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Radiation Therapy > [4621] Respiratory Tumors Power Point > Flashcards

[4621] Respiratory Tumors Power Point Flashcards

1
Q

What does the upper respiratory tract consist of?

A

Nose
nasopharynx
oropharynx
laryngopharynx (hypopharynx)
and larynx

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2
Q

What does the lower respiratory tract consist of?

A

trachea
bronchial tree
lungs

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3
Q

What is the name of the notch on the medial surface of the superior lobe of the left lung?

A

cardiac notch

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4
Q

What is the name of the projection on the inferior anterior surface of the left lung?

A

lingula

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5
Q

What is the name of the medial openings of the lungs?

A

hilum

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6
Q

What acts as a passage for mainstream bronchi, blood vessels, lymph vessels, and nerves to enter or leave the lung?

A

the hilum

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7
Q

What cartilaginous tube provides a pathway for air to move from the laryngopharynx to the lungs?

A

trachea

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8
Q

Where does the larynx bifurcate into the primary bronchi?

A

T5

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9
Q

What is the name of the bifurcation of the trachea ?

A

Carina

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10
Q

The primary bronchi branch off into _______.

A

secondary bronchi

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11
Q

The secondary bronchi branch off into ________.

A

tertiary bronchi

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12
Q

The tertiary bronchi branch off into __________.

A

bronchioles

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13
Q

The bronchioles branch off into ____________.

A

alveoli

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14
Q

Lung cancer is the _________ cancer and cancer related death in the world.

A

most common

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15
Q

Lung cancer is common in ages ________ and older.

A

65

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16
Q

What are the two major types of lung cancer?

A

Non small cell lung cancer

small cell lung cancer

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17
Q

Tobacco use accounts for _____% of lung cancers.

A

80

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18
Q

What are the environmental causes of lung cancer? (5)

A

radon

asbestos

certain metals

radiation

air pollution

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19
Q

Lung cancer is the most _________ form of cancer.

A

preventable

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20
Q

What are the 4 categories of signs and symptoms of lung cancer?

A

local disease

regional disease

distant metastasis

nonspecific

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21
Q

Paraneoplastic syndromes belong to what category of lung cancer signs and symptoms?

A

nonspecific

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22
Q

persistent cough, hemoptysis, dyspnea, fatigue and weakness, and weight loss are all signs and symptoms _________ disease in lung cancer.

A

local

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23
Q

what is hemoptysis?

A

blood in septum

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24
Q

chest pain, nerve entrapment vascular obstruction, dysphagia, hoarseness, pleural effusion, and SVC syndrome are signs and symptoms of ____________ disease in lung cancer.

A

Regional

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25
Q

What are the signs of SVC syndrome?

A

swelling in the face and arms, distended veins in the chest, difficulty breathing, and shortness of breath

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26
Q

headaches, visual changes, neurological deficit’s and personality changes from are signs and symptoms of _________ from lung cancer.

A

distant metastasis

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27
Q

What tumor is found in the superior sulcus and presents with pain in the shoulder and down the arm, atrophy of the hand muscles, erosion of the ribs and/or vertebrae?

A

Pancoast tumors

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28
Q

what is characterized by weakness or dropping of one eyelid, decrease
in pupil size of the same eye, and decreased or absent sweating on the same side of the face?

A

Horner syndrome

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29
Q

What occurs when hormone like substances are released into the blood and cause issues in areas away from the sight of cancer?

A

Paraneoplastic syndrome

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30
Q

What paraneoplastic syndrome are associated with lung cancer?

A

hypercalcemia

hypertrophic osteoarthropathy (clubbing)

syndrome of inappropriate ADH secretion

ACTH production syndrome

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31
Q

Paraneoplastic syndromes are more often present in patients with ____________ cell lung cancer.

A

small

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32
Q

individual ages 55-74, in
otherwise good health, who are current smokes or have quit smoking in the past 15 years, who have at least a 30 pack year history, and who are wiling to attend a smoking cessation program, are recommended ___________ for detection/diagnosis screening of lung cancer.

A

low dose CT

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33
Q

What is the most common form of diagnostic imaging for lung cancer?

A

chest x-ray

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34
Q

What form of imaging can reveal lung tumors greater than 5mm in size, atecltasis, pneumonitis, bronchitis, abscess, pleural reaction or effusion, rib erosion, or bulky disease in the mediastinum?

