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Radiation Therapy > [4621] Male Reproductive & Urinary Tumors > Flashcards

[4621] Male Reproductive & Urinary Tumors Flashcards

1
Q

The ________ is immediately posterior to the symphysis pubis.

A

prostate

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2
Q

The sacrum is formed by the fusion of _______ vertebral segments.

A

5

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3
Q

The ___________ is a prominent ridge on the first sacral segment that acts as a bony landmark separating the abdominal cavity from the pelvic cavity.

A

sacral promontory

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4
Q

The transverse processes of the five sacral segments combine to form the _______ (ala) which articulate with the os coax at the _______.

A

lateral mass

sacroiliac joints

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5
Q

The _______ articulates with the fifth sacral segment and consists of five small fused bony segments.

A

coccyx

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6
Q

The _______ delineates the boundaries of the abdominal and pelvic cavities.

A

pelvic brim

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7
Q

The region above the pelvic brim is called the ______ and the region below the _______.

A

false pelvis

true pelvis

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8
Q

The _________ is a pyramid-shaped muscular organ that rests on the
pelvic floor, immediately posterior to the symphysis pubis.

A

bladder

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9
Q

The ________ of the bladder is covered by peritoneum,
allowing loops of ileum and sigmoid colon to rest on

A

superior surface (body)

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10
Q

The posterior surface of the bladder is referred to as the _______ or base of the
bladder. It is closely related to the rectum in the male.

A

fundus

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11
Q

Three openings in the floor of the bladder form a triangular area called the ________.

A

trigone

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12
Q

In both genders, the urethra passes through the __________, which
contains the urethral sphincter muscle responsible for the voluntary closure of the
bladder.

A

urogenital diaphragm

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13
Q

What is the dose limiting structure in the treatment of prostate cancer?

A

the bladder

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14
Q

How is the bladder commonly visualized in the simulation process?

A

contrast agents

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15
Q

What is the most common area of the bladder for carcinoma?

A

trigone

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16
Q

What cancer is described by these epidemiological and etiological factors?

70 years or older (peak age of 73)
 Male: female ratio is approximately 4:1.
 Caucasian Americans are two times more likely than African Americans to
develop this cancer
 Most important risk factor for is smoking
 People who smoke are at least 3 times as likely to get this cancer as people
who do not smoke

A

Bladder cancer

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17
Q

What is the most important etiological factor in bladder cancer?

A

smoking

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18
Q

What is clinical presentation of bladder cancer?

A

painless hematuria

frequency
urgency
dysuria

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19
Q

What is the diagnostic work up for bladder cancer?

A

rectal and pelvic exam

chest x ray

cystoscopy

CXR

Urinalysis

CBC

liver function test

biopsy for diagnosis

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20
Q

What are the three major types of bladder cancer?

A

transitional cell carcinoma

squamous cell carcinoma

adenocarcinoma

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21
Q

What is the most common histology of bladder cancer?

A

transitional cell carcinoma (urothelial carcinoma)

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22
Q

Most bladder cancers start in the ________ lining of the bladder, sometimes called the ________.

A

innermost

urothelium or transitional epithelium

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23
Q

What lymph nodes are involved in bladder cancer?

A

external iliac

internal illiac

pre sacral lymph nodes

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24
Q

What is the treatment of choice for bladder cancer?

A

surgery

(segmental cystectomy)
the person can keep their bladder without reconstructive surgery

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25
Q

What is Bacillus Calmette Guerin (BCG) therapy?

A

intravesical immunotherapy used for treating early stage bladder cancer by inserting liquid drug directly into the bladder

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26
Q

What are the most common drugs used in chemotherapy when given with radiation?

A

cisplatin

cisplatin + fluorouracil (5-FU)

mitomycin with 5-FU

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27
Q

For bladder cancer, the bladder should be ______ in simulation, but _________ in treatment.

A

full

empty

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28
Q

A __________ is used to inject iodinated contrast into the bladder to outline the posterior portion of the bladder during simulation.

A

Foley catheter

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29
Q

For treatment of bladder cancer, the larger pelvic field to include the bladder and pelvic lymph nodes
is generally treated to a dose of ____________.

