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Imaging in Clinical Oncology

Netty Lubis Radiologist

• Oncology has made recently is exceptional and the multidisciplinary approach for each cancer patient is mandatory to ensure a longer and better life

• Radiologists may consider that without their contribution, timely detection of tumors and hence effective therapeutic intervention would be deemed impossible

• Oncologists should understand the potential applications, limitations and advantages of imaging techniques and the

radiologists should have adequate

knowledge of the pathology, prognosis, clinical information, and treatment options

for different types of tumors.

Breast Cancer

• screening with mammography

• detect more small non-palpable malignancies, in situ cancers and invasive breast lesions less than 15 mm

Breast ultrasound

• complementary to mammography

• Differentiating cystic lesions from solid masses and for guiding interventional procedures

• reliable diagnostic tool in evaluation of the axillary lymph node

MR Mammography (MRM)• Screening of women at high-risk of developing breast

cancer• Preoperative work up when breast-conserving surgery is contemplated in women with dense breast parenchyma

• When breast cancer is suspected clinically, while MG and US are inconclusive

• Detection of residual cancer status post lumpectomy

• Evaluation of breast implants

PET/CT Imaging

Gynecologic Cancer

• Endometrial Cancer• Ovarian Cancer• Cervical Cancer

• Endometrial cancer is surgically staged

• Ovarian cancer is surgically staged according to the FIGO

• Cancer of the cervix is clinically staged

Colorectal cancer

• Colorectal cancer is the third most common cancer in the world.

• more common in males than females CT :• suspicion of hematogenous or distal nodal

metastatic disease or invasion into adjacent organs or formation of abscess and presence of atypical symptoms

• Screening using CT colonography as a primary• method is feasible.• CT colonography over colonoscopy because the test is

noninvasive, they avoid sedation/anesthesia, they are able to drive after the test, they avoid colonoscopy risks and the test is able to identify abnormalities outside the colon.

• Similar yields for advanced neoplasia are seen in CT colonography, colonoscopy and sigmoidoscopy screening

Liver Malignancies• ultrasonography (US)• CT • MRI

• Pancreatic ductal adenocarcinoma is the fifth leading cause of cancer deaths in the Western hemisphere.

• Despite all the advances in oncological treatments, the overall 5-year-survival rates remain poor (< 5 %).

Imaging

• US ,• because it is widely available and noninvasive• exclude gallstones, choledocholithiasis• The accuracy of US for detection of pancreatic • cancer is 50–70 %

• CT : • diagnosis and staging of pancreatic cancer• The reported sensitivity of CT ranges between 76 and

92 %

• MRI can be used in imaging for pancreatic cancer in patients with equivocal findings

on MDCT 90 and 100 %

• Computed tomography (CT) and • magnetic resonance imaging (MRI) are

considered to be the conventional imaging modalities in the investigation of brain abnormalities

• In the investigation of brain tumors, both CT and MRI are performed before and after administration of contrast media.

Left convexity meningioma

Brain mets from lung Ca

Head and Neck malignancies

• CT and MRI• plays substantial role in the management of

head and neck cancer.

• Pretreatment diagnostic workup with both modalities has predictive value for patient outcome

• Based on pretreatment imaging,• individualized replanning during

radiotherapy may improve tumor control rates and spare normal tissues from unnecessary irradiation.

• A Multimodality (Hybrid) Imaging PET/ CT, SPECT/CT, PET/MRI

• improves the diagnosis, staging, treatment• response, and restaging, by providing

excellent anatomical localization of the PET findings

Evaluation of the Response of ‘‘Target-Lesions’’

Response Evaluation Criteria In Solid Tumors(RECIST )According to RECIST 1.1 :1. Complete Response (CR)2. Partial Response (PR): decrease of the baseline

‘‘sum of diameters’’ of the target lesions > 30 %.3. Progressive Disease (PD): increase of the ‘‘sum

of diameters’’ of the target lesions of at least 20 %

4 .Stable Disease (SD): changes of the ‘‘sum of diameters of target lesions’’ which do not fulfill the criteria for PR or PD

• There are not strict guidelines regarding the frequency of follow-up examinations.

• However,it is generally recommended to perform follow-up studies at the end of each chemotherapy cycle (usually every 6–8 weeks)