Ch 14 pathology #2 Flashcards
No matter how great the treatment planning,
there will always be normal tissue exposed
to radiation because (3)
- Malignant tumors infiltrate normal structures
- Normal tissue and blood cells are within the tumor
- Entrance and exit doses
Acutly and late responding tissues are based on ___
time
Late responding tissues show effects after ___ days
90
Something that can be restored is considered
Acute effect
Something that improved but not restored is considered ___ effect
Chronic effect
Regardless of time of expression, the cause is the same - Which is?
Depletion of parenchymal
Acute effects on hair doses
- Temporary at
- Permenant at
- 20-30 Gy
- 50 Gy
Primary chronic effect occurs as result of depletion of ____ ____ and appear ___
- Non-parenchymal cells
- later
Secondary chronic effect occurs as consquence of ___ ___ ___ and appear ___
- sever acute effect
- sooner
Both primary and secondary chronic effects are
permanent and irreversible
HEALING: “REGENERATION”
- Replacement by ___ type of cell
- ____ organ to pre-irradiated state
- Associated with ___ effects
- same
- restoring
- acute
HEALING: “REPAIR”
- Replacement by ___ type of cell
- (3) heal by repair instead of restoration
- Different
- Catastrophic, irreversible and acute changes
HEALING: REGENERATION
OR REPAIR
- A function of ___ and ___
- Dose and specific organ
HEALING: “REGENERATION”
- Occurs after doses (3)
- Maintains an organs ability to ___ ___
- All are ___ ___ normal tissue
- Low, moderate and high
- Actively divide
- Acutley responding
HEALING: REPAIR
- Occurs in ___ doses after destroying ___ cells
- ___ responding organs with ___ dividing cells
- Higher, parenchymal
- Late, slowly
Acute Responding Tissue show changes ___ vs ___Responding Tissue given same dose
- Sooner
- Late
Acutely responding normal tissue – shows ___ changes sooner, but may be ___
- Severe
- Restored
Acute changes are characterized by (4)
- Hemorrhage
- Edema
- Denudation of muscosal surfaces
- Inflammation
Chronic changes are characterized by (5)
- Fibrosis
- Atrophy
- Ulceration
- Stricture
- Obstruction
___ is the most critical factor in determination
Time
2^0 comes from ___ effect
acute
___ - the ultimate 2^0 chronic effect
Necrosis
Fractionation: ___cGy/day over __-__ weeks,
standard fractionation
- 200
- 4-6
Dose administered in multiple fractions is
biologically ___effective than a single dose
Less
SKIN: ACUTE CHANGES.
From moderate to high doses (4)
- Inflammation
- Erytherma
- Dry desquammation
- Moist desquammation
Sun burn occurs as ___ Gy
10
Skin chronic changes occur at ___ Gy
20
alopecia doses
- Temp Gy
- Permanent Gy
- 4-10 Gy
- > 50 Gy
Digestive system:
Moderately High dose over ___cGy
Produce ulceration, atrophy, fibrosis. Lasts
several ___to ___ year
- 5000
- months, one
The most radiosensitive portion of the GI tract is the
small intestine
GI tract is generally considered ___:
___cGy can cause atrophy, strictures, fibrosis, ulceration.
- Radiosensitive
- 500
DIgestive system:
The ___ is one of the major consideration in treatment planning.
- GI tract
DIGESTIVE SYSTEM-
ACCESSORY ORGANS
- Xerostomia occurs at ___ cGy
- 2000
Liver Radiation hepatitis @ ___-___ cGy. Clinical significance depends of volume treated.
3000-4500 cGy
Sometimes included in treatment fields of kidney, lymphomas, ovarian ca.
Liver
Liver Late effects include (3)
- Fibrosis
- Jaundice
- Liver failure
List follicle from most radio senstive to resistant
- Intermediate follicle
- Mature (Large) follicle
- Small follicle
Dose required to produce sterility is a function of
Age
Generally, > ___ Gy produces sterility in all women.
- 6.25
terility in female may cause ___ having profound physical and psychological effects
- artificial menopause
Blood vessel damage results in ___
occlusion
Vasculature clinical presentation (4)
- Petechial hemorrhages
- Telangictasia
- Vessel sclerosis
- Hardening
Vessels supply ___ and ___ to organs
O2 and nutrients
Smaller vessels are more or less radio sensitive?
