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Radiation Therapy > [4621] GI powerpoint > Flashcards

[4621] GI powerpoint Flashcards

1
Q

The _________ is anterior to the spine and posterior to the trachea.

A

esophagus

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2
Q

What level does the esophagus begin?

A

C6

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3
Q

What level does the esophagus end?

A

T10-T11

(the esophageal gastric junction)

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4
Q

What are the three regions of the esophagus?

A

upper thoracic (cervical)

middle thoracic

Lower thoracic

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5
Q

Where does the upper thoracic esophagus begin and end?

A

cricoid cartilage to thoracic inlet

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6
Q

Where does the middle thoracic esophagus begin and end?

A

carina to proximally to esophageal gastric junction

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7
Q

True or false: esophageal cancer can begin anywhere along the esophagus.

A

True

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8
Q

Where does a cancerous growth start in the esophagus in terms of layers?

A

It starts in the inner layer of the esophagus wall and
grows outward through the other layers

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9
Q

What are the layers of the esophagus in order from lumen to superficial?

A

epithelium

lamina propria

muscular mucosa

submucosa

muscular propria

adventitia

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10
Q

What layers does the mucosa of the esophagus consist of?

A

epithelium

lamina propria

muscular mucosa

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11
Q

True or false: the esophagus has an outer coating/ serial layer.

A

False

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12
Q

Esophageal cancer makes up 1% of all cancers and is 4 times more likely to occur in ______ rather than ________.

A

men rather than women

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13
Q

___________ of the esophagus is most common in Caucasians, While ________ is most common in African Americans.

A

Adenocarcinoma

squamous cell carcinoma

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14
Q

Esophageal cancer most commonly occurs in ____________.

A

Caucasians

males

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15
Q

Esophageal cancer is most common in ages _________.

A

55-85

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16
Q

What is the typical prognosis of esophageal cancer?

A

diagnosis at advanced stages

uniformly fatal disease

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17
Q

What are the etiological risk factors of esophageal cancer?

A

alcohol abuse (most common squamous)

cigarette abuse (most common squamous)

heavily seasoned foods

high nitrated foods

obesity

environmental factors

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18
Q

What can help prevent esophageal cancer?

A

A diet high in fruits and vegetables

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19
Q

What is Barret Esophagus?

A

Barret Esophagus is a condition in which the distal esophagus is lined with a columnar epithelium rather
than a stratified squamous
epithelium

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20
Q

What causes Barret Esophagus and what kind of cancer is associated with it?

A

Mucosal change usually caused by gastroesophageal reflux (GERD)

associated with adenocarcinoma

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21
Q

What is Achalasia?

A

loss of peristaltic activity in the lower 2/3rds of the esophagus

 The esophagus becomes dilated (termed megaesophagus) and the esophagogastric junction sphincter
also fails to relax, which prohibits the passage of food into the stomach

 Clinical symptoms include progressive dysphagia and regurgitation of ingested food

 Pts with achalasia have a 5%-20% risk of developing squamous cell carcinomas of the esophagus

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22
Q

What is Plummer-Vinson Syndrome (Patterson-Kelly Syndrome)?

A

Iron deficient anemia characterized by esophageal webs, atrophic glossitis

 Associated with the development of squamous cell carcinoma of the esophagus

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23
Q

What is Tylosis?

A

Rare inherited disorder that cause excessive skin growth on the palms of the hands and soles of the feet

 A mutation on chromosome 17, is though to cause tylosis and the associated SCC (squamous cell carcinoma)

 Individuals with this condition are at a significant risk (about 40%) of developing squamous cell carcinoma of the esophagus

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24
Q

What are the early symptoms of esophageal cancer?

A

dysphagia, weight loss (10% of body weight in less than 6 months), odynophagia.

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25
Q

What is the difference between dysphagia and odynophagia?

A

dysphagia is difficulty swallowing

odynophagia is painful swallowing

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26
Q

What are advanced symptoms of esophageal cancer?

A

hematemesis (voitting blood)

Chronic cough
 Caused by a tracheoesophageal fistula

 Choking after eating

 Hemoptysis (coughing blood)

 Horner syndrome

 Hoarseness
(When there is nerve involvement)

 Dysphonia
( Abnormal speech or voice)

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27
Q

What structures can esophageal cancer spread to?

