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Skin Radiation therapy > GI (anal, pancreas, liver) > Flashcards

GI (anal, pancreas, liver) Flashcards

1
Q 
which of he following nodal areas wouldn't be included in T3N1 rectal cancer?
A: pre sacral
B:  in IL
C: Ext IL
d: MESORECTUM
A

C

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2
Q 
for T2N1 gastric cancer which of the following regions may be excluded from RT tx fields
A: gastric remnant 
B: splenic hilum LN
C: celiac axis
D: porta 
E: pancreatic duodenal nodes
A

E

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3
Q 
Many LN areas are treated in both rectum and anal cancer except which of the following:
A: ING 
B: MESORECTUM]
C: EXT IL
D: Presacral
A

A

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4
Q 
which of the following are appropriate tx for adjuvant Tx for pancreatic cancer?
A: Adjuvant cx 
B: adjuvant chemoradiation 
C: clinical trial 
D: all of the above
A

D

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5
Q

OARS for anal cancer

A

fem heads, bladder, genitals, sm bowel, lg bowel and iliac crests

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6
Q

bladder dose constraint

A

<50% 35 gy

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7
Q

genitals dose constraint

A

<50% 30Gy

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8
Q

iliac crests constrraint

A

<50% 40 Gy

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9
Q

pt tx setup anal

A

supine with legs in foreleg position with patient with full bladder
Pt gets IV and oral contrast

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10
Q

Target volumes in anal cancer

A

GTV= tumour + LN
CTV= GTV +2-2.5cm
CTV ln= GTV+1.5cm
PTV= CTV + .7-1CM

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11
Q

what LN areas are at risk for anal cancer

A

mesorectum, pre sacral, int and ext IL & ING LN

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12
Q

anal XRT dose chemo+XRT vs XRT alone

A

45-50.4/25-28 for chemorads

60-65/33-35 XRT alone

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13
Q

boost plan doses in anal cancer

A 
PTV=50.4-54GY for T1-2
PTV=54-59GY for T3-4 
PTV LN 
PTV ln >3 cm 54-59.4GY
PTV <3 cm 50.4-54Gy
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14
Q

most common anal presentation

A

bleeding and anal discomfort

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15
Q

proximal anal tumours present with ____ symptoms

A

obstructive

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16
Q

small anal tumours have what type of appearance

A

nodular plaque like tumour

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17
Q

large anal tumurs havre what type of appearance

A

ulcerated and infiltrative

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18
Q

IS ANAL CANCEL COMMON OR UNCOMMON

A

V UNCOMMON

2% of all GI cancers- 600 dx/ yr

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19
Q

age for anal cancer

A

50-70 yo

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20
Q

is ana and perianal l cancer mor common in men o women

A

anal is more common in women

perianal area is same in m and w

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21
Q

factors that + risk of anal cancer

A

HPV, HIV, chlamidya, anal sex, smoking

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22
Q

how long is the anal canal

A

3-4cm

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23
Q

what is the tim for where the squamous cells turn into the columnar cells in the anal canal

A

the dentate / pectinate line

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24
Q

lymphatics above dentate line

A

perirectal, int Il & lat sacral LN

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25
Q

lymphatics below dentate line

A

ING LN

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26
Q

LN spreads _____ in anal cancer

A

early

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27
Q

what LN spread is most common and second most common in anal cancer

A

perirectal then ING LN

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28
Q

is anal canal or anal margin more common

A

85% anal canal

15% anal margin

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29
Q

how many ptr present with distant mets anal cancer

A

10% have distant mets at dx

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30
Q

what % pelvic LN and iNG LN are + at dx in anal cancer

A

pelvic 30%

ing 15-35%

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31
Q

sites of distant mets in anal cancer

A

liver and lungs

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32
Q

APR for anal cancer

A

used for very early cancer or for salvage treatment

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33
Q

treatment for anal cancr

A

typically chemorads - surgery for salvage treatment

chemo 5FU +MMC (mitomycin C) on week 1-4 of XRT which is 45-50.4Gy

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34
Q

most common SE of anal cancer

A

SCC- 80%

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35
Q

what subtypes of anal cancer occur most commonly near dentate line

A

basaxoid snd callogenic sybtypes

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36
Q

what subtype of anal cancer has worse prognosis

A

basaloid - it is located near dentate lin

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37
Q

SCC anal cancer is usually proceeded by

A

AIN

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38
Q

What blood level is a prognostic indicator for anal cancer

A

hemoglobin levels

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39
Q

what blood levels can be used in diagnosing liver cancer

A

serum alpha fetaprotein`

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40
Q

in early stages what are the symptoms of liver cancerq

A

they are asymptomatic

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41
Q

later stage liver cancer S&S

A

abdominal pain, N&V, wt loss, Diahrrea, weakness welling of limbs , hepatic encepalopATHY

