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Procedures Flashcards

1
Q

mammary glands are composed of

A

glandular tissue, subcutaneos fat, fibrous stroma

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2
Q

mammary glands are supported by

A

deep fascia overlying the pectoral muscle (pectoralis major and minor)

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3
Q

the protuberant portion of the adult breast is located

A

between the 2nd and 6th ribs in the sagittal plane and extends from the sternochondral junctions to the midaxillary line in the axial plane

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4
Q

2/3 of the breast rest on

A

the deep pectoral fascia that overlies the pectoralis major

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5
Q

1/3 of the breast rests on

A

fascia that covers the serratus anterior

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6
Q

the suspensory ligaments of cooper runs from the

A

pectoral fascia and branch out through and around breast tissue to connect to the skin overlying the breast (

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7
Q

what supports the breast and helps it maintain its shape

A

suspensory ligament of cooper

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8
Q

breast paraenchyma consists of

A

15-20 sections or lobes that are embedded in adipose tissue

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9
Q

what type of breast cancer originates in the lactiferous ducts

A

ductal carcinoma

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10
Q

type of breast cancer that originates from the lobules of the breast

A

lobular carcinoma

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11
Q

conical prominence in the center of the areola that is composed mostly of smooth muscle fibers that compress the lactiferous ducts

A

nipple

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12
Q

the breast does not contain

A

fat, hair, or sweat glands

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13
Q

in young nulliparous women the nipple is usually located

A

at the level of the 4th intercostal spaces

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14
Q

the areola contains

A

numerous subaceous glands

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15
Q

arterial supply of the breast is derived from

A

the medial mammary branches and anterior intercostal branches of the intermal mammary artery medially AND the lateral thoracic and thoracoacromial artery branches of the axillary artery and the posterior intercostal arteries laterally

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16
Q

venous drainage of the breast is mainly

A

to the axillary vein through the lateral thoracic and lateral mammary veins

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17
Q

Medially, the internal mammary vein is responsible for

A

venous drainage through its perforating branches

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18
Q

the nerves of the breast derive from the

A

anterior and lateral cutaneous branches of the fourth through sixth intercostal nerves

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19
Q

intramammary lymph nodes are located

A

within the breast parenchyma (although they can be involved with metastasis, they are not part of the nodal staging)

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20
Q

to describe the extent of lymph node metastasis in breast cancer

A

number and location of the regional lymph nodes involved are considered (axillary, supraclavicular/infraclavicular, internal mammary)

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21
Q

primary deep lymphatic drainage of the breast occur to the

A

ipsilateral axilla

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22
Q

how many nodes are in each axilla

A

10-38

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23
Q

level I lymph nodes of the axilla are located

A

in the caudal and lateral of the pectoralis minor and are the most superficial node in the axilla (often first station of drainage from breast)

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24
Q

level II lymph nodes in axilla

A

located beneath the muscle

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25
Q

level III lymph nodes in the axilla

A

infraclavicular lymph nodes, located cranial and medial to the pectoralis minor

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26
Q

order of spread of tumor cells for breast cancer

A

from level I to III is common but skip metastasis can occur rarely

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27
Q

internal mammary lymph nodes are located

A

in the parasternal space, embedded in fat in the intercostal spaces, and run alongside the corresponding artery and vein.

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28
Q

most mammary nodes are

A

in the first, second, and third intercostal spaces

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29
Q

inner quadrant tumors have a higher risk of

A

internal mammary lymph node involvement, 30% of patients have drainage localized to these nodes

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30
Q

supraclavicular lymph nodes are located within the

A

supraclavicular fossa

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31
Q

supraclavicular fossa

A

a space defined by the omohyoid muscle and tendon laterally and superiorly, the internal jugular vein medially, and the clavicle and subclavian vein inferiorly

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32
Q

supraclavicular lymph nodes provide drainage to

A

internal mamary nodes, axillary lymph node chain, small number of breast tumors (centrally located)

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33
Q

21% of all breast cancers

A

DCIS

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34
Q

5 subtypes of DCIS

A

1) comedo type-characterized by prominent necrosis in the centerof the involved spaces
2) cribroform type-characterized by formation of back to back glands without intervening stroma
3) micropapillary type and 4) papillary type-both show projection of tumor cells into the lumen
5) solid type-shows no significant necrosis, gland formation, or projections of tumor cells

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35
Q

estrogen receptor positivity is associated ith

A

90% of low- grade DCIS and 25% of high-grade DCIS

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36
Q

most common invasive cancer

A

invasive ductal carcinoma (accounts for 70%-80% of invasive lesions and 50% of invasive ductal carcinomas include a DCIS component

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37
Q

second most invasive breast cancer

A

invasive lobular carcinoma (5%-10% of all invasive lesions)

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38
Q

invasive lobular carcinoma originates?

A

from the glands, or lobules of the breast

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39
Q

under a microscope invasive lobular carcinoma cells are characterized by

A

small cells that infiltrate the surrounding tissues ina single file pattern, often growing in a target like configuration around the healthy breast ducts

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40
Q

invasive lobular carcinoma have a higher frequency of

A

bilateral breast involvement compared to invasive-DCIS

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41
Q

how is breast cancer staged

A

TNM

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42
Q

for clinical T stage in breast cancer

A

the larger the tumor is the higher the T stage

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43
Q

for breast cancer with tumor extention into the chest wall or skin it would be classified as

A

t$

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44
Q

what has the highest T staging classification of breast cancer

A

t4d (inflammatory cancer)

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45
Q

clinical N stage is based off of

A

location and extent of regional lymph node involvement (involvement of the typical first drainage station lymph node is a lower N stage ) ex: axillary lymph node is N1

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46
Q

T1 breast

A

20mm or less in size

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47
Q

T2 breast

A

20mm-50mm in size

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48
Q

T3 breast

A

more than 55mm in size

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49
Q

T4 breast

A

tumor of any size without direct extention to the chest wall or to the skin

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50
Q

receives 85% of drainage from breast

A

axillary node

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51
Q

procedure where injection of radioactive colloid or blue dye is injected into the breast tissue in the vicinity of the tumor. tracers then enter the lymphatic channel and flow to the lymph nodes that are first in line to receive the drainage from the tumor. lymph nodes are then identified and removed

A

sentinel lymph node biopsy

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52
Q

in patients with mets involving 3 or more sentinel lymph nodes what is recommended

A

axillary dissection

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53
Q

neoadjuvant therapy

A

systemic therapy given before surgery

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54
Q

most patients with locally advanced breast cancer receive

A

neoadjuvant therapy

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55
Q

side effects of breast RT

A

skin changes, fatigue, lymphedema, fibrosis, cardiotoxicity, pneumonitis

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56
Q

most common cancer in US and cause

A

lung; smoking

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57
Q

lung cancers spread via

A

local extention to other parts of the lung, and the ribs, heart, and other structures

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58
Q

lung cancers classified as

A

small cell and non-small cell carcinomas (small cell more likely to met early

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59
Q

usual tx for lung cancer

A

RT combied with chemo or surgery

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60
Q

what is used to define the extent of non-small cell carcinomas

A

PET & CT

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61
Q

death rate of lung cancer

A

4.5x greater for males

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62
Q

respiratory system includes the

A

nose, pharynx, larynx, trachea, and both lungs

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63
Q

name of where the trachea divides into 2 branches and location

A

carina; T5

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64
Q

hilium

A

area of the lung where the blood, lymphatic vessels, and nerves enter and exit each lung

