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P & P II > Chapter 33 WS > Flashcards

Chapter 33 WS Flashcards

1
Q

two types of polyps found in the colon

A

Villous adenomas and Tubular adenomas

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2
Q

which type is most likely to become malignant? (Villous adenomas or Tubular adenomas)

A

villous adenomas

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3
Q

what is FAP and how is it treated?

A

The studding of the entire large bowel wall by thousands of polyps.

Treated by completely removing the colon and rectum.

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4
Q

what is HNPCC?

A

Hereditary nonpolyposis colorectal syndrome (Lynch syndrome).

Inherited disorder that greatly increases the risk of colorectal cancers due to repair gene mutations.

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5
Q

What are symptoms/clinical presentations of rectal cancer.

A
  • Rectal bleeding
  • change in bowel habits
  • diarrhea versus constipation
  • change in stool caliber
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6
Q

Distinguish between symptoms/clinical presentation of cancers of the left side of the colon versus the right

A

Left Side of Colon: blood in stool, change in stool caliber, obstructive symptoms, and abdominal pain

Right Side of Colon: abdominal pain often accompanied with an abdominal mass, nausea, vomiting, occult blood in stool.

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7
Q

an anterior extrarectal mass may be indicative of _______

A

peritoneal seeding

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8
Q

how do colorectal cancers spread to the supraclavicular lymph nodes

A

As a result of spread from metastatically involved paraaortic nodes via the thoracic duct.

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9
Q

What imaging studies are performed in the staging workup for colorectal cancer.

A
  • Chest x-ray to detect mets to lungs,
  • CT scan or MRI of pelvis to determine if tumor extends into other pelvic organs or lymph nodes,
  • CT scan of abdomen to see if liver involved,
  • PET to determine mets.
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10
Q

ascending colon: intraperitoneal or retroperitoneal?

A

retroperitoneal

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11
Q

descending colon: intraperitoneal or retroperitoneal?

A

retroperitoneal

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12
Q

cecum: intraperitoneal or retroperitoneal?

A

intraperitoneal

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13
Q

transverse colon: intraperitoneal or retroperitoneal?

A

intraperitoneal

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14
Q

sigmoid colon: intraperitoneal or retroperitoneal?

A

intraperitoneal

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15
Q

hepatic flexure: intraperitoneal or retroperitoneal?

A

retroperitoneal

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16
Q

splenic flexure: intraperitoneal or retroperitoneal?

A

retroperitoneal

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17
Q

define peritoneal seeding

A

Tumor cells break off and shed into the abdominal cavity then take up residence on another surface.

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18
Q

Tumor cells break off and shed into the abdominal cavity then take up residence on another surface.

A

peritoneal seeding

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19
Q

what is the main dose limiting structure when treating colorectal cancer

A

Small bowel

If treating the ascending or descending colon, then kidney is also a dose-limiting structure.

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20
Q

acute side effects of radiation to the colon

A
  • diarrhea
  • abdominal cramps and bloating
  • proctitis
  • bloody or mucus discharge
  • dysuria

Also, leukopenia and thrombocytopenia. Chemoradiation increases gastrointestinal and hematologic toxicities. If perineum treated then moist desquamation can occur to this area.

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21
Q

chronic side effects of radiation to the colon

A
  • Persistant diarrhea
  • increased bowel frequency
  • proctitis
  • fistula
  • urinary incontinence
  • bladder atrophy.

Most common is enteritis, adhesions, and obstruction caused by damage to the small bowel.

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22
Q

What is the purpose of the surgeon placing clips during surgery for colorectal cancer.

A

To demarcate the tumor bed so radiation oncologist can more precisely outline the area at risk, thus using smaller treatment volumes

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23
Q

how does a full bladder change the location of the small bowel

A

pushes the small bowel more superiorly

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24
Q

What foods should patients avoid eating when being treated with radiation for colon cancer.

