CT Scan Reports for Lung Cysts and Cancer Staging

Q: CT Scan Reports for Lung Cysts and Cancer Staging

Hello： 1. <br>This is a preliminary imaging report. <br>The diagnosis of stage III can only be established if the left upper lung shadow is confirmed to be lung cancer; further examinations are necessary for confirmation before determining if it is indeed lung cancer, which will

Computed Tomography Report

Hello Doctor, my mother has been monitoring a lung cyst.
On July 10, 2017, she underwent a CT scan, which reported the cyst size as 2.6 cm, and she was referred to Kaohsiung Chang Gung Memorial Hospital, where it was determined that there were no issues and that she could continue to be monitored.
On March 23, 2018, she had another CT scan at a different hospital, and the report details are as follows:
1.
Imaging findings
- Imaging Modality: CT scan
- Imaging Protocol: The CT scan of the chest was performed without and with IV contrast enhancement.
2.
Tumor location/size:
- Right Upper Lobe
- Right Middle Lobe
- Size: 2.9 cm greatest dimension
3.
Tumor invasion:
- O-No or Equivocal: 0
- 1-Yes: 1
- T1 Tumor <= 3 cm: 0
- Surrounded by lung or visceral pleura: 0
- Not more proximal than lobar bronchus: 0
- T1a Tumor <= 2 cm: 1
- T1b 2 cm < Tumor <= 3 cm: 1
- T2 3 cm < Tumor <= 7 cm: 0
- Involves main bronchus, >= 2 cm from carina: 0
- Invades visceral pleura PL1 or PL2: 0
- Focal atelectasis or obstructive pneumonia to hilum: 0
- T2a 3 cm < Tumor <= 5 cm: 0
- T2b 5 cm < Tumor <= 7 cm: 0
- T3 Tumor > 7 cm: 0
- Invades chest wall, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium: 0
- Tumor in the main bronchus < 2 cm from carina: 0
- Atelectasis of entire lung: 0
- Separate tumor nodules in the same lobe: T4: 0
- Invades mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina: 0
- Separate tumor nodules in a different lobe: 0
4.
Regional nodal metastasis:
- 0-No or Equivocal: 0
- 1-Yes: 1
- If yes, suspicious lymph node location:
- Ipsilateral hilar lymph nodes: 0
- Contralateral hilar lymph nodes: 1
- Ipsilateral mediastinal and/or subcarinal lymph nodes: 0
- Contralateral mediastinal lymph nodes: 0
- Ipsilateral or contralateral supraclavicular lymph nodes: 0
5.
Distant metastasis:
- In this study: 0 Yes, 1 No
- If yes, location: __
6.
Other findings:
- A small ground-glass nodule size 0.3 cm in the left lower lobe is noted.
Suggest follow-up.
- Fibrotic scarring in the left upper lobe with small fibrocalcified nodular opacities in the left apical lung is noted, which may be due to old inflammation.
Suggest clinical correlation and follow-up.
- Fluid density nodular opacities with a short axis less than 1 cm in the pretracheal-retrocaval space of the mediastinum are seen, may be superior pericardial recess or reactive node.
Suggest clinical correlation and follow-up.
- A 0.5 cm hypodense nodule in segment 8 of the liver is noted, suspected to be a cyst.
Suggest clinical correlation and follow-up.
- A 0.5 cm hypodense nodule in the left thyroid lobe is suspected.
Suggest follow-up with neck sonography.
- Mild scoliosis of the thoracic spine with convex to the right side is noted.
- A Schmorl's node over the L2 vertebra is seen.
IMPRESSION:
1.
CT imaging staging T2N2Mx, stage IIIA if the left upper lobe mass is proven to be lung cancer according to the 7th edition of AJCC cancer staging.
2.
The N and M staging are suggested to be correlated with PET.
3.
For other details, please see the above-mentioned findings.
This is the content of the report.
Since we live in Penghu, the internal medicine doctor who explained the report to us did not go into detail, but according to the report, it indicates stage III lung cancer.
My mother has now been transferred to Kaohsiung Chang Gung Memorial Hospital, but due to scheduling issues, it won't be soon.
I would like to understand the report better in advance to prepare myself mentally (surgery, chemotherapy).
Please help me with this.
Thank you.
🙏

Xiao Bei, 30~39 year old female. Ask Date: 2018/04/04

Dr. Zhou Ziguang reply Pulmonology

Hello: 1.
This is a preliminary imaging report.
The diagnosis of stage III can only be established if the left upper lung shadow is confirmed to be lung cancer; further examinations are necessary for confirmation before determining if it is indeed lung cancer, which will allow for the arrangement of subsequent treatment options.
2.
It is essential to promptly coordinate with Kaohsiung Chang Gung Memorial Hospital for further examinations and management.

Reply Date: 2018/04/04

More Info

Understanding CT scan reports, especially in the context of lung cysts and potential cancer staging, can be quite complex and understandably concerning for patients and their families. Based on the information provided in your mother's CT scan report, let's break down the findings and what they imply.

Key Findings from the CT Scan Report
1. Tumor Size and Location: The report indicates a tumor in the right upper lobe and right middle lobe, measuring 2.9 cm. This size is significant because it helps in staging the cancer. According to the AJCC (American Joint Committee on Cancer) staging system, tumors are classified based on their size and extent of invasion into surrounding tissues.

2. Tumor Staging: The report suggests a staging of T2N2M0, which corresponds to Stage IIIA lung cancer if confirmed as malignant. Here’s what each component means:
- T2: The tumor is larger than 3 cm but less than 5 cm, indicating a moderate size.

- N2: This indicates that there are regional lymph nodes involved, specifically in the mediastinum, which is a critical factor in staging lung cancer.

- M0: There is no distant metastasis, meaning the cancer has not spread to distant organs.

3. Additional Findings: The report mentions a small ground-glass nodule (0.3 cm) in the left lower lobe, fibrotic scarring, and other incidental findings like nodules in the liver and thyroid. These findings may require further follow-up but are not necessarily indicative of malignancy.

Implications of the Findings
Given that the report suggests a potential diagnosis of lung cancer, it is crucial to understand the implications of the staging:
- Stage IIIA lung cancer typically indicates that the cancer is locally advanced but has not spread to distant sites. Treatment options often include a combination of surgery, chemotherapy, and possibly radiation therapy, depending on the overall health of the patient and the specific characteristics of the tumor.

Next Steps
1. Follow-Up with Specialists: It is essential for your mother to follow up with an oncologist who specializes in lung cancer. They will provide a more detailed interpretation of the CT findings and discuss the next steps, which may include:
- Biopsy: To confirm the diagnosis of lung cancer and determine the specific type.

- PET Scan: This imaging test can help assess the metabolic activity of the tumor and check for any additional areas of concern.

- Treatment Planning: Based on the confirmed diagnosis and staging, the oncologist will recommend a treatment plan tailored to your mother’s specific situation.

2. Emotional Support: It’s understandable to feel anxious during this waiting period. Consider seeking support from family, friends, or support groups for individuals facing similar health challenges.

3. Lifestyle Considerations: If your mother is a smoker or has a history of smoking, discussing smoking cessation with her healthcare provider can be beneficial. Smoking is a significant risk factor for lung cancer and can impact treatment outcomes.

Conclusion
In summary, while the report indicates a concerning finding that may suggest lung cancer, it is essential to await further diagnostic confirmation through biopsy and additional imaging. The staging of T2N2M0 suggests that if it is indeed lung cancer, it is at an advanced stage, but there are treatment options available. Engaging with healthcare professionals for a comprehensive understanding and a clear treatment plan will be crucial in navigating this challenging situation.

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