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42
Q

Hepatic ncepalopathy S&S

A

breath with sweet musty doors
confusion, forgetfulness
coma, shaking ‘
nervousness, anxiety, personality/ mood changes

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43
Q

where is abode pain most common in liver cancer

A

upper right quadrant

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44
Q

what countries is HCC most common in

A

asia and africa

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45
Q

age for HCC

A

40-60 in developed countries and 20-40 yo in developing countries

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46
Q

is the incidence of HCC +/-

A

its increasing due to hepatitis C , B and HIV

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47
Q

Hepatitis C is associated with ____ disease

A

ulticenteric

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48
Q

chirosiss of the liver and the development of cancer

A

1-4%/year risk of HCC diagnosis

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49
Q

western world HCC is most commonly associated with

A

Hepatitis C

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50
Q

Is liver cancer more common in Mor W

A

2-3 X more common in M than women

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51
Q

what causes cholangiocarcinoma

A

UC, liver flukes, exposure to thrum dioxide

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52
Q

gallbladder cancer occurs in what ages

A

50-70

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53
Q

what is required to cure gallbladder cancer

A

surgical

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54
Q

how many lobes of the liver

A

4

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55
Q

what are th lobes of the liver

A

rt and lt and caudate and quadrate lobes

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56
Q

what is the falciform ligament

A

demarcates the lt and rt lobes of he liver

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57
Q

most of the blood in the liver comes from where?

A

portal vein

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58
Q

function of the liver

A
  • makes bile
  • filters substances from blood
  • stores vitamins & releases them as needed
  • metabolized carbohydrates
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59
Q

what LN are most commonly involved in Liver cancer

A

hilar and portal Ln

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60
Q

what are areas of distant mets in liver cancer

A

bone skin, brain and lung

61
Q

what is child push score

A

is a prognostic indicator used for liver cancer and takes into consideration:
-ascities, bilirubina Lvl, albumin lvl, photothrombotin time hepatic encephalopathy

62
Q

typical treatment for liver cancer

A

surgery (however not typically possible) then chenorads (21/7) with doxorubicin +5 FU every other day

63
Q

what liver treatment gives the best outcomes

A

liver transplant/ resection

64
Q

liver resection indications

A

small tumours with preserved liver function with no chirrosis and a childs put score of A

65
Q

Liver transplant indications

A

its with chirossis, single HCC <5cm in 1 nodule or3 nodules <3cm

66
Q

percutaneous ablative procedures list

A

ethanol injection, RFA, TACE

67
Q

Ethanol injection indications

A

small tumours with preserved liver function <5cm several injections are required

68
Q

RFA proceeder

A

high frequency radio waves are given to tumour by sticking thin needle like probe into the tumour is best for tumour <4 cm not good if its close to the GI mucosa, diaphragm, large vessels

69
Q

TACE

A

transarterial chemoembolization lipid is injected in liver cancer through the blood supply of liver with or without chemo agents: 5FU, cisplatin, doxorubicin, mitomycin C and epirubicin used for palliation and unresectable tumours

70
Q

HCC is radio ______.

A

sensitive

71
Q

what liver cancer is most common in children

A

hepatoblastoma

72
Q

what is the most common live tumour type

A

HCC (hepatocelular carcinoma)

73
Q

what are HCC subtyps

A

HCC conventional and HCC fibrolamellar variant

74
Q

What HCC has the best prognosis

A

HCC FIBROLAMELAR Variant has best prognosis

75
Q

what SE for liver cancer

A

N&V, fever and pancytopenia (n.b. pancytopenia is - in all blood levels platelets, WBC, RBC)

76
Q

What is the only curative treatment for biliary and gallbladder cancer

A

surgery

77
Q

how often is biliary gallbladder cancer unresectable? why?

A

60-80% of cases due to comorbidities, nets, vascular involvement etc.