A

trachea
main bronchus
pleura
lung

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28
Q

What is notable about spread of esophageal cancer?

A

spread is usually longitudinal

EARLY SPREAD TO DRAINING LYMPHATICS ARE COMMON

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29
Q

True or False: lymphatic spread in esophageal cancer is unpredictable and is at risk for skip metastasis and nodal involvement.

A

True

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30
Q

What lymph nodes does the cervical esophagus drain into?

A

internal jugular, cervical, paraesophageal, and supravlavicular

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31
Q

What lymph nodes do the upper and mid thoracic esophagus drain into?

A

paratracheal, hilar, subcarinal, paraesophageal, and paracardial lymph nodes

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32
Q

What lymph nodes does the lower thoracic esophagus drain into?

A

lower mediastinal, left gastric, celiac nodes, and nodes of the lesser curvature of the stomach

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33
Q

Esophageal cancer spreads to what organs?

A

lung
liver
bones
adrenal glands
brain

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34
Q

physical palpation of cervical and supraclavicular lymph nodes and abdomen can assess potential spread to ___________.

A

lymph nodes of the liver

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35
Q

What diagnostic studies are done for esophageal cancer?

A

barium swallow (esophagram)

CT of upper thorax and abdomen

bronchoscopy

esophagoscopy/endoscopy
(confirmed with brushings and biopsies)

Bone scan

liver function test

PET scan

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36
Q

What can PET scans detect?

A

involvement of lymph nodes and the liver, as well as the primary tumor

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37
Q

What part of the esophagus is squamous cell carcinoma most commonly found?

A

upper and middle thoracic region

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38
Q

What part of the esophagus is adenocarcinoma most commonly found?

A

the lower one third of the esophagus

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39
Q

What is the most common type of esophageal cancer in the US?

A

adenocarcinoma (distal end of the esophagus and GE junction)

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40
Q

What is the common combined treatment modality of esophageal cancer?

A

preoperative radiotherapy with concurrent chemo 5-FU

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41
Q

What is the nonsurgical treatment of choice for esophageal cancer?

A

radiation therapy and concurrent chemotherapy

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41
Q

What is the standard treatment of choice for esophageal cancer?

A

neoadjuvant chemotherapy followed by curative surgery

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42
Q

What is the length and duration of chemotherapy treatment for esophageal cancer?

A

2-3 week cycles over 3-6 months

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43
Q

What beam energy is used for esophageal cancers?

A

6 MV or higher

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44
Q

What is the palliative EBRT dose for esophageal cancer?

A

30-50 Gy

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45
Q

What is the preoperative EBRT dose for esophageal cancer?

A

30-45 Gy

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46
Q

What is the combined radiation and chemotherapy EBRT dose for esophageal cancer?

A

40- 50 Gy approximately

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47
Q

What is the EBRT for radiation alone to esophageal cancer?

A

60-65 Gy

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48
Q

What are the OARs of esophageal cancer?

A

lung
heart
spinal cord
kidneys
liver

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49
Q

What are the acute side effects of esophageal radiation treatment?

A

esophagitis

weight loss

fatigue

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50
Q

what are the chronic side effects of esophageal radiation treatment?

A

stenosis

stricture

radiation pneumonitis

carditis

spinal cord injury

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51
Q

When does esophagitis typically occur?

A

two weeks into treatment

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52
Q

What can manage side effects of odonophagia?

A

liquid analgesics

viscous lidocaine

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53
Q

What are the prognostic factors of esophageal cancer?

A

tumor size, weight loss of 10%, poor performance status, older than 65 years old

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54
Q

What is the overall 5 year survival of esophageal cancers?

A

23%

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55
Q

What are the anatomical sections of the large intestine?

A

Cecum

Ascending colon

Descending colon

Splenic flexure

Hepatic flexure

Transverse colon

Sigmoid colon

Rectum

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56
Q

What region of the large intestine is a pouch like section of the proximal portion at the illeocecal valve and is the area of attachment of the slender vermiform appendix on the posteromedial surface of the colon?

A

cecum

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57
Q

What is the largest section of the large intestine?

A

colon

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58
Q

What are the 4 sections of the colon?

