Cancer Management Test (GI, Male and Female)

Question 1

Which of the following is the structure located immediately superior and medial to the left kidney?

Answer 1

Adrenal gland

The adrenal glands are located superior and medial to each kidney.

Question 2

Which of the following describes the anatomic relationship of the esophagus to the trachea and vertebral column?

Answer 2

The esophagus is posterior to the trachea and anterior to the vertebral column.

Question 3

A patient is to be treated with a pelvic field on a linear accelerator. The patient is quite obese and the port films show that the field shifts superiorly and inferiorly on a daily basis. What bony landmark may measurements be taken from to stabilize this treatment portal?

Answer 3

Anterior superior iliac spine (ASIS)

The iliac crest extends from the ASIS to the posterior superior iliac spine (PSIS). The ASIS is palpable, and measurements may be taken from it in the superoinferior or mediolateral direction.

Question 4

Which organ begins at the lower border of the cricoid cartilage and travels through the diaphragm to the cardiac sphincter?

Answer 4

Esophagus

The esophagus begins at the lower border of the cricoid cartilage in the neck and travels through the diaphragm to the cardiac sphincter, the entrance to the stomach, at the level of T10 approximately 2 to 3 cm to the left of midline.

Question 5

At what age should a person of average risk have his or her first screening colonoscopy?

Answer 5

45

According to the American Cancer Society screening guidelines for the early detection of colorectal cancer, beginning at age 50, an average-risk person is recommended to undergo an annual fecal occult blood test or fecal immunochemical test, a flexible sigmoidoscopy and double contrast barium enema every 5 years, and a colonoscopy every 10 years.

Question 6

Familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal syndrome (HNPCC) are most closely associated with which type of cancer?

Answer 6

Colorectal

Other principal factors in the development of colon cancer include the following: chronic ulcerative colitis, carcinomas arising in preexisting adenomatous polyps, and the hereditary cancer syndromes. These syndromes are FAP and HNPCC.

Question 7

Gastroesophageal reflux disease (GERD) is associated with cancer of which anatomic region?

Answer 7

Esophagus

Long-standing gastroesophageal reflux disease, called GERD, is associated with the development of adenocarcinomas of the distal esophagus.

Question 8

What is the treatment of choice for most anal cancers?
I. Surgery
II. Chemotherapy
III. Radiation therapy

Answer 8

II and III

A combination of radiation therapy and chemotherapy (5-FU and mitomycin C) is advocated as the preferred method of treatment and considered the standard of care for most patients.

Question 9

The Whipple is a surgical procedure associated with cancer of which organ?

Answer 9

Pancreas

The most common potentially curative surgical procedure for pancreatic cancer is a pancreaticoduodenectomy (Whipple procedure).

Question 10

The vermiform appendix is most closely associated with which portion of the digestive tract?

Answer 10

Cecum

The vermiform appendix is a diverticulum of the cecum.

Question 11

What is the dose-limiting structure of most concern for radiation treatments of colorectal cancers?

Answer 11

Small bowel

For irradiation of the pelvis, the dose-limiting structure or organ-at-risk (OAR) is the small bowel. The small bowel dose should be less than 45 Gy.

Question 12

What is the dose-limiting structure of most concern for radiation treatments of the esophagus?

Answer 12

Spinal cord

Careful dosimetry planning is necessary to avoid overdosing the spinal cord when treating esophageal cancers. AP/PA fields are used initially; as cord tolerance is approached, an off-cord technique is implemented.

Question 13

What is the most common histologic type of cancers that occur in the lower third of the esophagus?

Answer 13

Adenocarcinoma

Question 14

Which of the following cancers is most common in the United States?

Answer 14

Colorectal

Cancer of the colon is ranked third in incidence when comparing men and women separately.

Question 15

Which of the following is not a risk factor for anal cancer?

Immunosuppression
Diet
Anal intercourse
Human papillomavirus

Answer 15

Diet

Question 16

Which of the following cancer sites can be treated with endocavitary radiation therapy?

Answer 16

Rectum

Endocavitary radiation therapy is a sphincter-preserving procedure done for curative intent in a select group of patients with low- to middle-third rectal cancers that are confined to the bowel wall.