78
Q

main cancer of the bile ducts is called

A

cholangiocarcinoma

79
Q

lN dos commonly involved in cholangiocarcinoma

A

pericholedochal, peripancreatic, hilar

80
Q

distant mets in cholangiocarcinoma

A

to liver and peritoneum

81
Q

which cholangiocarcinoma is moreresectable

A

distal is more resectable than perihilar

82
Q

gallbladder cancer usually presents at ____ stage

A

advanced

83
Q

therapies for resectable vs unresectable cholangiocarcinoma

A

if resectable pt will get surgery followed by chemorads

for unresectable pt may be radiation alone +/- Cx

84
Q

tx plan for biliary duct cancer

A

3-4 field arrangement

AP and lats or AP.PA and lats

85
Q

most common S&S of gallbladder ca

A

pain then anorexia and N&V

86
Q

pts with intrahepatic cholangiocarcinoma presentation

A

jaundice and abdominal S&S

87
Q

What levels may be elevated in liver cancer and cholangiocarcinoma

A

CA19-9 >100U/ml

88
Q

how common is cholangiocarcinoma

A

155 of all liver cancers

89
Q

gallbladder cancer gender

A

more common in women 2.5:1`

90
Q

cholangiocarcinoma risk factors western vs eastern countries

A

in general the risk factors are similar to that of liver cancer
western countries: IBD, hepatitis C and UC
Easton countriesL chronic infections of the biliary tract and liver flukes

91
Q

gallbladder cancer causes

A

porcelain galbladder, obesity, smoking and alcohol and its with polyps >10mm

92
Q

cholangiocarcinoma LN drainage

A

hepatoduodenal ligament ->paraaortic nodes -> retropancreatic nodes

93
Q

tagret volume cholangiocarcinoma

A

GTV tumour made visible by the CT
CTV =GTV+1.5cm expansion
PTV=CTV +.5cm- 1cm margin

94
Q

Dose cholangiocarcinoma

A

45-50

95
Q

most common hepatobiliary tract tumour

A

gallbladder in 2.3 of cases the remaining 1/3 is the bile duct

96
Q

most bile duct tumours are what pathology

A

adenocarcinoma

97
Q

subtypes of adenocarcinoma in bile duct cancers

A
  • sclerosing (most common)

- nodular and papillary

98
Q

what adenocarcinoma subtype is the best prognosis for biliary tumours

A

papillary

99
Q

what adenocarcinoma subtype is the worst prognosis for biliary cancers

A

nodular

100
Q

pt positioning for pancreas

A

supine with arms above head

101
Q

liver constrain for pancreas tx

A

70% liver <30Gy

102
Q

field borders for pancreas

A

Superior: T11 but may extend more superiorly with body lesions to obtain an adequate margin on the primary lesion
Anterior: 1.5-2 cm beyond gross disease
Posterior: 1.5 cm behind the anterior portion of the vertebral body

103
Q

LN included in tx of the pancreatic head

A

pancreaticoduodenal, porta hepatis, celiac and superior mesenteric

104
Q

tx fields for pancreatic head

A

The entire duodenal loop + margin is included
Sup: T11
Inf: L2-L3
Lats: 1.5-2 cm beyond gross disease
The dose to the lats is limited to 15-18Gy as the kidney is in the lat fields

105
Q

IMRT for resectable pancreatic cancer

A

45 Gy in 1.8 Gy/fraction followed by a 5.4 GY in 1.8 Gy/fraction boost to the tumour bed with a 2 cm margin

106
Q

IMRT of unresectable pancreatic cancer

A

Treat gross tumour with a smaller 1 cm margin to 54-59.4 GY in 1.8 Gy/fraction

107
Q

most common presentation of pancreatic cancer

A

Most common: jaundice, abdominal pain, anorexia , weight loss

108
Q

pancreatic cancer usually presents ____

A

late

109
Q

urine/ stool presentation on pancreatic cancer what does this indicate?

A

Dark urine, light stool system resulting in excess bilurubin to excrete in the urine and less bilrubin to be excreted in the stools
Indicates obstruction of the bilary

110
Q

what part of the pancreas is most likely to get tumours

A

head and neck is more common than body and tail of the pancreas

111
Q

tumours of the body and tail of the pancreas typically has wha presentation

A

back pain and weight loss

112
Q

tumour of the head and neck of the pancreas s&s

A

jaundice by invading or compressing the bile duct , they also are associated with steatorrhea, weight loss and pain