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65
Q

mediastinum

A

anatomy between the lungs including the heart, thymas, great vessels, and other structures that help positionthe lung on either side of the midline

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66
Q

one of the principal routes of regional spread in lung cancer

A

lymphatic

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67
Q

the superior mediastinal nodes include

A

upper paratracheal, lower paratracheal, and tracheobronchial angle nodes

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68
Q

inferior mediastinal nodes include

A

subcarinal, paraesophageal and pulmonar ligament nodes

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69
Q

most common form of lung cancer in north america

A

adenocarcinoma; more common in women and arise in the bronchioles or alveoli

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70
Q

lung cancer thats prone to early spread, and 3 year survival is 10-15%

A

SCLC

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71
Q

lung caner with 15-20% 5 year survival

A

NSCLC

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72
Q

how is lung cancer staged

A

TNM

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73
Q

tumors of the lung are more likely to extend to

A

other parts of the lung, ribs, heart, esophagus, and vertebral column

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74
Q

tumors of the lung that are not encapsulated have the ability

A

to invade and attach themselves to local tructures such as the chest wall, diaphragm, pleura, paricardium

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75
Q

lung cancer direct extention can occur through

A

visceral pleura into the pleural cavity

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76
Q

a tumor at the midline of the lung can grow

A

directly into the hilum of the other lung

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77
Q

primary lymphatics that drain the lungs

A

mediastinal and intrapulmonic channels

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78
Q

the thoracic duct drains

A

the left side of the body

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79
Q

commons site of mets for lung tumors

A

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

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80
Q

critical structures of concern when treating lung cancer

A

spinal cord, esophagus, heart, and the healthy ung

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81
Q

spinal cord tolerance

A

4500-5500 cgy

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82
Q

pneumonitis occurs

A

1-3 mos following tx

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83
Q

fibrosis occurs

A

2-4 mos following tx

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84
Q

other strutures included in the lung field that arent as critical

A

esophagus, bone marrow, skin, and sometimes liver with right lower lobe tumors

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85
Q

simplest field when treating lung cancer that included primary tumor volume and adjacent mediastinum

A

anterior posterior parallel opposed mediastinal fields

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86
Q

used to deliver high dose to a small volume

A

boost field

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87
Q

dose for definitive tx of SCLC

A

4500-6000 cGy a 180-200 cGy per fraction

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88
Q

dose for definitive tx of NSCLC

A

6000-6600 cGy at 180-200 cGy daily dose fractions

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89
Q

initial field arrangement dose for lung

A

4000-4500 cGy

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90
Q

conventional fractionation uses

A

180 cGy-200 cGy dose given once per day

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91
Q

what part of the lung are primary SCC usually found

A

centrally

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92
Q

the incidence of distant mets is greatest with tumors of

A

the nasopharynx and hypopharynx

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93
Q

most common site of distant mets in H&N cancer?

A

lungs

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94
Q

most common part of the aerodigestive tract affected

A

oral cavity, phayrnx, paranasal sinuses, larynx, thyroid gland, and salivary gland

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95
Q

etiologic risks for h&n cancer

A

tobacco and alcohol use, ultraviolet light, viral infection, environmental exposure

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96
Q

3 divisions of the pharynx

A

nasopharynx, oropharynx, and laryngopharynx

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97
Q

how do you stage and classify H&N cancer?

A

based on involvement of subsites

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98
Q

respiratory tubes

A

nasopharynx

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99
Q

digestive tubes

A

oropharynx and hypopharynx

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100
Q

location of cervical vertebral body

A

first cervical vertebra- C1- lies at the inferior margin of the nasopharynx, whereas C2-C3 contain the oropharynx.
The epiglottis is in line wih C3, whereas the true vocal cord lie opposite C4

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101
Q

cranial Nerve I

A

olfactory-smell

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102
Q

cranial Nerve II

A

optic-site

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103
Q

cranial nerve III

A

oculomotor-eye movement (up and down)

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104
Q

cranial nerve IV

A

trochlear-eye movement (side to side)

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105
Q

cranial nerve V

A

trigeminal-sensory (facial) and motor (jaw)

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106
Q

cranial nerve VI

A

abducens-eye movement (lateral)

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107
Q

cranial nerve VII

A

facial (masticator)- expressions, muscle contractions, and mouthing

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108
Q

cranial nerve VIII

A

acoustic-hearing

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109
Q

cranial nerve IX

A

glossopharyngeal- tongue and throat movement

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110
Q

crania nerve x

A

vagus-talking and sound

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111
Q

crania nerve xi

A

spinal accessory-movement of shoulders and head

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112
Q

cranial nerve XII

A

hypoglossal-movement of tongue and chewing

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113
Q

most H&N tumors are

A

infiltrating lesions in the EPITHELIAL lining

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114
Q

endophytic tumors

A

more aggressing h&n and spread and harder to control locally

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115
Q

exophytic tumors

A

noninvasive neopplasms characterized by raised, elevated borders with 60% of patients reporting otalgia (ear pain)

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116
Q

nearly 1/3 of the bodies lymph nodes are located

A

in the H&N

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117
Q

lymph drainage in H&N

A

mainly ipsilateral but

soft palate, tonsils, base of tongue, posterior phayngeal wall, and especially nasopharynx drain bilerally

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118
Q

jugolodigastric lymph node also called

A

subdigastic node

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119
Q

node of Rouviere also called

A

lateral retropharyngeal node

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120
Q

spinal accessory node also called

A

posterior cervical lymph node chain

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121
Q

mastoid node is also called

A

retroauricular node

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122
Q

more than 80% of H&N cancers arrise from

A

the surface of the epithelium of the mucousal linings of the upper digestive tract (mostly SCC)

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123
Q

SCC in H&N are often seen in the

A

lymphoepithelial, spingle cell carcinoma, and undifferentated carcinoma

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124
Q

lymphoepithelioma occurs in places of

A

abundance lymphoid tissue ( i.e. nasopharynx, tonsil, and base of tongue) patients w this type have better cure rate than SCC

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125
Q

to a lesser extent in H&N adenocarcinomas are found

A

in the salivary glands

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126
Q

staging for H&N is based on

A

manual for staging cancer by the AJCC.

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127
Q

for H&N the inferior cervical node are positive in

A

6%-23% of cases

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128
Q

75 % of all H&N cancers recur

A

locally or regionally abov the clavicle

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129
Q

oral cavity tumor symptom

A

swelling or ulcer that doesnt heal

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130
Q

oropharnx tumor symptom

A

painful swallowing ad referred otalgia. pain in the ear originating from somewhere else

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131
Q

nasopharyn tumor symptom

A

bloody discharge, difficulty hearing

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132
Q

hypopharynx tumor symptom

A

dysphagia, painful neck node

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133
Q

larynx tumor symphtom

A

hoarseness

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134
Q

nose/sinus tumor sympyom

A

obstruction, discharge, facial pain, diplopia (double vision), local swelling

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135
Q

SCC of neck tx

A

200 cgy per day 5x/week usually 6.5-7.5 weeks

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136
Q

histopath of oral tongue cancer

A

90-95% SCC either well differentiated or moderatelly well differentiated

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137
Q

oral cavity cancer metastatic behaviorq

A

cervical lymph node involvement is rare
lowest incidence (except glottic) of nodal mets in H&N region
less than 20% bloodborne spread

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138
Q

tx dose oral cavity cancer

A

IMRT-all gross disease 70 Gy (7000 cGY)

with a 0-5mm expansion for PTV

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139
Q

the lymphatic of the upper lip drain into

A

the submandubular and preauricular nodal beds

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140
Q

lymphatics from the mid-lower lip and anterior floor of mouth drain into

A

submental nodal group

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141
Q

lymphatics from the oral tongue drain into

A

anterior cervical chin

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142
Q

lip cancers are treated the same as

A

the skin (less than 2cm 200-300 cgy/day X 4-6 weeks…..larger tmors 5000-6000cgy)

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143
Q

triangular space behind the last molar tooth

A

retromolar trigone (carcinomas are rare here)

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144
Q

3 part of the pharynx

A

oropharynx, nasopharynx, and hypopharynx (A.K.A laryngopharynx.