More (damage to liver and kidney***)
Heart
- Undamaged at ___ and ___ doses
- High doses produce ___ and ___
- Normal dose of ___ cGy
- Low and moderate
- Pericarditis and pancarditis
- 4000
The heart is radioresistant because it has ___ cells
Postmototic
Mature bone and cartilage are radio___ because is has ___ cells
- Resistant
- Nondividing
Growing bone and cartilage are moderately
radio___ because it has ___ cells
- Sensitive
- Dividing
Radiation injury to growing bone is also a result of damage to ___ and bone marrow
- Small vessels
- Bone marrow
Bone and cartilage:
Moderate doses temp. inhibit ___
Mitosis
Bone and cartilage:
Most effects are ___ changes
Late
Bone and cartilage:
Fractionated doses > ___ cGy in children, less than ___ years of age show significant effects, such as learning difficulties and stunted growth
- 2000
- 2
Bone and cartilage:
- Doses of ___ cGy to children causes temporary effects stunting height by the time they are adults
- Dose above ___cGy can lead to permanent effects in growing bone
- 100
- 1000
Bone:
Late effects are highy dependant on ___
Age
Bone:
Radiation osteitis seen as a___ effect in ___ bone
irradiation. Presenting with ___.
- Late
- Adult
- Pain
Radiation induced sarcoma of the bone is ___ cGy
- 5000
Respiratory system
- Consists of (4)
- Nose
- Lungs
- Pharymx
- Trachea
Lungs:
- Responsive at ___ doses
- Relatively radio___
- High
- Resistant
___ of the lungs is the primary early change
after irradiation. Occurs at ___ doses.
- Inflamation
- Moderate
___ cGy to both lungs can be lethal
2500
RESPIRATORY SYSTEM:
Response is dependent on ___
- Volume
RESPIRATORY SYSTEM:
Main reaction is ___
Pneumonitis
Urinairy system consists of (4)
- Kidney
- Ureters
- Bladder
- Urethra
Kidney:
- Must be shielded at ___ cGy total dose when both
kidneys are included in treatment field.
- ___ cGy to both kidneys in 5 weeks results in high
probability of fatal radiation nephritis
-___ minimizes renal failure***
- 2600
- 2800
- 1/3
The urinary system is considered relatively
radio___.
Resistant
___ cGy to both kidneys can lead to renal failure
and death
2500
URINARY SYSTEM:
Main reaction
Clinical Nephritis
(Inflamation of the kidneys)
Damage to bladder occurs after ___ months with a
large single dose (in mice)
6
Bladder:
Major change is ___
Epithelial dendation
Bladder:
Fibrosis of muscularis after ___ months
12
Urinary system doses: cGy
- Acute cystitis
- Chronic cystitis
- Contraction/Hemorragic
- 3000-4000
- 5000
- 7000
Urinary system:
main reaction
Symp. bladder conracture and volume loss
CENTRAL NERVOUS SYSTEM:
Is relatively radio___
Resistant
CENTRAL NERVOUS SYSTEM:
Is considered the most ___ ___ system un the adult
Radioresistant
CENTRAL NERVOUS SYSTEM:
Early changes after high dose include ___
Myelitis (inflammation of the brain)
CENTRAL NERVOUS SYSTEM:
- Early changes due to
- Chronic changes due to
- Loss of glial cells
- damage to vasculature
CENTRAL NERVOUS SYSTEM:
White or gray matter more radiosensitive
White matter
Gray matter forms what shape in the white matter
“H”
White matter is the tissue through which ___
pass
Messages
CENTRAL NERVOUS SYSTEM: Doses cGy
- Delayed radiation necrosis of brain
- Radiation myelitis (small volume)
- Radiation myelitis (large volume)
- 5000
- 5000
- 4500
Spinal cord is often included in
treatments of which cancers (3)
- Lung
- Esophagus
- Hodgkins
CENTRAL NERVOUS SYSTEM:
Brain and Spinal cord is considered radio___ because it has ___ nerve cells
- Resistant
- Fixed Post-mitotic
CENTRAL NERVOUS SYSTEM:
Fibrosis and necrosis can occur @ ___ cGy
2000
CENTRAL NERVOUS SYSTEM:
20% response in childhood tumors with dose ___ cGy and ___ fractions
- 3600
- 20
CENTRAL NERVOUS SYSTEM:
Acute reaction to cranial irradiation include (3)
- Headache
- Nausea
- Somnolence
CENTRAL NERVOUS SYSTEM:
Cerebral edema and changes is vascular permeability are controlled with ___
Corticosteroids
CENTRAL NERVOUS SYSTEM:
“Early delayed” symptoms include (2), at ___ to ___ months post treatment
- Somnolence, fatigue
- 1 to 4