A

ascending colon

transverse colon

descending colon

sigmoid colon

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59
Q

What are the layers of the large intestine from lumen to superficial surface?

A

mucosa

submucosa

muscular propria

serosa

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60
Q

What layer does colorectal cancer start in?

A

starts in innermost layer (mucosa) and grows outward

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61
Q

What is the 3rd most common cancer in both men and women?

A

colorectal cancer

62
Q

What is the 2nd leading cause of cancer death in the USA?

A

colorectal cancer

63
Q

What are two epidemiology factors of colorectal cancer?

A

common in men

higher risk 55 and older

64
Q

What are the etiological factors of colorectal cancer?

A

diet

obesity

smoking

type 2 diabetes

excessive alcohol

low physical activity

chronic ulcerative colitis

genetic familial adenomatous polyposis

gardner syndrome

Lynch syndrome

65
Q

What are the signs and symptoms of colorectal cancer?

A

change in bowel habits

hematochezia

diarrhea

rectal bleeding

small caliber stools

66
Q

What is the route of spread for colorectal cancer?

A

direct extension

lymphatics

hematogenous spread

67
Q

True or false: lymphatic spread in colorectal cancer is unpredictable.

A

False

68
Q

What are the initial nodes involved in rectal cancer?

A

perirectal nodes

69
Q

What is the most common location of hematogenous spread in colorectal cancer?

A

LIVER

lung

bone

ovaries

adrenal glands

70
Q

Peritoneal seeding is common in what kind of cancer?

A

colorectal cancer

71
Q

What is the most common site of lymphatic spread in colorectal cancers?

A

internal iliac nodes

72
Q

What age should colonoscopy screening start?

A

45

73
Q

How often should colonoscopies typically be done?

A

10 years

74
Q

How often should a sigmoidoscopy be performed?

A

every 5 years

75
Q

What is a DRE?

A

Digital rectal exam

76
Q

How often should a fecal occult blood test be done?

A

Every 3 years

77
Q

What is the carcinoembryonic antigen (CEA)?

A

A type of protein molecule that is associated with certain malignant tumors such as colon and ovarian cancer

78
Q

What is the most common histological type of colorectal cancer?

A

adenocarcinoma (90%)

79
Q

What is the second most common histological subtype of colorectal cancer?

A

carcinoid

80
Q

What is the staging system used for colorectal cancer?

A

TNM

Dukes

Modified Astler Coller

81
Q

What is the most common site of the large intestine for colorectal cancer?

A

Rectum

82
Q

What is the treatment of choice for rectal cancer?

A

surgery

83
Q

What are the two common surgical procedures to treat rectal cancer?

A

Low anterior resection (LAR)
(no colostomy afterward because bowel is re anastomosed)

Abdominoperineal resection
(needs a colostomy afterward)

84
Q

What role does radiation therapy play in treatment of colorectal cancers?

A

preoperative or postoperative adjuvant therapy (60-70 Gy).

Or

Intraoperative Radiation Therapy (IORT) (1000-2000 cGy) of electrons in a single fraction directly to tumor bed)

85
Q

What is the chemotherapy regimen used for colorectal cancers?

A

5-fluorouracil (5-FU)

 Bevacizumab and Cetuxima

86
Q

True or false: For colorectal cancers, radiation combined with chemotherapy 5-fluorouracil has proved more effective than radiation
alone in relieving symptoms, decreasing tumor progression, and increasing overall survival.

A

True

87
Q

What is the typical patient positioning for colorectal cancers?

A

prone position

full bladder

88
Q

Why is IV contrast used in CT of colorectal cancers?

A

assists in outlining lymph node groups at risk

89
Q

What is the beam arrangement for colorectal cancers?

A

4 field or 3 field (PA and laterals)

Lateral treatment portals and prone positioning with full bladder distention allow the
small bowel to be excluded from the treatment volume.

90
Q

What is the standard dose for colorectal cancers?

A

60-70 Gy

91
Q

What are the OARs for colorectal cancer treatment?

A

small intestine

kidneys

bladder

femoral heads

92
Q

What are the dose limiting structures in the treatment of the ascending and descending colon?

A

kidneys and small bowel

93
Q

What are the acute side effects of colorectal radiation therapy treatment?