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145
Q

location of nasopharynx

A

located behind the nose and extending from the posterior nares to the level of the soft palate

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146
Q

oropharynx location

A

behind the mouth from the soft palate above to the level of the hyoid bone below

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147
Q

larygopharynx/hypopharynx

A

extends from the hyoid bone to its termination in the esophagus

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148
Q

clinical presentation pharynx cancer

A

persistent sore throat painful swallowing, referred otalgia. often enlarged cervical nodes are present.

for advanced disease- fetororis, dyspnea, dysphagia, hoarseness, dysarthria, nd hypersalvation

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149
Q

histopath of pharynx cancer

A

90% SCC

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150
Q

pharynx cancer mets behavior

A

with oropharyngeal carcinoma-cervical lymph node involvement is common

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151
Q

hypopharynx is composed of

A

pyriform sinus, postcricoid and lower posteriorpharyngeal walls below base of tongue. anatomically located between the vertebral bodies C3 and C6. the cricoid cartilage represents the inferior border, and the epiglottis is the superior border.

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152
Q

site of highest incidence of hypopharyngeal cancer

A

pyriform sinus (highest rate of nodal mets in pyriform sinus tumor-70-75%)

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153
Q

nasopharynx region includes

A

posteriosuperior pharyngeal wall, lateral pharyngeal wall, eustacian tube orfice, and adenoids

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154
Q

nasopharynx structure

A

cuboidal structure that lies on a line from the zygomatic arch to the external auditory meatus. lies behind the nasal cavities and above the level of the soft palate

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155
Q

larynx location

A

extends from the tip of the epiglottis at the level of the lower border of the C3 vertebra to the lower border of the cricoid cartilege at the level of the C6 vertebra.

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156
Q

larynx is subdivided into 3 sites

A

the glottis, supraglottis and subglottis

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157
Q

glottic cancer accounts for roughly

A

65% of larynx cancer

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158
Q

30% of glottic cancer site

A

supraglottic region

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159
Q

5% of glottic cancer site

A

subglottic

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160
Q

most common cancer of the upper aerodigestive tract

A

larynx

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161
Q

spinal cord location

A

starts in the brain (medulla) and ends approx. L1-L2 in adults (does not extend the entire length of the spinal column)

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162
Q

cauda equina loc

A

starts at approx L1 and ends at the coccyx

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163
Q

most spinal cord tumors originate

A

outside the dura mater (extra dural) and are metastatic

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164
Q

primary spinal tumors

A

intra sural spine tumors (rare)

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165
Q

cerebrum function

A

interpretation of sensory impulses and voluntary muscular activities (center for memory, learning, reasoning, judgement, intelligence, and emotions

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166
Q

cerebellum

A

part of the brain that plays a role in the coordination of voluntary muscular movement

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167
Q

20-40% of people with cancer eventually have

A

brain mets

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168
Q

most common primary brain tumor

A

gliomas which include 2 most common types of tumor-astrocytoma nd gliobasloma multiforme

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169
Q

astrocytoma

A

most common type of brain tumor in children, originated in the brain tem, cerebellum, white matter of the cerebrum, or spinal cord

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170
Q

glioblastoma multiforme (GBM)

A

most common type of brain tumor in adults, originates in the glial cells in the cerebrum. HIGH GRADE TUMOR WITH POOR PROGNOSIS

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171
Q

brainstem glioma

A

originates in the medulla, pons, or midbrain. diffucult to biopsy due to location. overall bad prognosis

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172
Q

schwannoma

A

originates in the Schwann cell which surrounds the cranial nerves or other nerves responsible for hearing and balance. usually benign

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173
Q

ependymoma

A

originates in the ependymal cells which line the ventricles. may block the exit of cerebrospinal fluid causing the ventricles to enlarge. avg age 21 y.o

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174
Q

medulloblastoma

A

2nd most common type of brain tumor in children. originates in the 4th cerebral ventricle an the cerebellum. often invades the meninges

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175
Q

oligodendrolioma

A

originates in the brain cells called oligodendrocyetes. benign, slow growing tumors. usually occur in the frontal lobe

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176
Q

secondary (metastatic) brain tumors

A

more common than primary brain tumors

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177
Q

in adults most common cancers that spread to brain are

A

lung, breast, melanomas, and G.I

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178
Q

route of spread for primary tumors of the CNS

A

rarely spread outside CNS. they can spread via local invasion and CSF seeding

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179
Q

wilms tumor

A

nephroblastoma (lungs most common site of mets)

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180
Q

most common renal tumor in children, usually occurs between 2-5 years old

A

wilms tumor

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181
Q

outer cover that protects the brain

A

cranial bone, meninges, CSF

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182
Q

a fold of dura matter that is the outer covering of the brain

A

tentorium

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183
Q

where does the blood supply to the brain come from?

A

internal carotid arteries and vertebral arteries via the circle of Willis

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184
Q

how do gliomas spread

A

invasively because they do not form a natural capsule that inhibits growth. they rarely met outside of the CNS; expand through local invasion

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185
Q

common route of spread for medulloblastoma and primitive neuroectodermal tumors (PNET)

A

seeding via CSF into spinal and intracranial subarachnoid spaces

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186
Q

screening tests for CNS tumor?

A

none, must show symptoms first`

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187
Q

PET (positron emission tomography) is a beneficial took that ay be useful in determining what?

A

necrosis and malignancy, which are associated with areas of high metabolism

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188
Q

intracranial tumors are considered

A

locally malignant based on the limited space for expansion in the cranium

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189
Q

most importan prognostic factor for CNS tumor

A

histopathology diagnosis; benign lesions have a better progosis

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190
Q

what approach is used to treat the whole brain for palliative reasons

A

lateral port fields; inferior margins of the field may intersect the superior orbital ridge and external auditory meatus.

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191
Q

most complex CNS tx

A

craniospinal axis- radiation needs to encompass the entire brain and spinal cord simultaneously (most common tx for medulloblastoma)

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192
Q

GTV

A

gross tumor volume-gross tumor seen on the MRI, CT, or other imaging study

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193
Q

CTV

A

clinical tumor volume-central nervous system tissue with suspected microscopic tumor- usually extends 1-3 CM beyond GTV

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194
Q

PTV

A

planning target volume-margin beyond GTV & CTVand account for factors such as internal organ motion, setup variation, and patient movement. USUALLY CONTAINT AND EXTENDS 0.5-1 CM BEYOND GTV AND CTV

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195
Q

TV

A

TREATMENT VOLUME- volume enclosed by the desired prescription isodose line (usually greater than 95%); this contains GTV, CTV, and PTV)

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196
Q

IR

A

irradiate volume- tissue volume that receives a significant dose of radiation and contains the GTV, CTV, and PTV

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197
Q

PRV

A

planning risk volume for OAR(organs at risk)

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198
Q

when treating cranium temporary hair loss occurs with doses ranging from

A

2000-4000cGy

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199
Q

permanent hair loss can occur with doses higher than

A

4000cGy

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200
Q

whole brain tolerance dose

A

4500-500 cGy

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201
Q

partial brain tolerance dose

A

6000 cGy

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202
Q

spinal cord tolerance dose

A

4500-5000 Cgy

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203
Q

what isotope is mostly used or brachytherapy

A

I-125

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204
Q

SRS is used with

A

isolated CNS tumors and solitary brain mets

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205
Q

set up for SRS

A

pt. positioned in a Halo device to immoblize them. TV is spherical and only up to 3 CM at max dimenson. Gives a high (necrosing) local dose to the tumor and spares surrounding tissue.