Question 17

Which of the following methods may reduce the dose to the small bowel during radiation therapy?
I. Supine positioning
II. Prone positioning
III. Full bladder
IV. Empty bladder

Answer 17

II and III

The reduction of the small-bowel dose is achieved through patient positioning and positioning devices, bladder distention, multiple-shaped fields, and dosimetric weighting.

Question 18

What are the growths that arise from the mucosal lining and protrude into the lumen of the bowel?

Answer 18

Adenomatous polyps

Adenomatous polyps are growths that arise from the mucosal lining and protrude into the lumen of the bowel.

Question 19

What condition is most closely associated with gastroesophageal reflux?

Answer 19

Barrett esophagus

Barrett esophagus is a condition in which the distal esophagus is lined with a columnar epithelium rather than a stratified squamous epithelium. This mucosal change usually occurs with gastroesophageal reflux.

Question 20

What condition is most closely associated with adenomatous polyposis?

Answer 20

Gardner syndrome

Patients with Gardner syndrome have adenomatous polyposis of the large bowel and other abnormal growths, such as upper gastrointestinal polyps, peri-ampullary tumors, lipomas, and fibromas.

Question 21

Radiation treatment fields for the distal esophagus typically include which of the following lymph nodes?

Answer 21

Celiac axis

Regional spread to draining lymphatics is a common early presentation and must be taken into consideration in the design of the radiation field. The cervical, supraclavicular, mediastinal, and sub-diaphragmatic (celiac axis) lymph node regions are at risk. The degree to which these nodal groups are at risk depends on the location of the primary tumor. Supraclavicular nodes are involved more often with a proximal lesion than a distal lesion.

Question 22

The width of the anterior field in the treatment of rectal cancer should the iliac lymph nodes. Therefore, the lateral borders of this field should __________________.

Answer 22

extend about 2 cm beyond the pelvic brim

The width of the PA/AP fields is designed to provide adequate coverage of the iliac lymph nodes. This border is placed 2 cm lateral to the pelvic brim and inlet.

Question 23

Cancer of which female reproductive organ is most deadly?

Answer 23

Ovarian

Question 24

Cancer of which organ can be genetically linked to breast cancer?

Answer 24

Ovarian

Risk factors for ovarian cancer include an older age; late or few pregnancies; late menopause; a lack of oral contraceptive use; a family history of ovarian cancer; and a personal history of breast, colon, or endometrial cancer.

Question 25

Overall, cervical cancer occurs most frequently with those associated with which of the following factors? I. Women of lower socioeconomic status II. Early sexual activity and multiple partners III. Multiple instances of pelvic infection

Answer 25

I, II, and III ## Footnote Patients that are of lower socioeconomic status often have less than average participation in screening programs. Also, those that have early instances of sexual activity often with multiple partners and higher instances of pelvic infections have been associated with an increase in cervical cancer risk.

Question 26

Intraperitoneal radiopharmaceuticals can be used to treat which of the following cancers of the female reproductive system?

Answer 26

Ovarian ## Footnote Use of the radioisotope P-32 as a colloidal solution placed into the peritoneal cavity is an accepted alternative to single agent chemotherapy for treating high-risk stages I and II ovarian cancers.

Question 27

Pap testing is a screening tool used to detect cancers of the _________.

Answer 27

Cervical ## Footnote Routine Papanicolaou (Pap) smears have played a crucial role in the early detection of cervical cancer.

Question 28

The prescription point A can be measured from the cervical os ______________.

Answer 28

2 cm superior and 2 cm lateral ## Footnote Central doses are traditionally prescribed to the point A prescription point, usually defined as 2 cm superior to the cervical os and 2 cm lateral to the endocervical canal.

Question 29

Diarrhea is a side effect of pelvic irradiation. Patients experiencing this side effect should be advised to adhere to a _________diet.

Answer 29

low-fiber ## Footnote Low-fiber diets, sucralfate, Lomotil, and loperamide are useful for alleviating diarrhea.

Question 30

Cancer of which urinary organ is most common?

Answer 30

Bladder ## Footnote Approximately 67,160 new cases and 13,750 deaths from bladder cancer are reported in the United States annually. The incidence peaks in the seventh decade, and in men this cancer is the fourth most prevalent malignant disease.

Question 31

Cancer of which of the following male reproductive system components is most common?

Answer 31

Prostate ## Footnote Carcinoma of the prostate is the most common malignancy in males in the United States.