A

diarrhea

abdominal cramps/bloating

proctitis

bloody mucus discharge

dysuria

perineal skin reaction

leukopenia

thrombocytopenia

94
Q

What are the chronic side effects of radiation therapy treatment of colorectal cancer?

A

radiation proctitis

radiation ulceration

persistent diarrhea

increased bowel frequency

fistula

urinary incontinence

bladder atrophy

95
Q

What is the most common chronic side effect in treatment of colorectal cancer?

A

Damage to the small bowel resulting in:

enteritis
adhesions
obstruction

96
Q

What foods should a colorectal cancer patient eat?

A

White bread

meat that is baked broiled or roasted until tender

macaroni

cooked vegetables

peeled apples and bananas

97
Q

What foods should a colorectal cancer patient avoid?

A

whole grain breads or cereals

fried or fatty foods

milk and milk products

raw vegetables

fresh fruit

98
Q

What are the epidemiological factors for anal cancer?

A

increased incidence in

women
people 60+years old

99
Q

What are the etiological risk factors for anal cancer?

A

HPV (PRIMARY RISK FACTOR)

genital warts, infections, anal intercourse, intercourse before age 30, and HIV

Smoking

Immunosuppression

100
Q

What are the signs and symptoms of anal cancer?

A

rectal bleeding (MOST COMMON)

pain

change in bowel habits

palpable mass

rectal discharge

101
Q

What is the most common histological subtype in anal cancer?

A

squamous cell carcinoma

102
Q

What staging system is used for anal cancers?

A

TNM

103
Q

What does a diagnostic workup for anal cancers entail?

A

physical exam (DRE and palpation of inguinal lymph nodes)

proctoscopy/anoscopy with biopsy

transrectal ultrasound

CBC, creatinine and liver function test

CT of pelvis and abdomen

104
Q

Which lymph nodes are assessed in a diagnostic workup for anal cancer?

A

perirectal

inguinal

pelvic

paraaortic

105
Q

What is the most common route of spread for anal cancer?

A

direct extension

106
Q

What lymph nodes are involved in the lymphatic spread of anal cancer?

A

Superficial inguinal (MOST COMMON)

perirectal

internal iliac

inferior mesenteric

107
Q

True or false: hematogenous spread to the liver or lungs in anal cancer can occur but is less common.

A

True

108
Q

What is the treatment of choice for anal cancer?

A

combined radiation therapy and chemotherapy

109
Q

What is the chemotherapy regimen used for treatment of anal cancer?

A

5FU and/or mitomycin C

110
Q

True or false: surgery can be used to treat anal cancers.

A

False

111
Q

What beam arrangement is typical for treatment of anal cancer?

A

AP/PA fields

112
Q

Electron fields to the inguinal nodes, including a boost to the tumor bed with a perineal electron field or another multifield technique is a typical standard for treatment of what kind of cancer?

A

Anal cancer

113
Q

What is the patient positioning for anal cancer?

A

supine or prone

May frog leg to reduce inguinal folds

114
Q

What is the dose for treatment of anal cancer with EBRT?

A

54-59 Gy

115
Q

What are the acute side effects of radiation therapy for anal cancer?

A

perineal irritation and soreness

nausea

vomiting

diarrhea

desquamation (50% patients experience moist)

myelosuppression (MOST SEVERE IS BONE MARROW SUPPRESSION)

116
Q

What is the most severe kind of myelosuppression in anal cancer treatment and what is the cause?

A

bone marrow suppression

from irradiation to the pelvis and the 5 FU and mitomycin regimen

117
Q

What organ is a long, narrow
retroperitoneal organ that lies posterior to
the stomach and extends transversely at
an oblique angle between the duodenum
and splenic hilum?

A

Pancreas

118
Q

What are the sections of the pancreas?

A

head

uncinate process

neck

body

tail

119
Q

What organ has both an endocrine and an exocrine function? What are these functions related to?

A

Pancreas:

endocrine: insulin and glucagon

exocrine: digestive enzymes

120
Q

What thoracic level is the pancreas?

A

T12-L2

121
Q

Because the pancreas is in direct contact with and commonly invades these structures, it is usually unresectable at the time of diagnosis. What are these structures?