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206
Q

cervix

A

lower 1/3 of the uterus,

divided into 2 parts: the cervix and the body (fundus)

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207
Q

common risk factor or cervical cancer

A

HPV,
early age intercourse,
large # of pregnancies,
35-55 years old

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208
Q

signs and symptoms of cervical cancer

A

increased menstrual bleeding, foul smelling discharge, bleeding following intercourse, pain, and urinary/rectal symptoms in late stage

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209
Q

common histopath and route of spread for cervical cancer

A

SCC, direct extension and lymphatics

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210
Q

3 layers of the cervix in order

A

Inner-Endometrium (mucous membrane), Middle-myometrium (smoothe muscles), Outer- perimetrium (parietal peritoneum)

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211
Q

extending laterally from the superior uterus is the

A

fallopian tubes

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212
Q

3rd most common malignancy in women worldwide

A

cervical cancer

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213
Q

outer most portion of the female genitalia

A

vulva

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214
Q

parts of the vulva

A

labia majora, labia minora, the clitoris, and the area bound by these three is called the vestibule

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215
Q

vestibule

A

triangular space that is located anterior to the vaginal opening and contains the opening of the female urethra

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216
Q

perineum

A

area between the vaginal and anus in females and scrotum an anus in males

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217
Q

signs & symptoms vulva cancer

A

red, white, or pink bumps. itching, bleeding, discharge

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218
Q

signs & symptoms vagina cancer

A

bleeding, discharge, mass, pain during intercourse, painful urination

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219
Q

vagina

A

musculartube that extends 6-8 inches from the cervix of the uterus to the vulva

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220
Q

common histopath of vagina and vulva cancer

A

SCC

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221
Q

fornices

A

where cervix project through the vaginal wall and formed a circular sulcus that serves as an anatomical landmark that surrounds the superior portion of the vagina

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222
Q

lowest part of the uterus where it connects with the superior portion of the vagina

A

cervix

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223
Q

2 primary types of cervical cancer

A

80-90% is SCC

10-20% is adenocarcinoma

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224
Q

Cervical intraepithelial neoplasm (CIN)

A

precancerous cndition in which Squamous cells that line the cervix become dysplastic

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225
Q

staging system for cervical cancer

A

TNM & FIGO (International Federal Gynecology and Obstetrics) staging systems (two staging systems are very similar except FIGO does not have a stage 0)

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226
Q

most significant prognostic factor in patients with invasive carcinoma of the cervix

A

staging (other factors may be age, race, socioeconimical status, tumr size, location, lymph nde involvement)

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227
Q

cervical cancer route of spread

A

direct extension into the uterus, vagina, parametrium, abdomen, pelvis, rectum, and bladder. (can also spread via hematogenous routes)

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228
Q

most common distant site of met

A

lungs, liver, and bone

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229
Q

cervical cancer lymphtic involvement

A

usually ordrly, involving parametrial nodes, followed by pelvic, common, illiac, periaortic, an even supraclavicular node. with periaortic nodal invovlement a 35% risk exists for supraclavicular spread`

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230
Q

cervical cancer tx

A

RT used for all stages, surgery resrved for pt w medicall operable stges (in situ, Ia, Ib1, IIa)

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231
Q

cerical tx setup

A

whole pelvis is initially tx with a 4-field (minimum 16MV photon) technique. The lower border generally falls at the inferior aspect of the foramen, unless the vagina is involved. Upper border is usually at the top or bottom of L5, lateral borders are 1.5-2cm lateral to the pelvis sidewall in the AP/PA plame

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232
Q

most common gynecological malignncy and 4th most common cancer overall in women in the USA

A

endometrium (hormone related cancer)

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233
Q

histopath endometrium cancer

A

adenocarcinoma (80%) and arise in the lining of the uterus and grow and invade the uterine wall

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234
Q

most definitive method of diagnosis for endimetrial cancer

A

D&C dilation and curetage

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235
Q

uterus is located

A

in the pelvis between the bladder and rectum

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236
Q

endometrial cancers affects mostly…

A

post menopausal 55+ year old women, cases are higher in white women but more deaths in black women.

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237
Q

risk factors for endometrial

A

postmenopausal, nulliparity, hormone-replacement therapy, late menopause, early menarche, irregular menstration, diabetes, and history of infertility.

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238
Q

screening for endometrial cancer?

A

none

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239
Q

mets for endomatrial cancer

A

pelvic, para-aortic nodes. lymphatic spread occurs initially to the intenal and external iliac pelvic nodes (stage 1-10% nodal involvement, 25-35% stage II nodal involvement,

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240
Q

tx and sim for endometrial cancer

A

for lower stages a vaginal cylinder is used for tx, 60-70Gy brachytherapy surface dose in 2 sessions or a high dose brachy. of 7 Gy to a 0.5 cm depth for 3 sessions. for higher stages pelvic irradiation is done, with fields similar to cervical fields. Heyman capsule technique or intrauterine tandems can be used is uterus is still present pelvic nodal tx volume is 4-50 Gy with boostins up to 65 Gy for gross involvement.

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241
Q

endometrial cavity can be treated up to

A

75-90 Gy with combines xternal beam therapy and low dos brachytherapy, but the bladder and rectum must be kept to65-75 Gy and the small bowel kept at or below 45-50Gy if tx w RT alone.

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242
Q

5th most common cancer among women in the US an d leading cause of death in gyn. cancers

A

ovarian cancer

243
Q

what are the ovaries

A

almond shaped bodies attached to both sides of the uterus. their function is to produce an egg (ova) and 2 hormones (estrogen and progesterone). they are attached to the uterus by the utero-ovarian ligaments,

244
Q

common cause ovarian cancer

A

nulliparity, intertility, family hx, estrogen hormone replacement therapy

245
Q

signs and symptoms ovarian cancer

A

back pain, fatigue, bloating, constipation, abdominal pain, urinary frequency

later symptoms include:swelling of the abdomen, cramping, pressure, vaginal bleeding, and back pain

246
Q

most common histopath ovarian cancer

A

epithelial carcinoma(most common) or malignant germ cell tumor (more prevalent in younger women)

247
Q

staging for ovarian cancer

A

FIGO & AJCC TNM staging

248
Q

ovarian route of spread

A

direct extention to surrounding organs, peritoneal fluid, or lymph nodes. hematagenous spead is rare. 80% of pt.. w ovarian cancer present with abdominal involvement

249
Q

most common malignancy in males in the US (excluding skin cancer)

A

prostate

250
Q

prostate location

A

inferior to the bladder and anterior to the rectum

prostate gland surrounds the male urethra between the base of the bladder and the urogenital diaphragm

