Lab # 4 Lung

Question 1

Lung cancer is the ________ cause of cancer related deaths in both men and women in the U.S., surpassing breast cancer in women

Answer 1

leading

Question 2

The most significant etiology is related to

Answer 2

tobacco and the number of cigarettes smoked.

Question 3

Lung cancer lends itself to ___________ techniques due to tumor location, tumor burden, reduction of tumor, and location of critical structures.

Answer 3

shrinking field (i.e. boost; cone down; off-cord)

Question 4

how many lobes are in the right lung?

Answer 4

three

Question 5

how many lobes are in the left lung?

Answer 5

two

Question 6

what is the major airway into the thoracic cavity?

Answer 6

trachea

Question 7

where does the trachea begin and end?

Answer 7

inferior border of the larynx and ends at the level of T5

Question 8

what is the area of bifurication?

Answer 8

where the trachea divides into the left and right bronchi

Question 9

what is the bifurication of the trachea refered to?

Answer 9

carina

Question 10

the area where the blood, lymphatics, and nerves enter and exit each lung

Answer 10

hilum

Question 11

is the anatomical area separating the lungs; it includes the heart, thymus, great vessels, and other structures that help position the lungs on either side of midline.

Answer 11

mediastinum

Question 12

where do tumor cells gain access to the circulatory system

Answer 12

hilium and carina

Question 13

what is included in the mediastinum

Answer 13

he heart, thymus, great vessels, and other structures that help position the lungs on either side of midline

Question 14

Lung cancer is most frequently divided into

Answer 14

Small Cell Lung Cancer (SCLC) and Non–Small Cell Lung Cancer (NSCLC)

Question 15

what histologies are included in NSCLC

Answer 15

adenocarcinoma, large cell carcinoma, and epidermoid (squamous cell) carcinoma

Question 16

Squamous Cell lung cancer arises most commonly in the

Answer 16

lining and central portion of the lung

Question 17

Adenocarcinoma arises more often in the

Answer 17

periphery of the lung

Question 18

_________ is now the most common form of lung cancer in North America.

Answer 18

adenocarcinoma

Question 19

is it becoming more and more common for nonsmokers and never smokers to present with which histology?

Answer 19

adenocarcinoma

Question 20

what is another name for small cell lung cancer

Answer 20

oat cell lung cancer

Question 21

where does SCLC arise?

Answer 21

in the central region

Question 22

Due to its rapid growth, SCLC has an early _____ and _____ involvement

Answer 22

lymphatic spread

Superior vena cava

Question 23

what are some signs of superior vena cava syndrome

Answer 23

swollen face, telangiectasia, and shortness of breath due to tumor obstruction

Question 24

is superior vena cava syndrome an oncologic emergency?

Answer 24

yes

Question 25

what are the primary routes of spread for lung cancer?

Answer 25

blood, lymphatics, and intrathroacic direct extension

Question 26

what is the order of lymphatic involvement

Answer 26

intrapulmonary nodes  hilar nodes  mediastinal nodes  supraclavicular (S/C) nodes.

Question 27

Involvement of the S/C nodes increases disease incidence in the ________ or __________

Answer 27

superior mediastinal nodes or upper lobe of the lung.

Question 28

which type of lung cancer is usually treated with PCI as well

Answer 28

SCLC

Question 29

when is PCI performed?

Answer 29

after a patient's lung radiation therapy

Question 30

where does lung mets occur most often in the

Answer 30

cervical lymph nodes, liver, brain, bones, adrenal glands, kidneys, and the contralateral lung

Question 31

what is virchow's node?

Answer 31

name given to the nodes in the left S/C fossa.

Question 32

another mets site is......

Answer 32

the lymph nodes of the S/C fossa (i.e. scalene nodes).

Question 33

Small Cell Lung Cancer (SCLC) treated with

Answer 33

multiagent chemotherapy and localized radiation therapy offers the best chance for a positive response to treatment

Question 34

Surgery is the treatment of choice for Non-Small Cell Lung Cancer (NSCLC) when the tumor is ______ and ______

Answer 34

small and localized

Question 35

If the tumor is inoperable due to its size, location, or regional lymph node involvement what is the best treatment?

Answer 35

high dose radiation therapy

Question 36

The signs and symptoms of lung cancer are often subtle and especially difficult to differentiate from the symptoms of ________

Answer 36

COPD

Question 37

Treatment borders for upper lobe tumors include the

Answer 37

primary tumor with a 2 cm margin, both hilar areas, the superior mediastinum, and both supraclavicular areas.

Question 38

what is prescription for lung cancer?

Answer 38

Primary tumor – 180cGy / fraction x 25 fx. = 4500 cGy

Question 39

what is the energy used when treating lung cancer?

Answer 39

6MV

Question 40

what is boost prescription for lung cancer?

Answer 40

200cGy / fraction x 10 fx. = 2000 cGy

Question 41

what are other names for boost?

Answer 41

shrinking field, cone down, off-cord

Question 42

during the boost, _____________ can be used to avoid the tolerance dose to critical structures

Answer 42

oblique fields

Question 43

what is the total dose for lung cancer?

Answer 43

6500 (to 7000) cGy

Question 44

what are the critical structures when treating the lungs?

Answer 44

spinal cord heart esophagus normal lung

Question 45

what is the TD 5/5 for the spinal cord?

Answer 45

4700 cGy

Question 46

what is the TD 5/5 for the heart?

Answer 46

4000 cGy

Question 47

what is the TD 5/5 for the esophagus?

Answer 47

5500 cGy

Question 48

what is the TD 5/5 for the normal lung?

Answer 48

1750 cGy