A
  • whole grain breads or cereals
  • fried or fatty foods
  • milk and milk products
  • raw vegetables
  • fresh fruit.
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25
Q

what foods are recommended for patient being treated to the colon

A
  • White bread,
  • meat baked, broiled, or roasted until tender,
  • macaroni,
  • cooked vegetables
  • peeled apples and bananas.
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26
Q

define dentate line of rectum

A

Also known as pectinate line. Divides the upper 2/3 and lower 1/3 of the anal canal. Line at which the cells transition from stratified squamous epithelium to columnar epithelium (cuboidal at dentate line)

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27
Q

define anal verge

A

The surface of the ringed opening of the anus. It is the lower edge of the anal canal that marks the junction of the anal canal and the external hair-bearing skin.

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28
Q

what are OARs

A

organs at risk

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29
Q

What are the OAR in the treatment for anal cancer.

A
  • Femoral heads and neck,
  • genitalia/perineum,
  • small bowel,
  • bladder.
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30
Q

define unresectable

A

tumor cannot be surgically removed

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31
Q

What are the two most important etiologic factors in the development of squamous cell carcinoma of the esophagus in Western countries.

A

excessive alcohol and tobacco use

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32
Q

At what vertebral body does the esophagus start and when does it terminate

A

starts at C6 and ends at T10/11

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33
Q

define barrett esophagus

A

A condition in which the distal esophagus is line with a columnar epithelium rather than a stratified squamous epithelium, usually due to gastroesophageal reflux. The cells undergo metaplasia.

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34
Q

A condition in which the distal esophagus is line with a columnar epithelium rather than a stratified squamous epithelium, usually due to gastroesophageal reflux. The cells undergo metaplasia.

A

barretts esophagus

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35
Q

define achalasia

A

A disorder in which the lower 2/3 region of the esophagus loses its normal peristaltic activity and prohibits the passage of food into the stomach

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36
Q

A disorder in which the lower 2/3 region of the esophagus loses its normal peristaltic activity and prohibits the passage of food into the stomach

37
Q

define tylosis

A

Inherited disorder (rare). Mutation on Chromosome 17 is thought to be the reason for the disorder. Results in excessive skin growth on palms of hands and soles of feet.

38
Q

Inherited disorder (rare). Mutation on Chromosome 17 is thought to be the reason for the disorder. Results in excessive skin growth on palms of hands and soles of feet.

39
Q

List the layers of the wall of the esophagus

A

Mucosa, submucosa, muscular, adventitia(instead of serosal layer

40
Q

What layer is lacking in the wall of the esophagus that is found in the bowel wall.

41
Q

List the nodes that the upper 1/3 of the esophagus drain into.

A
  • Internal jugular, cervical
  • paraesophageal
  • supraclavicular lymph nodes.
42
Q

List the nodes that the thoracic portion of the esophagus drain into.

A
  • Paratracheal
  • hilar
  • subcarinal
  • paraesophageal
  • paracardial lymph nodes.
43
Q

List the nodes that the lower third (distal) of the esophagus drain into.

A
  • Celiac
  • axis
  • left gastric nodes
  • nodes of the lesser curvature of the stomach.
44
Q

What foods should patients avoid eating when being treated with radiation to the thoracic area.

A
  • Hot and spicy foods,
  • dry to coarse foods,
  • crackers, nuts, and potato chips,
  • raw vegetables,
  • citrus fruits,
  • juices,
  • alcoholic beverages
45
Q

what foods are recommended for patients being treated with radiation therapy to the thoracic area

A
  • Cottage cheese,
  • yogurt, and milkshakes,
  • puddings,
  • casseroles,
  • scrambled eggs,
  • meats and vegetable in sauces or gravies
46
Q

List the main lymph nodes that drain the pancreas.

A
  • Superior and inferior pancreaticoduodenal nodes,
  • porta hepatis,
  • suprapancreatic nodes,
  • par-aortic nodes.
47
Q

three parts of the pancreas

A

head, body, & tail

48
Q

what are the four most common presenting symptoms of pancreatic cancer.