A

Chest radiograph

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35
Q

What are the forms of imagining used in detection of lung cancers?

A

Chest x ray

CT

MRI

PET

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36
Q

What lab studies are done for suspected lung cancers?

A

CBC

serum calcium

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37
Q

what does elevation of serum calcium indicate?

A

bony disease

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38
Q

What is atelectasis?

A

collapsed lung

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39
Q

what is pneumonitis?

A

inflammation of the lung

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40
Q

Lung cancer spreads locally by ________.

A

direct extension

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41
Q

Lung cancer spreads regionally by __________.

A

lymphatics

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42
Q

Lung cancer spreads distantly through ________.

A

hematogenous routes

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43
Q

Lung cancer travels to ________ nodes after the intrapulmonary nodes.

A

hilar

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44
Q

Lung cancer travels to ________ nodes after the hilar nodes.

A

mediastinal

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45
Q

Lung cancer travels to __________ nodes after the mediastinal nodes.

A

supraclaviclar

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46
Q

Which primary lymphatics drain the lungs?

A

Hilar and mediastinal nodes

47
Q

Left lung: lymph moves from the left lung into the____________ then into
the _____________.

A

thoracic duct

left subclavian vein

48
Q

Right lung: the lymph moves into the _________ and then into the _______.

A

right lymphatic duct

right subclavian vein

49
Q

The pleura drain into the ________.

A

hilum

50
Q

What are the common sites of metastasis of lung cancer? (5)

A

Brain

bone

liver

adrenal gland

contralateral lung

51
Q

What is the staging system for lung cancer?

A

TNM or AJCC system

52
Q

What are the most important prognosis factors for lung cancer? (3)

A

performance status

stage

weight loss

53
Q

What scales measure the performance status of lung cancer patients?

A

Karnofsky Performance Status (KPS)

Eastern Cooperative Oncology Group (ECOG)

54
Q

A ______ KPS score indicate a better prognosis.

A ______ ECOG score indicate a better prognosis.

A

high

low

55
Q

What is the most common category of lung cancer?

A

Non small cell lung cancer

56
Q

What are the types of non small cell lung cancer?

A

adenocarcinoma

large cell carcinoma

squamous cell carcinoma (epidermoid)

57
Q

What is the most common type of non small cell lung cancer?

A

adenocarcinoma

58
Q

Where are adenocarcinomas usually found in the lung?

A

In the periphery

59
Q

What is the most common type of lung cancer in non smokers?

A

adenocarcinoma non small cell lung cancer

60
Q

What are two epidemologic factors of adenocarcinoma?

A

females

younger individuals

61
Q

What is the slowest growing type of non small cell lung cancer?

A

adenocarcinoma

62
Q

What type of lung cancer arises from cells that line the airway?

A

squamous cell carcinoma

63
Q

Where are squamous cell carcinomas usually found?

A

in the central parts of the lung near the bronchi

64
Q

squamous cell carcinoma is common in _______ and _________.

A

smokers

men

65
Q

what is the least common type of non small cell lung cancer?

A

Large cell carcinoma

66
Q

What is another name for large cell carcinoma?

A

undifferentiated

67
Q

Where do large cell carcinomas appear in the lung?

A

Can appear in any part of the lung but may appear in the periphery or central location

68
Q

Where does large cell carcinoma have a high tendency to metastasize?

A

brain

69
Q

What kind of prognosis does large cell carcinoma have?

A

poor

70
Q

What is the treatment of choice for non small cell lung cancers?

A

surgery

71
Q

What kinds of surgery are used to treat lung cancer? (3)

A

lobectomy

wedge resection

pneumonectomy

72
Q

What would recommend a lung cancer patient to radiation therapy treatment?

A

incomplete resections

positive mediastinal metastasis

73
Q

What kind of tumor is known as “oat cell?”

A

small cell lung cancer

74
Q

Where do small cell lung cancers typically occur?

A

centrally in the lung

75
Q

small cell lung cancer has a _________ incidence of metastasis.

A

higher

76
Q

__________ has poorest prognosis of all lung tumors.

A

small cell lung cancer

77
Q

What is the treatment of choice of small ell lung cancer?

A

chemotherapy

78
Q

What is the most effective chemotherapy drug in the treatment of small cell lung cancer?