251
Q

where does prostate cancer originate

A

periphery of the gland

252
Q

2nd leading cause of cancer deaths in males

A

prostate

253
Q

lymphatic spread from the prostate

A

in order - periprostatic and obturator nodes, followed by external iliac hypogastric, common iliac, and periaortic

254
Q

most malignant tumors of the prostate are

A

adenocarcinoma

255
Q

location of bladder

A

when empty lies entirely within the true pelvis. the apex of the bladder is directed toward the upper part of the pubic symphysis and is joined to the umbilicus by the middle umbilical ligament (the urachal remnant)

256
Q

in males what seperates the bladder from the rectum

A

rectovesical puch

257
Q

the lymphatics of the bladder form 2 plexuses

A

one in the submucosa and one in the muscular layer

258
Q

most bladder cancers are

A

epithelial (99%), in the western hemisphere 98% of epithelial tumors are transitional cell carcinoma, 6-7% SCC, and 1-2% adenocarcinoma

259
Q

morphology of bladder cancer

A
  1. papillary, 2. papillary infiltrating, 3. solid infiltrating, 4. nonpapillary, non infiltrating, or carcinoma in situ. (at the time of diagnosis 70% of these cancers are papillary, 25% show papillary or solid infiltration, and 3-5% indicate carcinoma in situ)
260
Q

bladder cancr is staged using

A

TNM

261
Q

bladder cancer route of spread

A

direct extention into or through the wall of the bladder

262
Q

tx for bladder carcinoma in situ

A

radical cystectomy (usually curative)

263
Q

bladder tx set up

A

include total bladder and TV, prostate and prostatic urethra, and pelvic lymph nodes. a 4-field pelvic technique ap/pa. fields extend 1 cm inferiorly to the caudal border of the obturator foramen and superiorly to just below the sacral promontory or just below S1-L5. ***(portals are usuall 12x12 cm to include the EMPTY bladder)88

264
Q

bladder dose

A

larger pelvic fields that include the bladder and pelvic lymph nodes is generally tx to dose of 45-50 Gy and 180 cGy/day, which requires 5-5.5 week of tx

265
Q

most common malignancy in men age 20-34 (although it is still considered rare)

A

testicular cancer

266
Q

testis anatomy

A

contained in the scrotum and suspended by the spermatic cords. Left is usually longer than the right. it is invested by the tunica vaginalis, tunica albuginea, and tunica vasculosa. testis produce testosterone.

267
Q

testis lymphatic drainage

A

lymphatics from the hilum of the testes accompany the spermatic cord up to the internal inguinal ring along the cords of the testicular-spermatic veins. these then drain into the retroperitoneal lymph nodes between the level of T11 and L4 but are concentrated at the level of the L1 -L3 vertebrae

268
Q

most common type of testicular cancer

A

seminoma

269
Q

3 subtype of seminoma

A

classic, anaplastic, and spermatocytic

270
Q

nonseminomatous tumors are

A

embryonal carcinoma, teratoma, choriocarcinoma. yolk sac.

271
Q

most common single cell type testicular cancer

A

embryonal carcinoma

272
Q

histopath of testicular cancer

A

germ cell

273
Q

route of spread for testicular cancer

A

pure seminomas have a higher chance to remain localized, or involve only one lymph node. non-seminomatous germ cell tumors may spread via lymphatics of hematogenous routes.

274
Q

order of spread for seminoma

A

lymph nodes in the retroperitoneum, then to the next echelon of draining lymphatics in the mediastinum and supraclavicular fossa (stage III). only rarely and late does pure seminoma spread hematogenousy to involve the lung paraenchyma, bone, .iver. or brain (stage IV)

275
Q

non- seminoma met sites

A

if met outside the lymph nodes usually spreads to lungs and liver.

276
Q

standardized radiation dose for seminoma

A

2500 cGy/fraction

277
Q

initial tx for nonseminoma

A

radical inguinal orchiectomy, followed by cisplatin-based chemo

278
Q

RT set up seminoma

A

MV irradiation to the paraaortic or paraaortic and ipsilateral pelvic lymph nodes. top of the portal should be at T10-T12. inferior border should be at the bottom of L5 or at the top of the obturator foramen. the lateral b orders must include the para-ortic lymph nodes and ipsilateral renal hilum.

279
Q

location of kidneys and ureters

A

kidney, ureter, and their vascular supply and lympatics are located in the retroperitoneal space between the parietalperitoneum and the posterior abdominal wall.

280
Q

kidney loction

A

located at the level of between the 11th rib and the transverse process of the 3rd lumbar vertebra. the renal axis is parallel to the lateral margin of the psoas muscle. yeach kidney is 10-12 in length and the right kidney sits 1-2 cm lower than the left

281
Q

lymphatic drainage of the kidney and renal pelvis

A

occurs along the vessels in the renal hilum to the para-aortic and paracaval nodes.

282
Q

lymphatic drainage of the ureters

A

is it segmented and diffuse and involves any of the following renal hilar, abdominal para-aortic, paracaval, common iliac, internal iliac, or external iliac.

283
Q

tissue of origin for renal cell carinoa

A

proximal tubular epithelium

284
Q

2 cell types for renal and ureter cancer

A

transitional cell carcinoma -more than 90%
SCC- 7-8%
adenocarcinoma of the upper urothelial tract is rare
SCC ofthe renal pelvis is often deeply invasive and is associated with a worse prognosis than transitional cell carcinoma

285
Q

route of spread for kidney cancer

A

via local infiltration through the lung 75%, soft tissue 36%, bone 20%, liver 18%, cutaneous area 8% and CNS 8%

286
Q

upper urinary tract carcinoma i a multifocal process meaning/

A

patients with cancer at one site in the upper urinary tract are at greater risk of dev. of tumors elsewhere in the urinary tract

287
Q

transitional cell carcinoma of the upper urothelial tract may spread via

A

direct extention, blood, or lymphatics

288
Q

standardized tx for pt with localized renal cell cracinoma T1 amd T2

A

radical nephrectomy (complete removal of the infact Garota’s fascia and its contents, including kidney, adrenal gland, and perinephric fat. regional lymphadenectomy is often performed at the time of radical nephrectomy

289
Q

when is RT often performed for renal cell carcinoma

A

postoperatively, for a tumor left behind after sx or for reoccurence

290
Q

TV for renal cell carcinoma includes

A

renal fossa, and site of gross reoccurence, if present along with the para-aortic nodal drainage sites in the adjuvant setting.

291
Q

post-op RT for renal cell carcinoma range

A

4500-5000 cGy, the usual recommended dose that can be given safely to the upper abdomen with an acceptable complication rate of 5040 Cgy at 180 cGy/fraction over 5-6 weeks

a boost of 540 cGy in 3 fractions to smaller volume may be dded, with special care, to bringthe TD to 5580 cGy

292
Q

for prostate tx bladder should be

A

full

293
Q

for bladder tx bladder should be

A

empty when entire bladder is being tx. During boost field bladder should be full to reduce the amount of bladdr tx to the boost field

294
Q

normal adult pulse

A

60-100 beats per min

295
Q

normal adult respirations

A

12-18 breaths per min

296
Q

normal adult BP

A

90-140 mm Hg

60-80 mm Hg

297
Q

systolic BP

A

when the heartbeat disappears

298
Q

diastolic BP

A

when heartbeat reappears after releasing the cuff

299
Q

2nd leading cause of overall cancer deaths in US

A

colorectal (affects men more than women)

300
Q

causes of colorectal cancer

A

diet high in animal fat, obesity, smoking, excessive drinking, NSAID, chronic ulcerative colitis

301
Q

Gardner’s syndrome

A

hereditary disease where pt. have adenamatous polyposis of the large bowel and other abnormal growths, such as upper G.I. polyps, periampullary tumors, lipomas, and fibromas.

