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

Evaluation of breast implants

lumpectomy

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 5070 %

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 TargetLesions

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
68 weeks)