flows across each lamella from the medial to the lateral side (Fig. 1). Air enters the lamellae from the third, posterior side, after passing through a network of irregular cuticular struts (air filter) which lines the atrium of the book lung.
The solitary pulmonary nodule is a common finding on CXR and the widespread use of CT has further increased the detection of this type of nodule.The initial goal of the clinician is to distinguish the benign from the malignant lesion
• Because SPNs are first detected on chest x-ray films, ascertaining whether the nodule is in the lung or outside it is important. A chest x-ray film taken from a lateral (side) position, fluoroscopy, or CT scan may help confirm the location of the nodule.
• Although nodules of 5 mm diameter are occasionally found on chest x-ray films, SPNs are...