302
Q

colon is divided into 8 regions

A

cecum, ascending colon, descending colon, splenic flexure, hepatic flexure, transverse colon, sigmoid, and rectum.

303
Q

what parts of the colon are considered freely mobile

A

located intraperitoneally, the cecum, transverse colon, and sigmoids, and they have a complete mesentary and serosa

304
Q

what parts of the colon are immobile

A

located retroperitoneally, the ascending and descending colon, and the hepatic and splenic flexures are considered immobile

305
Q

the rectum is continuous with the sigmoid and begins at

A

he level of the 3rd sacral vertebra and like the sigmoid is covered by the peritoneum

306
Q

the lower 2/3 of the rectum is located

A

retroperitoneally

307
Q

3 transverse folds ivide the rectum into areas known as

A

upper valve, middle valve. ad lower valve or ampulla

308
Q

rectum middle valve loc.

A

11 cm superiorly from the anal verge

309
Q

large bowel has 4 main layers:

A

the mucosa, submucosa, muscularis propria, and serosa (these layers are used in the staging system to define the amount of involvement through the bowel)

310
Q

innermost layer of large bowel

A

mucosa-forms the lumen of the bowel and consists of 2 supporting layers: the lamina propria and the muscularis mucosa.

311
Q

2nd layer from the inside of the large bowel

A

the submucosa- rich in blood vessels and lymphatics

312
Q

3rd layer from the inside of the large bowel

A

muscularis propria-contains 2 muscle layers: one circular are one longitudinal which are responsible for peristalsis (beneath the muscularis layer is a layer of sat called the subserosal layer)

313
Q

oter most layer of the large bowel

A

serosa (not all segments oft he colon have a serosal layer)

314
Q

lymphatic drainage of the colon

A

(follows the mesenteric vessels) right colon follows the superior mesenteric vessel and includes the ileocolic and righ colic nodes and the left colon follows the inferior mesenteric vessels and includes the regional node termed the midcolin, inferor mesenteric, and left colic.

315
Q

sigmoid region drains into the

A

inferior mesenteric system but also includes the nodes along the superior rectal, sigmoidal, and sigmoidal mesenteric system.

316
Q

lymphatic drainage of the upper rectum follows the

A

superior rectal vessels into the inferior mesenteric system

317
Q

middle and lower rectum lymphatic drainagw

A

is along the middle rectal vessels with the principal nodal group that comprises the internal iliac nodes

318
Q

other nodal groups at risk for involvement with rectal cncer

A

perirectal, lateral sacral, and presacral nodes.

low rectal lesions that entend into the anal canal can drain into the inguinal nodes

319
Q

most common malignancy of the large bowel

A

adenocarcinoma (90-95%)

(other types include mucinous adenocarcinoma, signer-ring cell carcinoma, and SCC

320
Q

staging used to large bowel cancer

A

TNM set by the AJCC

321
Q

route of spread for large bowel

A

usually spread via direct extension, lymphatics, and hematogenous spread

  • *direct extension of the tumor is typically in a radial fashion, with penetration into the bowel wall rather than longitudinally
  • *lymphatic spread occurs if the tumar has invaded the submucosal layer of the boel (lymphatics spread orderly, the initial node invovled is perirectal node
  • *blood-borne spread to the liver is the most common type of distant mets
322
Q

2nd most common site of distant spread for largebowel cancer

A

lung

323
Q

tx of choice for large bowel

A

surgery

324
Q

for rectal cancer the 2 most common procedures are

A

low anterior resection (LAR) and the abdominoperineal resection (APR)

325
Q

what is low anterior resection

A

removal of the tumor plus a margin and immediately adjacent lymph nodes (used on pt with rectal cancer in the lower 3rd of the rectum)

326
Q

RT is most commonly used as what for rectal cancer

A

adjuvant therapy (before or after surgery)

327
Q

preoperative RT is commonly used technique on patients

A

who have large rectal cancers that have invaded through the muscle layer (T3) or who have imaging studies (MRI) that show enlarged lymph nodes that indicate N1 or N2 disease. (goal is sphincter preservation)

328
Q

sphincter-preserving procedure done for curative intent in a select group of pt. with lower-third to middle-third rectal cancers that are confined to the bowel wall.

A

endocavitary RT

329
Q

for rectal cancer most reoccurences occur?

A

posterior aspect of the pelvis, including metastasis to the internal iliac and presacral lymph nodes

330
Q

OAR for RT of the pelvis

A

small bowel (dose should be less than 45 Gy

331
Q

tx/sim set up for rectal cancer

A

a 3 field technique where pt is prone (PA and opposed laterals wedged), which allows homogenous dose to the tumor bed while sparing of anterior structures such as the prostate or vagina

332
Q

dose limiting structures for tx of ascending or descending colon cancer include the

A

kidney and small bowel

333
Q

pt who undergo IORT may receive a dose of

A

1000-2000 cGy of electrons in a single fractions

334
Q

IORT dose is calculated at the

A

90% isodose line

335
Q

leukopenia

A

abnormal reduction in white blood cell count

336
Q

thrombocytopenia

A

abnormal decrease in platelet count

337
Q

anal canal is how long

A

3-4 CM long and extends from the anal verge to the anorectal ring at the junction of the anus and rectum

338
Q

lymphatic spread of the anal canal

A

occurs initially to the periretal and anorectal lymph nodes

**if the tumor extends above the dentate line, the nodal groups at risk are in the internal iliac and lateral sacral nodes; this is similar to rectal cancer

339
Q

anal cancer histology

A

SCC 80% of cases, the next most common is basaloid, or cloagenic

340
Q

perianal cancers are typically

A

SCC or basal cell carcinoma (consistent w skin cncer)

341
Q

route of spread anal tumor

A

most frequently direct extention into the adjacent soft tissues. lymphatic spread occurs relatively early to pelvic nodes but more commonly to inguinal lymph nodes, hematogenous spread to the liver or lungs is less common

342
Q

tx setup/sim for anal cancer

A

IMRT static or VMAT with a 4-field AP/PA pelvic field with electron field to the inguinal nodes including a boost to the tumor bed with a perineal electon field or another multifield technique. the pelvic field extends from the lumbosacral-sacroiliac regiom to 3 CM distal to the lowest extent of the tumor . the inf erior border typically flashes the perineum. the lateral border may extend to include tx of the inguinal nodes on the AP field only. tthe PA field is kept narrower because the anteriorly located inguinal nodesdo not receive much contribution from the posterior field

343
Q

OAR for anal cancer tx

A

femoral head and neck, genitalia/perineum, small bowel, and bladder

344
Q

the most severe and life-threatening complication from irradiation to the pelvis and the 5-FU and mitomycin reginment for anal cancer

A

bone marrow suppression

345
Q

standard of care for tx of anal cancer

A

RT combines w chemo provides sphincter preservtion and better cure rates

346
Q

accounts for 1% o all cancers in the US, 3-4x more common in men, and diagnosed between age 55-85

A

esophageal cancer (has nearly uniformly fatal death rate)

347
Q

cancer of the esophagus occurs more in

A

northern china, northern iran, and south africa

348
Q

factors that increase the risk of esophogeal cancr

A

tobacco, excessive alcohol, Barrett esophagus, GERD (associated with 30% of esophageal cancer), diets low in fresh fruit and veggies and high in nitrates, obesity