A

45 to 50 Gray at 180 cGy per day

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30
Q

What is the preoperative dose for bladder cancer?

A

45-50 Gy

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31
Q

what is the postoperative dose for bladder cancer?

A

65-70 Gy

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32
Q

What is the EBRT +chemotherapy dose for bladder cancer?

A

45-65 Gy

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33
Q

What is located inferior to seminal vesicles and bladder, anterior to rectum, posterior
to symphysis pubis?

A

prostate

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34
Q

What are the zones of the prostate?

A

transitional, central, and peripheral

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35
Q

The ______ passes through the prostate gland.

A

urethra

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36
Q

What does the prostate do?

A

produces the liquid portion of semen to carry sperm.

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37
Q

What is the most common cancer in males?

A

prostate cancer

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38
Q

_________ Americans have a higher incidence of prostate cancer as well as later stages and higher mortality rates.

A

African

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39
Q

What age is at most risk for prostate cancer?

A

65 years and older

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40
Q

The ________ genes increase the risk of prostate cancer in men.

A

BRCA 1 or BRCA 2

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41
Q

What is benign prostatic hypertrophy?

A

enlarged prostate gland

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42
Q

what are the presenting symptoms of prostate cancer?

A

benign prostatic hypertrophy

frequent urination

nocturne

hesitancy

narrow stream

elevated PSA

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43
Q

Men without a family history of prostate cancer begin screening at ______ years.

A

50

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44
Q

For men at greater risk, prostate screening should begin ages __________.

A

40-45

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45
Q

What is the diagnostic workup for prostate cancer?

A

DRE

PSA

Pelvis CT

Chest X ray

bone scan

ultrasound

MRI

PET

Needle biopsy (transrectal ultrasound guided)

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46
Q

What is the most common histology of prostate cancer?

A

adenocarcinoma

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47
Q

Most prostate carcinomas are multifocal and develop in the ______ zones of the prostate.

A

peripheral

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48
Q

What is the order of lymph node involvement for prostate glad

A

periprostatic and obturator

to

external iliac

hypogastric

common iliac

paraaortic

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49
Q

Where does distant metastasis usually occur from prostatic cancer?

A

bones of the pelvis and vertebral column

(assess with bone scan and PET)

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50
Q

What is used to assess the grade of prostate cancers?

A

Gleason system

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51
Q

The __________ looks for the differentiation level of cells by adding 2 grades together.

A

Gleason score

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52
Q

The Gleason score ranges from ______, and most cancers score ________. The higher the score, the more poorly differentiated the tumor.

A

2-10

6-7

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53
Q

Cancers with a Gleason score of 6 or less are called _______.

A

well differentiated or low grade

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54
Q

Cancers with a Gleason score of 7 are called __________.

A

moderately differentiated or intermediate grade

55
Q

Cancers with Gleason scores of 8-10 are called _________.

A

poorly differentiated or high grade

56
Q

What is the most common treatment of choice for prostate cancer?

A

surgery (main type is radical prostatectomy)

57
Q

What are the disadvantages of surgery for prostate cancer?

A

difficulty controlling urine flow

high risk of impotence

58
Q

How is brachytherapy used in prostate cancer?

A

Brachytherapy only - generally used only in men with early-stage prostate cancer that is relatively slow growing (low-grade).
 Brachytherapy combined with external radiation is sometimes an option for men who have a higher risk of the cancer growing outside the prostate

59
Q

What role does hormone therapy play in treatment of prostate cancer?

A

large role in halting the proliferation of prostate cancer by cutting off supply of testosterone

60
Q

When is chemotherapy used in prostate cancer?

A

only in patients with metastatic disease

61
Q

What does the Arch study do?

A

determine whether or not to see if the prostate is an appropriate size to treat with brachytherapy.

62
Q

What kind of applicator is used in prostate brachytherapy?

A

Mick applicator

guided with transrectal ultrasound

63
Q

What are the commonly used permanent isotopes to treat prostate cancer?

A

Iodine 125 (dose of 160 Gy)

Cesium 131

Palladium 103

64
Q

After receiving permanent isotope implants, prostate patients should receive CTs ___________.