A
  • Jaundice,
  • abdominal pain,
  • anorexia,
  • weight loss.
49
Q

most common tumor marker associated with pancreatic cancer

A

CA-19 serum carbohydrate antigen

50
Q

define residual disease as it relates to cancer

A

Small number of cancer cells that remain in body after treatment

51
Q

explain the whipple procedure

A

A resection of the head of the pancreas, entire duodenum, distal stomach, gallbladder, and common bile duct.

Reconstruction follows with the remaining pancreas, bile ducts, and stomach anastomosed into various sites of the jejunum.

52
Q

what organs are removed during a whipple procedure

A
  • head of the pancreas,
  • entire duodenum,
  • distal stomach,
  • gallbladder,
  • common bile duct.
53
Q

A surgical connection of two vessels or tubes

A

anastomosis

54
Q

anastomosis

A

A surgical connection of two vessels or tubes

55
Q

tenesmus

A

spasms of rectum accompained by a desire to empty the bowel

56
Q

spasms of rectum accompained by a desire to empty the bowel

57
Q

colostomy

A

Surgical creation of an artificial opening from the colon onto the abdominal surface

58
Q

Surgical creation of an artificial opening from the colon onto the abdominal surface

59
Q

colonscopy

A

medical examination of the colon using an endoscope

60
Q

medical examination of the colon using an endoscope

A

colonscopy

61
Q

retroperitoneal

A

behind the peritoneal membrane against the abdominal wall

62
Q

behind the peritoneal membrane against the abdominal wall

A

retroperitoneal

63
Q

mesentery

A

A double layer of peritoneum that supports the intestines and conveys blood vessels and nerves to supply the wall of the intestine.

64
Q

A double layer of peritoneum that supports the intestines and conveys blood vessels and nerves to supply the wall of the intestine.

65
Q

Identify the level of vertebral body associated with the umbilicus

66
Q

Identify the level of vertebral body associated with the cecum

67
Q

Identify the level of vertebral body associated with the bifurcation of abdominal aorta

68
Q

Identify the level of vertebral body associated with the common iliac nodes

69
Q

Identify the level of vertebral body associated with the iliac crest

70
Q

Identify the level of vertebral body associated with the start of the rectum

71
Q

Identify the level of vertebral body associated with the spleen

72
Q

what is cisterna chyli

A

A dilated sac at the lower end (beginning) of the thoracic duct into which lymph from the intestinal trunk and lumbar lymphatic trunks flow.

73
Q

A dilated sac at the lower end (beginning) of the thoracic duct into which lymph from the intestinal trunk and lumbar lymphatic trunks flow.

A

cisterna chyli

74
Q

the internal iliac nodes are also known as the _____ nodes

A

hypogastic

75
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): kidney

A

2300 cGy

clinical nephritis

76
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): bladder

A

6500 cGy

symptomatic bladder contracture and volume loss

77
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): femoral head

A

5200 cGy

necrosis

78
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): rectum

A

6000 cGy

severe proctisis/necrosis/fistula/stenosis

79
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): prostate

A

8000 cGy

incontinence

80
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): small bowel

A

4000 cGy

obstruction, perforation, fistula

81
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): esophagus

A

5500 cGy

clinical stricutre, perforation

82
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): colon

A

4500 cGy

obstruction, perforation, fistula

83
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): liver

A

3000 cGy

liver failure

84
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): testes

A

100 cGy

hormonal imbalances, sexual dysfuction, infertility

85
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): stomach

A

5000 cGy

ulceration, perforation

86
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): uterus

A

10000 cGy

necrosis, perforation

87
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): vagina

A

9000 cGy

ulcer, fistula

88
Q

Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): ovaries

A

200 cGy

sterility

89
Q

Tumors in the tail of the pancreas drain to the

A

splenic hilar nodes

P & P II (34 decks)

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