349
Q

Barrett esophagus

A

condition in which distal esophagus is lines with a columnar epithelium rather than a stratified epithelium

350
Q

achalasia

A

disorder in which the lower 2/3 of the esophagus loses its normal peristaltic activity

351
Q

what is the esophagus

A

a thin-walled 25 cm long tube lones with stratified squamous epithelium. begins at the level of C6 and traverses through the thoracic case to terminate at the esophageal gastric junction (T10-T11)

352
Q

esophagus is divided into 3 regions

A

upper thoracic, middle thoracic, and lower thoracic (or GE junction)

353
Q

staging system for esophagus cancer is based on

A

pathology: SCC or adenocacinoma

354
Q

the esophagus lies directly

A

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

355
Q

located laterally and to the left of the esophagus is the

A

aortic arch. the descending aorta is situated lateral and posterior to the esophagus

356
Q

layers of the esophagus

A

adventitia (outer layer, consisting of thin loose connective tissue, mucosa, submucosa, and muscular layers

357
Q

lymph drainage of esophagus

A

lymph fluid cn travel the entire length f the esophagus and drain into any adjacent draining nodal bed, which places the entire esophagus at risk for skip mets and nodal involvement

358
Q

the upper third (cervical area) of the esophagus drains into

A

internal jugular, cervical, paraesophageal, and supraclav. nodes

359
Q

upper and middle thoracic portion of the esophagus drain into

A

paratracheal, hilar, subcarinal, paraesophageal, and paracardial nodes

360
Q

principal draining lymphatics for the distal or lower thirs of the esophagus include the

A

celiac axis, left gastric nodes, nodes of the lesser curvature of the stomach

361
Q

most common pathological type of esophageal cancer

A

SCC and adenocarcinoma *SCC is more common in black people and adenocarcinoma is more common in white people

362
Q

rare type of esophagus cancer

A

non-epithelial which is Leiomyosarcoma (a tumor of the smooth muscles)-this is the most common nonepithelil tumor

363
Q

route of spread of esophagus cancer

A

spread is usually longitudinal. occassionally skip lesions my be present at a significant distance from the primary lesion (up to 5cm)

364
Q

standard tx of esophageal cancer

A

RT and concomitant chemo or preoperative chemoradiation followed by curative surgery (RT w/ chemo is considered the current nonsurgical tx of choice)

365
Q

nodes at risk for esophageal RT

A

cervical, supraclavicular, paraesophageal, amd subdiaphragmatic (celiac axis), lymph node region are at risk

366
Q

CTV esophageal cancer

A

includes regional lymphatics and encompasses the primary tumor with a 3 cm to 4 cm margin above and below the GTV and a 1 cm radial margin. the margin for the nodes should be expanded 0.5-1.5 cm from the GTV. the PTV is also expanded 0.5-1cm for radial or lateral margins.

367
Q

lesions of the upper third of the esophagus are treated with what type field set up

A

a field that begins at the level of the thyroid cartilage and ends at the level of the carina to include the supraclav, low anterior cervical, and mediastinal lymph nodes

368
Q

tumors of the distal third esophagus field set up

A

the inferior margin must include the celiac-axis lymph node, which are located at the T12-L1 vertebral level. the superior extent of the tx field should include the paraesophageal nodes and mediastinal nodes because they are a low risk of being involved.

369
Q

RT technique for esophageal cancer

A

3D conformal fields (AP/PA, laterals, or obliques), step and shoot IMRT fields and VMAT

370
Q

OAR for esophageal RT

A

lung, heart, spinal cord, kidneys, and liver

371
Q

TX dose for RT for esophageal cancer

A

60-65 Gy (6000-6500cGy)

if combined with chemo total dose should be 41.4-50.4 Gy

372
Q

RT tolerance dose of spinal cord

A

45-50 Gy

373
Q

Sim set up esophagus tx

A

-standard supine position. pts arms are often above the head, w pt. clasping the elbows or wrist. immobilization devices are used to help maintain position
(if pt. cant put arms above head, place arms along their sides with elbows slighty bend so marks can be placed)
-a 3 point set up is used. a thermoplastic mold may be used to maintain shoulder and headposition.
-a set of 3 marks are placed on the lower thoracic cage and are used to establish isocenter

374
Q

4th leading cancer-related death in the US

A

pancreatic (more common in men than women, and greater in blacks than white)

375
Q

cause of pancreatic cancer

A

no known cause

376
Q

location of pancreas

A

located retroperitoneally at the L1-L2 level and lies transversely in the upper abdomen.

377
Q

pancreas is divided into 3 anatomic regions

A

the head, body, and tail

378
Q

location of the head of the pancreas

A

C-loop of the duodenum

379
Q

location of the body of the pancreas

A

lies just posterior to the stomach near the midline and is anterior to the IVC.

380
Q

location of the tail of the pancreas

A

extends laterally to the left of the pancreas body, the tail terminates at the splenic hilum

381
Q

what does the pancreas come in direct contact with and often invade what?

A

duodenum, jejunum, stomach, major vessels (IVC), spleen, kidney (usually unresectable at the time of diagnosis)

382
Q

lymph nodes that drain the pancreas

A

main lymph node group includes the superior and inferior pancreaticoduodenal nodes, porta hepatis, suprapancreaetic nodes, and para-aortic nodes

383
Q

tumors that arise in the tail of the pancreas drain to the

A

splenic hilar nodes

384
Q

4 common symptoms of pancreatic cancr

A

jaundice, abdominal pain, anorexia, and weight loss

385
Q

tumors that arise in the head of the pancrease can obstruct

A

the biliary system, resultng in jaundice. it causes excess bilirubin to be excreted in urine and less bilirubin to enter the bowel, which result in dark urine and light color stool.

386
Q

pancreatic cancers occur most frequently in the

A

head and neck of the pancreas

387
Q

symptoms of tumor in body of tail of the pancrease

A

severe back pain and weight loss

388
Q

2 contraindications for pancrease tumor resection

A

liver mets and involvement of superior mesenteric artery or other major vessel

389
Q

hisopath of pancreatic tumor

A

adenocarcinoma (80%), other types include islet cell tumor, acinar cell carcinoma, and cystadenocarcinoma

390
Q

staging system for pancreas

A

TNM

391
Q

route of spread pancreas tumor

A

invade locally. lymph node involvement or direct extension into the duodenum, stomach, an colon is not uncommon at time of diagnosis,

hematogenous spread to the liver via the portal vein is also common

392
Q

tx of choice for pancreatic tumor

A

sx though often un-resectable.

most common potentially curative sx is the Whipple procedure (pancreaticodenectomy), involves a resection of the head of the pancreas, entire duodenum, distal stomach, gallbladder, and common bile duct

393
Q

tx set up for pancreatic cancer

A

4-field technique that encompasses the primary tumor ed. a dose of 45-50 Gy is delivered in 1.8 Gy fractions with high energy photons

394
Q

OAR for pancreatic tx

A

kidney, liver, stomach, small bowel. spinal cord

395
Q

typical AP/PA field set up for head of the pancreas

A

extend approx. from T10-T11 for inclusion of the tumor ned, draining lymphatics, and celiac axis (T12-L1). width of the field should encompass the entire duodenal loop and the margin that extends across the midline to the left. the lateral fields are designed to provide a 1.5 cm-2cm margin anteriorly beyond the tumor. posteriorly, the field extends 1.5 behind the anterior vertebral body for adequate coverage of the para-aortic nodes.