Question 32

What is the most common histology found in kidney cancer?

Answer 32

Transitional cell carcinoma ## Footnote Transitional cell carcinoma accounts for more than 90% of malignant tumors of the renal pelvis and ureter, and squamous cell carcinoma accounts for 7% to 8%.

Question 33

What is the most common histology found in bladder cancer?

Answer 33

Transitional cell carcinoma ## Footnote Approximately 92% of bladder tumors are transitional cell carcinomas, 6% to 7% are squamous cell carcinomas, and 1% to 2% are adenocarcinomas.

Question 34

What is the standard total dose used when irradiating the entire bladder?

Answer 34

4500 to 5000 cGy ## Footnote The larger pelvic field to include the bladder and pelvic lymph nodes is generally treated to a dose of 45 to 50 Gy at 180 cGy per day, which requires 5 to mc037-1.jpg weeks of treatment.

Question 35

What is the most common histology found in testicular cancer?

Answer 35

Germ cell tumors ## Footnote About 95% of testicular neoplasms originate in germinal elements.

Question 36

What is the most common form of penile cancer?

Answer 36

Squamous cell carcinoma ## Footnote Most malignant penile tumors are well-differentiated squamous cell carcinomas.

Question 37

What is the primary treatment option for kidney cancer?

Answer 37

Surgery ## Footnote Radiation and chemotherapy have limited roles in the management of kidney cancers.

Question 38

What is the most common symptom of testicular cancer?

Answer 38

Painless mass ## Footnote Usually, a testicular tumor appears as a painless swelling or nodular mass in the scrotum and is sometimes noted incidentally by the patient or a sexual partner.

Question 39

Which of the following would likely by the first treatment for testicular cancers?

Answer 39

Surgery ## Footnote The initial management goal for a suspected malignant germ cell tumor of the testis is to obtain serum alpha-fetoprotein and beta- human chorionic gonadotropin measurements and, after staging procedures, to perform a radical inguinal orchiectomy with high ligation of the spermatic cord. Further management depends on the pathologic diagnosis of the stage and extent of the disease.

Question 40

Who has the most significant risk of developing prostate cancer? a) 70-year-old black male Unselected b) 45-year-old black male Unselected c) 81-year-old black female Unselected d) 50-year-old white male

Answer 40

70-year-old black male ## Footnote The incidence increases with each decade of life; more than 65% of prostate carcinomas occur in men 65 years and older. African-American men in the United States have one of the highest incidences of prostate cancer in the world, significantly higher than that of white men of comparable age.

Question 41

Which of the following positions and strategies are most frequently used when irradiating the prostate? I. Supine positioning II. Prone positioning III. Full bladder IV. Empty bladder

Answer 41

I and III ## Footnote Patients are most often simulated in the supine position. Patients should be treated with a full bladder to minimize the amount of bladder in the treatment portals.

Question 42

Which of the following cancers is most likely to occur in a 27-year-old male?

Answer 42

Testicle ## Footnote Although testicular tumors are relatively rare, they are the most common malignancy in men between 20 and 34 years of age.

Question 43

Which of the following management strategies is least likely to be used in the management of a patient with prostate cancer? a) Radiation therapy Unselected b) Watchful waiting c) Chemotherapy d) Hormone therapy

Answer 43

Chemotherapy ## Footnote Prostate cancer is noted as having several pathways associated with disease management, including surgery, hormone therapy, watchful waiting, and radiation therapy as mainline options. Chemotherapy is used often after hormone therapy has not yielded an acceptable response.

Question 44

To which surface of the prostate gland do the seminal vesicles attach?

Answer 44

Posterior superior ## Footnote The seminal vesicles pierce the posterosuperior aspect of the prostate gland.

Question 45

Screening of prostate cancer is done by a blood test called:

Answer 45

Prostate Specific Antigen

Question 46

The Gleason system assigns a value based on the ____ of malignant cells.

Answer 46

grade

Question 47

The hockey stick field extends superiorly from to the bottom of the ischial tuberosity.

Answer 47

T-10

Question 48

Which lymph node group is most commonly involved in testicular cancer?

Answer 48

Para-aortic

Question 49

A hard nodule in the peripheral area of the prostate gland is typical of:

Answer 49

a malignant tumor

Question 50

The vast majority of prostate cancers first develop in the _______ zone.