113
Q

what other s&s are accompanied by jaundice

A

itching and pruritis

114
Q

what imaging is the best in the diagnosis of pancreatic cancer

A

CT is the best

115
Q

what blood test can detect pancreatic csncer

A

CA-19-9 but it is not used in diagnosis as it is also elevated in other GI cancers, ovarian cancer

116
Q

what is an elevated ca19-9 level

A

> 37 ml

117
Q

ethnicity of pancreatic cancer

A

more common in blacks than whites

118
Q

age pancreatic cancer

A

50-80 yo

119
Q

what mutations is pancreatic cancer associated with

A

BRCA1-2

120
Q

What other cancers diagnoses are associated with + risk of pancreatic cancer

A

breast and colorectal

121
Q

what dietary/ lifestyle factors are associated with pancreatic cancer

A

smoking, obesity type 2 diabetes + fat and red meat intake

122
Q

what syndromes are pancreatic cancer associated with

A

FAP, Lynch syndrome, Peutz-Jeghers syndrome, Li fraumeni and helicobacter pylori infections

123
Q

LN drainage of the head of the pancreas

A

pancreaticduodenal, porta hepatic, celiac and superior mesnteric

124
Q

Body and tail of the pancreas LN drainage

A

splenic artery, inferior pancreatic, celiac, superior mesenteric and para-aortic nodal basins

125
Q

t level of the pancreas

A

between the L1-L2 levels

126
Q

pancreas divisions

A

head tail, body and neck

127
Q

lt side of pancreas drains to what LN

A

splenic hilar LN

128
Q

RT side of the pancreas drains o what

A

post and ant pancreatic duodenal LN and RT par aortic Ln

129
Q

pancreatic head and body and neck spread to ____ and the tail spreads o____

A

head body and neck spread to to duodenum and the tail spreads to the spleen

130
Q

what stage is pancreatic cancer usually diagnosed at

A

metastatic disease

131
Q

what prt of the pancreas most commonly has metastatic disease

A

body and tai more commonly has mets than the head and neck

132
Q

most common sites of distant mets for pancreatic cancer

A

liver, peritoneum, lungs and bone

133
Q

COD for pancreatic cancer

A

result of hepatic failure, secondary to biliary obstruction

134
Q

median survival resectable vs unrsectable pancreatic tumours vs metastatic

A

resectable: 13-20 months
unresectable: 8-14 months
mets: 4-6 months

135
Q

what tumour is whipple procedure used to treat

A

pancreatic head and sometimes gallbladder cancer

136
Q

whipple procedure description

A

The removal of the head of the pancreas, duodenum, proximal jejunum (first 15 cm), gallbladder and part of the (distal) stomach and common bile duct, the rest of the pancreas, dil ducts and stomach is reanamastosed

137
Q

what surgery is used for head of pancreas? tail?

A

head is whipple procedure

tail is distal pancreatectomy with splenectomy

138
Q

main pathology of pancreatic cancer

A

adenocarcinoma

139
Q

side effects of XRT for pancreatic cancer

A

Most common is nausea and vomiting ( antiemetics may be given)
Less common side effects are leukopenia ( low white blood cell count), thrombocytopenia (low thrombocytes), diarrhea and stomatitis

140
Q

typical dose for pancreatic XRT

A

50.4 with field eduction after 45Gy

141
Q

a portion of the 4 field treatment of the pancreas has a limited dose? why ? what dose is it limited to?

A

the lats have a maximum dose contribution of 20Gy in order to avoid over dosing the kidneys which would be treated in the lat fields

142
Q

functions of the pancreas

A

an exocrine function that helps in digestion and an endocrine function that regulates blood sugar.

143
Q

function of the biliary ducts

A

To drain waste products from the liver into the duodenum. To help in digestion with the controlled release of bile.

144
Q

function of the galbladder

A

Its primary function is to store and concentrate bile(which breaks down the fat in food)

145
Q

XRT for locally advanced pancreatic tumours

A

LN are no included and it is limited to the tumour itself

146
Q

typical treatment for pancreatic cancer

A

resection if possible followed by adjuvant chemorads 50.4/28 with concurrent 5FU+ gemacatabine

147
Q

what chemo agents are used for pancreatic cancer

A

5FU + gemcetabine

148
Q

IORT for radiation therapy

A

Used to target tumour bed and is accomplished by isodose of 10-20Gy intraoperative electrons as a boost following 50.4Gy delivered with external beam radiation therapy its advantage is to deliver more dose to the primary because of all the dose limiting structures which are shielded in IORT

Skin Radiation therapy (40 decks)

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