A

after a month and then every three months for a year

65
Q

For prostate simulation, patients should have a _____ bladder and a _____ rectum.

A

full

empty

66
Q

What is the patient positing for prostate cancer?

A

supine

67
Q

For prostate cancer, CT images are taken in _____ thickness with scanning superiorly below the _______ and inferiorly to mid ______.

A

3-5 mm

diaphragm

femur

68
Q

What is a urethrogram?

A

a catheter with contrast inserted into the penis to the penile bulb which is 1 cm below the prostate. Locate the prostate by going 1 cm superior

69
Q

Hydrogel can be injected into the perineum to create space between the prostate and the ______.

A

rectum

70
Q

An empty rectum ensures _______ in prostate treatment.

A

that it will be out of the field

71
Q

What are organs at risk in prostate treatment?

A

femur

bladder

rectum

72
Q

What is the typical beam arrangement for prostate treatment?

A

five or six oblique treatment angles

73
Q

What is the common 5 field arrangement for prostates?

A

right and left posterior oblique

right and left anterior obliques

PA field

74
Q

True or False: Cyberknife, SRS/SBRT are treatment options for prostate patients with low grade tumors.

A

True

75
Q

What are the advantages of proton therapy?

A

low entrance dose

high dose to tumor

no exit dose beyond tumor (Bragg’s peak)

76
Q

What is the total dose to the whole prostate?

A

75-80 Gy

77
Q

What is the total dose to the prostate bed?

A

64-68 Gy

78
Q

What is the limit to the bladder?

A

65 Gy

79
Q

What is the limit to the rectum?

A

60 Gy

80
Q

What is the limit to the femoral head and neck?

A

52 Gy

81
Q

What are the acute side effects of prostate cancer?

A

diarrhea

abdominal cramping

rectal discomfort

occasional rectal bleeding

dysuria

nocturne

UTIs

Erythema

82
Q

What are the chronic side effects of prostate cancer?

A

sexual impotence

erectile dysfunction (EBRT or interstitial implant)

83
Q

True or false: penile cancer is rare in the Western Hemisphere.

A

True

84
Q

what etiology and epidemiology risk factors are associated with penile cancer?

A

no exact cause known

presence of foreskin and poor hygiene

higher incidence in ages 58-68

85
Q

What is the most common histology of penile cancer?

A

well differentiates squamous cell carcinoma

86
Q

What is the most common route of spread in penile cancer?

A

lymphatic spread to inguinal lymph nodes

(30-45% present with lymph node involvement)

87
Q

True or false: distant metastasis is uncommon in penile cancer.

A

True

88
Q

What are the acute side effects of treatment of penile cancer?

A

erythema

dry/moist desquamation

swelling of subcutaneous tissue in shaft

**ulceration or necrosis of glans and shaft are rare

89
Q

What are the chronic side effects of treatment of penile cancer?

A

telangiectasia

fibrosis

lymphedema after inguinal and pelvic irradiation

90
Q

What is telangiectasia?

A

widened blood vessels

91
Q

_______ accounts for 1% of all male cancers.

A

testicular

92
Q

Testicular cancer is the most common malignancy between the ages ________.

A

15-35

93
Q

Testicular cancer is more common in African Americans or Caucasians?

A

Caucasians

94
Q

What is cryptorchidism?

A

undescended testes

risk factor for testicular cancer

95
Q

What are two risk factors for testicular cancer?

A

cryptorchidism

atrophy of testes

96
Q

What are the symptoms of testicular cancer?

A

painless swelling or mass

dull ache/ heaviness in scrotum or lower abdomen

acute/ severe pain

previous trauma

gynecomastia (germ cell tumors) –producing HCG such as choriocarcinoma

97
Q

What is the diagnostic workup for testicular cancer?

A

h and p

ultrasound

tumor markers (AFP- serum alpha feta protein) and beta HCG –human chronic gonadotropin)

orchidectomy

CT scan of chest, abdomen, and pelvis for lymph node involvement and distant metastasis

98
Q

What is an important consideration for patients with testicular cancer?