A

cisplatin

79
Q

_______ is commonly delivered to prevent brain metastasis.

A

prophylactic cranial irradiation (PCI)

80
Q

What is standard practice in treating small cell lung cancer?

A

delivery of chemotherapy during accelerated hyperfractioned radiation therapy

81
Q

Fusion of PET- CT can help distinguish _____ vs ________.

A

tumor

vs

atelectasis

82
Q

For EBRT of lung cancer, TOTAL doses up to _____ Gy are employed to the primary tumor and areas of gross disease.

A

70 Gy

83
Q

For EBRT of lung cancer, initially treatment portals use AP/Pa fields to doses of _________ to avoid exceeding tolerance to sensitive structures such as lung, spinal cord, and heart.

A

40-45Gy

84
Q

_______ portals are often used to boost the lung tumor.

A

oblique

85
Q

In lung cancer treatment, what is the total dose if the treatment approach is EBRT as the primary radiation alone?

A

60-75 Gy

86
Q

In lung cancer treatment, what is the total EBRT dose if the treatment approach is surgery+ post op EBRT?

A

60-65 Gy

87
Q

In lung cancer treatment, what is the total EBRT dose if the treatment approach is chemotherapy + EBRT?

A

30-50 Gy

88
Q

In lung cancer treatment, what is the total dose if the treatment approach EBRT for palliation or recurrence?

A

40-50 Gy

89
Q

In lung cancer treatment, what is the total dose if the treatment approach is EBRT for post op of the superior sulcus?

A

30-50 Gy

90
Q

If there is disease in upper lobe, the field includes the:

A

primary tumor
hila
superior mediastinum
both supraclavicular areas

91
Q

If there is disease in the middle lobes, without mediastinal involvement, the field includes the:

A

primary tumor
hila
superior mediastinum

92
Q

The treatment field for lower loves without mediastinal involvement include the:

A

primary tumor and mediastinum

93
Q

For treatment planning of lung cancer, motion management needs to be considered if the range of tumor motion is greater than ______ in
any direction.

A

5mm

94
Q

________ allows reduction of treatment volumes and uses hypofractionation to increase the daily dose and reduce the
overall treatment time. It is typically delivered in 5 or less treatments.

A

SBRT

95
Q

What are the radiation side effects specific to the treatment of the lung?

A

pneumonitis

esophagitis

dysphagia

odynophagia

96
Q

Painful swallowing occurs about 3 weeks into treatment at _____Gy.

A

30

97
Q

Esophagitis resolves ______ after treatment is completed.

A

1-2 weeks

98
Q

What is used to treat esophagitis?

A

viscous isocyanine
(with or without liquid antacids.)

liquid analgesics

99
Q

What can cause esophageal stricture (narrowing)?

A

high dose to the mediastinum

100
Q

Radiation pneumonitis can start as early as _____Gy.

A

20

101
Q

What is radiation fibrosis?

A

irreversible scarring that limits the movement of the diaphragm.

102
Q

What is transverse myelitis?

A

inflammation of both sides of the spinal cord

103
Q

how long after treatment does radiation pneumonitis occur?

A

6-22 weeks after treatment

104
Q

What is used to treat radiation pneumonitis?

A

prednisone

O2

antibiotics

105
Q

What form of brachytherapy is used for patients with localized large unresectable lung tumors?

A

Interstitial brachytherapy

106
Q

What isotope is used for intraoperatively placed implants for lung tumors?

A

Iodine 125

107
Q

What isotope is used in removable implants for intrabronchial brachytherapy for lung tumors? What catheter is it inserted with?

A

Iridium 192

Teflon catheter

108
Q

What is the chemotherapy regimen for unresectable NSCLC tumors?

A

cisplatin/vinblastin regimen with hyper fractionated radiation therapy

109
Q

What dose is used for PCI?

A

30-35 Gy

110
Q

What are the treatment portals for superior sulcus (pan coast tumors)?

A

ipsilateral supraclavicular nodes

adjacent vertebral body

upper lobe

hilar nodes

111
Q

What is the treatment of choice for mesothelioma?

A

Surgery:

localized lesion-surgery

extensive lesion- radical pleuroectomy

112
Q

What is the PRE-operative dose for a lung?

A

45-50 Gy

113
Q

What is the definitive dose for a lung?

A

60-70 Gy

Radiation Therapy (26 decks)

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