A

duodenum

jejunum

stomach

IVC

spleen

kidney

122
Q

Pancreatic cancer represents ______ of all cancers.

A

2%

123
Q

Pancreatic cancer is the _______ leading cause of cancer deaths in the U.S.

A

4th

124
Q

Pancreatic cancer is more common in ________ than in _______.

A

men

women

125
Q

Pancreatic cancer is more common in ________(race) and those ages _________ years old.

A

African Americans

50-80 years

126
Q

What are the risk factors for pancreatic cancer?

A

No known cause exists for the development of pancreatic cancer, although smokers have two times higher risk of development of pancreatic cancer

127
Q

What are the most common signs and symptoms of pancreatic cancer? ***

A

weight loss

anorexia

abdominal/back pain

jaundice

128
Q

A pancreatic tumor can obstruct the biliary system and can result in an enlarged ________, __________, or _________.

A

pancreas

gallbladder

liver

129
Q

What is the most valuable and important diagnostic test for pancreatic cancer?

A

CT scan of the abdomen

130
Q

What is the diagnostic workup for pancreatic cancer?

A

CT

MRI

CA-199

carcinoembryonic antigen (CEA)

CT guided fine needle biopsy (if positive CT first)

131
Q

What is the most common histology for pancreatic cancer?

A

adenocarcinomas 80%

132
Q

What section of the pancreas is the most common site of tumors?

A

head of the pancreas

133
Q

What are 4 histologies of pancreatic cancer?

A

adenocarcinoma

islet cell tumor

acing cell carcinoma

cystoadenocarcinoma

134
Q

What staging system is used for pancreatic cancer?

A

TNM

135
Q

What is the typical stage of disease at the time of diagnosis for pancreatic cancer?

A

advanced local and/or metastatic disease at the time of diagnosis

136
Q

Lymph node involvement or direct extension into the duodenum, common bile duct, stomach, and colon is common at the time of diagnosis for what cancer?

A

pancreatic cancer

137
Q

What sites are affected by direct extension of pancreatic cancer?

A

bile duct system

duodenum

stomach

spleen

138
Q

What nodes are typically involved in pancreatic cancer?

A

Peripancreatic

hepatic

paraaortic

139
Q

What are the sites affected by hematogenous spread in pancreatic cancer?

A

liver

lung

pleura

140
Q

What is the treatment of choice for pancreatic cancer?

A

Surgery

141
Q

Even though pancreatic cancer treatment of choice is ______, tumors are often _________.

A

surgery

unresectable

142
Q

The most common surgical procedure for a pancreas is a ______________. What is removed during this procedure?

A

pancreaticoduodenectomy (aka Whipple procedure)

A procedure in which the head of the pancreas, entire
duodenum, distal stomach, gallbladder, and common bile
duct are removed

143
Q

True or false: for pancreatic cancer, surgery and radiation have similar rates of morbidity.

A

True

144
Q

What is the preferred treatment for borderline and locally advanced, UNRESECTABLE pancreatic tumors?

A

radiation therapy and chemotherapy

145
Q

What is the common beam arrangement for pancreatic cancer?

A

VMAT with 2-3 full 360 degree arcs

Sometimes static IMRT

146
Q

What is the EBRT dose for treatment of pancreatic cancer?

A

a dose of 45-54 Gy delivered in 1.8 Gray fractions with reduction after 45 Gy

147
Q

True or False: pancreatic cancer can also be treated with SRS or proton therapy

A

true

148
Q

What is the patient positioning for pancreatic cancer?

A

supine

arms above head

149
Q

Describe CT simulation for pancreatic cancer.

A

(can have post op surgical clips that should be noted)

CT/MRI fusion

renal contrast and barium necessary in simulation *****

150
Q

What are the organs at risk for treatment of pancreatic cancer?

A

Spinal cord

kidney

small intestine

liver

stomach

151
Q

What are the acute side effects of pancreatic cancer treatment?

A

nausea

vomiting

leukopenia

thrombocytopenia

diarrhea

stomatitis

152
Q

What are the chronic side effects of pancreatic cancer treatment?

A

renal failure (rare but suggests that the kidney possibly received a higher dose of radiation)

Radiation Therapy (26 decks)

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