Answer 50

peripheral

Question 51

The prostate gland is located ___ to the seminal vesicles and bladder, ___ to the rectum, and ____ to the symphysis pubis.

Answer 51

inferior, anterior, posterior

Question 52

____ is the only established lifestyle risk factor for developing pancreatic cancer?

Answer 52

smoking

Question 53

What is the definition of achalasia?

Answer 53

lack of a nerve plexus to relax the lower esophageal sphincter

Question 54

What is a typical early sign of cancer in the ascending colon?

Answer 54

occult blood in the stool

Question 55

Increased levels of which tumor marker(s) may indicate germ cell cancer? (Mark all that may apply) hCG BRCA-1 LDH AFP PAP PSA

Answer 55

hCG, LDH

Question 56

Which of the following are common acute side effects of radiation treatment to the pelvic region may include. (Mark all that apply) Fibrosis Dysuria Gynecomastia Cystitis Fatigue Diarrhea Erythema Proctitis

Answer 56

Dysuria Fatigue Diarrhea Erythema

Question 57

What is the staging system used in management of esophageal cancer? (select all that apply)

Answer 57

TNM

Question 58

Colorectal cancers are the _______ most common cancer in the United States.

Answer 58

third

Question 59

Reductions in _______ intake in both Japan and the United States have coincided with _______ rates in colon cancer.

Answer 59

fiber; increasing

Question 60

In several studies, high levels of _______ consumption were associated with distal, but not proximal, colon cancer.

Answer 60

processed meat

Question 61

Currently, _______ remains the gold standard for colon cancer screening.

Answer 61

endoscopic colonoscopy

Question 62

The total preoperative radiation dose for rectal tumors is _______ Gy.

Answer 62

50.4

Question 63

Preoperative external beam radiation therapy increases overall mortality in patients with colon cancer.

Answer 63

False

Question 64

Endometrial cancer is the most common gynecologic malignancy.

Answer 64

True

Question 65

Cancers of the ____ are the most deadly type of gynecologic cancer.

Answer 65

ovaries

Question 66

The uterine walls contain which of the following tissue layers? endometrium myometrium perimetrium

Answer 66

d) 1, 2, and 3

Question 67

The molecular genetics and histology of gynecologic cancers can vary significantly

Answer 67

True

Question 68

Uterine carcinomas arise from ______ tissues.

Answer 68

epithelial

Question 69

Patients who have advanced vaginal cancer might receive: 1. EBRT of involved inguinal lymph nodes. 2. EBRT of involved para-aortic lymph nodes. 3. brachytherapy.

Answer 69

d) 1, 2 and 3

Question 70

The most important risk factor for prostate cancer is:

Answer 70

age

Question 71

Incidence of and mortality from prostate cancer vary significantly based on: 1. socioeconomic status. 2. geographical region. 3. ethnicity.

Answer 71

d) 1, 2, and 3

Question 72

The principal screening methods for prostate cancer are the prostate specific antigen (PSA) test and:

Answer 72

digital rectal examination (DRE).

Question 73

The cancer detection rate is higher when the PSA test and DRE are used in combination than for either test alone.

Answer 73

True

Question 74

What causes differences in prostate volume, shape, and position between the volume study and the operating room? 1. imaging technique 2. equipment 3. patient positioning

Answer 74

1, 2 and 3

Question 75

What is the TD 5/5 of the Bladder (whole organ)?

Answer 75

6500cGy

Question 76

When treating a prostate patient with radiation, what is the dose limit to the rectum in cGy?

Answer 76

6000

Question 77

What is the most critical structure when treating a seminoma with opposed hockey stick fields?

Answer 77

Kidney

Question 78

What is the most critical structure when treating a prostate cancer with radiation therapy?

Answer 78

Rectum

Question 79

What is the TD 5/5 of the femoral heads?

Answer 79

52 Gy

Question 80

What is the TD 5/5 of the kidney? (whole organ)

Answer 80

23 Gy

Question 81

What is the TD 5/5 of the Stomach? (whole organ)

Answer 81

50 Gy

Question 82

Which urinary cancer can be treated by filling the organ with chemotherapy?

Answer 82

Bladder

Question 83

Which isotopes are used for prostate brachytherapy treatment? (Mark all that apply)

Answer 83

iodine 125