A

semen analysis and sperm banking

99
Q

What is the most common histology of testicular cancer?

A

seminoma

100
Q

What are the subtypes of seminoma?

A

classic

anapestic

spermatohytic

101
Q

What are the non seminoma tumors?

A

embryonal adenocarcinoma

teratoma

choriocarcinoma

yolk sac (children)

102
Q

What is the staging system for testicular cancer?

A

The European Organization for Research on Treatment of Cancer (EORTC)

International Union Against Cancer (UICC)

AJCC

103
Q

In testicular cancer, ______ tend to remain localized or involve only lymph nodes. _____ tend to spread via lymphatics or hematogenously.

A

seminomas

non seminomas

104
Q

What is the order of lymphatic spread for testicular cancer?

A

paraaortic

mediastinal

supraclavicular

105
Q

What are the sites of rare metastasis in testicular cancer?

A

lung

bone

liver

brain

106
Q

What is the treatment of choice for testicular cancer?

A

surgery and postoperative radiation

107
Q

What is the most common treatment for stage I seminoma?

A

radical orchiectomy and postoperative irradiation of the paraaortic and ipsilateral pelvic nodes

108
Q

What is the simulation setup for testicular cancer?

A

supine
frog legged
arms high on chest
clam shell-scrotal shield for unaffected testicle

109
Q

Patients with stage I testicular cancer seminoma should receive irradiation to the _______.

A

paraaortic

or

paraaortic and ipsilateral pelvic lymph nodes

110
Q

What is the treatment field for testicular cancer?

A

hockey field

AP/PA treatment

111
Q

What are the borders for a testicular cancer treatment field?

A

Superior T10-11

Inferior: bottom of L5 or top of Acetabulum based on lymph nodes

Lateral: about 10 cm wide to include entire vertebrae

bottom: edge of allium

112
Q

The periarotic and ipsilateral inguinal areas are usually treated with a ________ portal or _______.

A

hockey stick

two abutting periarotic and iliac fields

113
Q

The single hockey stick portal avoids potential in __________.

A

overlap or under dosage caused by treating two separate ports

114
Q

________ are used to shape hockey stick fields and protect critical organs.

A

custom blocks

115
Q

what is the beam energy used to treat seminomas?

A

6-18 MV photons

116
Q

What is the total dose for paraaortic fields in treatment of testicular cancer?

A

20 Gy

117
Q

What is the total dose of hockey stick fields for testicular cancer?

A

20-25 Gy

118
Q

What is the total dose to lymph nodes in testicular cancer treatment?

A

30-36 Gy

119
Q

What is the postoperative dose to periaroritc and ipsilateral inguinal iliac areas for testicular cancer treatment?

A

25 Gy

120
Q

What is the primary treatment for non seminomas?

A

radical orchiectomy followed by cisplatin based chemotherapy

121
Q

What role does radiation therapy have in non seminomas?

A

palliation of brain and other metastatic sites

122
Q

________ is the main treatment in advanced stage non seminomas.

A

chemotherapy

123
Q

What are the side effects for testicular cancer treatment?

A

nausea

fatigue

diarrhea

decreased fertility

permanent sterility

124
Q

Spermatogenesis is affected at doses as low as ______.

A

50 cGy

125
Q

Permanent sterility occurs at ______ to the scrotum.

A

15-20 Gy

126
Q

At what vertebral level are kidneys located?

A

T11- L3

127
Q

What is the average age of diagnosis of kidney cancer?

A

55-60 years old

128
Q

Males are _____ as likely to get kidney cancer than females.

A

twice

129
Q

What is the most common presenting symptom of kidney cancer?

A

gross or microscopic hematuria

130
Q

What is the tissue of origin for renal cell carcinoma?

A

proximal tubular epithelium

131
Q

What is the most common subtype of renal cell carcinoma?

A

clear cell carcinoma

132
Q

What is the treatment of choice for kidney cancer?

A

Nephrectomy

133
Q

What role does radiation play in treatment of kidney cancer?

A

postoperatively for a tumor left behind or for recurrence after surgery

Radiation Therapy (26 decks)

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