396
Q

sim set up for pancreatic tumor

A

supine position, with armsabove head for easier placement of lateral isocenter marks. an immobilization device is used. for sim with pt having SBRT a full-body immibolization device is used. patients have to drink a contrast 30min-1hr beforethe 4D-CT due to large amount of movement associated w the pancreas

397
Q

non melanoma is used to describe

A

basal (80%) and SCC (20%)

398
Q

most common malignancy in humans

A

skin cancer

399
Q

skin cancer that occurs in sites typically not exposed to the sun and is often aggressive

A

SCC

400
Q

junctional melanocytic nevi

A

uniformly brown or black, circular, well-circumscribed, flat, small (less than 6mm)

401
Q

compound nevi

A

contain melanocyte clusters in the dermis and epidermis, small, well circumscribed, slightly raised papules that often contain excess hair. the surfce is rough an color ranges from tan to brown

402
Q

intradermal nerci

A

small, well-circumscribed, dome shaped lesion, only found in dermal layer.

403
Q

dysplastic nevi

A

atyppical mole

404
Q

people with family history of melanoma are

A

8x more likely to get the disease

405
Q

largest organ in the body

A

skin (covers 17-20ft on the avg person)

406
Q

function of the skin

A

regular temp, acts as a barrier, participates in the production of vitamin D, provides eceptores for external stimuli

407
Q

connective tissue lyer of the skin

A

epidermis

408
Q

deeper layer of the skin composed of connective tissue that contains blood and lymhatic vessels, nervesm nerve ending, sweat glands, and hair follices

A

dermis

409
Q

layer below the dermis that contains nerves, blood vessels, adipose tissue, areolar connective tissue

A

subcutaneous layer

410
Q

epidermis is the extremely thin outer later of the skin that is composed of what layers

A
  1. stratum basale (base layer)-produces keratinocytes
  2. stratum spinosum (spiny layer)-contains rows of keratinocytes which have a spiney appearence microscopiclly
  3. stratum granulosum (granular layer)-contains 305 rows of somewhat flattened cells
  4. stratum lucidum (clear layer)-found typically ony in areas w/ thick skin (soles and palms), contains 3-5 rows of clear, flat cells that contain eleidin
  5. stratum corneum (horny layer) - forms the skin surface nd contains thicker rows of flat, dead, scaly squamous cells that are completely filled w keratin that have lost all their internal organelles including nuclei
411
Q

slow growing skin cancer that does not typically met. arises from stem cells and if left untreated can cause extensive damage

A

basal cell carcinoma

412
Q

faster growing cancer with higher chance for mets. arises from more mature keratinocytes of the upper layers of the Dermis

A

squamous cell carcinoma

413
Q

rare tumor thought to arise from Merkel (tactile) cells. known for high-rates of recurrence after surgical excision. frequently involves lymph nodes and and distant mets and cn lead to death

A

merkel cell carcinoma

414
Q

skin melanoma characteristics

A

asymmetric, notched uneven borders, diff shades of black, brown, or tan, have a diameter greater than 6mm

415
Q

melanomas are classified base on

A

growth pattern nd histological appearence

416
Q

superficial spreading melanomas

A

most common melanoma subtype. 70%

417
Q

nodular melanpmas

A

15% of melanomas, tend t be raised throughout and vary in color from dark brown, black, blue, or blue-black

418
Q

lentigo maligna melanomas

A

5% of melanomas. minimal elevation, tend to occur on sun exosed skin in older white females

419
Q

acral lentiginous melanomas

A

10% of melanomas. found mostly on palms, poles, nail beds, or mucous membranes.

420
Q

stage I tumor

A

low risk

421
Q

stage II -IIIA

A

intermediate risk

422
Q

stage III B

A

high risk

423
Q

stage IIIC and IV

A

very high risk

424
Q

stomach tolerance dose

A

4500 cgy

425
Q

small bowel tolerance dose

A

4500 cgy

426
Q

liver tolerance dose

A

3000-3200 cgy

427
Q

kidney tolerance dose

A

1500-1800 cgy

428
Q

area where liver tumors appear

A

right upper quadrant

429
Q

large bowel tolerance dose

A

5500 cgy

430
Q

histopath stomach cancer

A

adenocarcinoma

431
Q

route of spread stomach cancer

A

gastric cancers spread via direct extension and also through the rich lymphatics network

432
Q

rectum tolerance dose

A

6000cgy

433
Q

femoral head tolerance dose

A

5400cgy

434
Q

bladder tolerance dose

A

6500cgy

435
Q

6 sections of the stomach

A

cardia, fundus, body, greater curvature, lesser curvature, pylorus

436
Q

histopath stomach csncer

A

90-95% adenocarcinoma

Leiomyosarcomas and lymphomas 5-8%

437
Q

route of spread stomach

A
  • 1/3 have distant mets at diagnosis
  • may spread through lymph, blood, or direct
  • more likely o spread to bowel, omenta, pancreas, colon, regional nodes, peritoneum
  • will take blood route to the liver and lung since portal systems is in close proximity.
438
Q

stomach lymph drainage

A

drainage is tohe nodes along the greater and lesser curvature, then splenic, celiac, and hepatic nodes

439
Q

stomach staging

A

TNM

440
Q

rt Tx delivery for stomach

A

4-field box technique with beam shapers, use IMRT

441
Q

divisions of the small bowel

A

duodenum,jejunum,ileum

442
Q

histology of small bowel

A

adenocarcinoma (in duodenum and jejunum), sarcomas, lymphomas, carcinoid

443
Q

small bowel route of spread

A

regional lymph nodes and neighboring organ

444
Q

small bowel staging

A

classified y histological site and TNM

445
Q

small bowel Rt set up

A

irradiate whole abdomen for lymphomas, and csrcinoids

usually donde post-op. 20-25 Gy in 1-1.25 Gy fractions (limits dose to other organs in absomen)

446
Q

causes of liver cancer

A

hep B, hep C, cirrhosis, aflatoxin B (toxic metabolite of fungi that can grow in stored grain and peanuts)

447
Q

causes of gallbladder cancer

A

Cholelithiasis (stones irritate or bile acid is carcinogenic)

448
Q

histology liver cancer

A

Hepatocellular (HCC) (most common)

449
Q

histology of gallbladder cancer

A

adenocarcinoma (most common)

450
Q

lymph drainage for liver and gallbladder

A

regional lymph nodes including porta hepatic, celiac, cystic, pericholeductal, and hilar nodes

451
Q

route of spread for liver

A

can spread throughout the liver, may invade the portal vein, hepatic vein, or diaphragm. 1/3 of HCC have regional spread at diagnosis, then spread to regional nodes and then to lung, brain, or muscle tissue in absomen.

452
Q

gallbladder spread

A

40-50% of gallbladder carcinomas have distant spread at diagnosis, usually to liver or peritoneum

453
Q

liver/gallbladder staging and grading

A

grading is used, 1-2=low grade, 3-4 high grade.

454
Q

grading

A

based on appearance, shows degree of differentiation at a cellular level, can be a major prognostic factor

455
Q

brain (limited) tolerance dose

A

6000cgy

456
Q

while brain tolerance dose

A

4500cgy

457
Q

brain stem tolerance dose

A

5000cgy

458
Q

optic nerve tolerance dose

A

5000cgy

459
Q

retina tolerance dose

A

4500cgy

460
Q

ear tolerance dose

A

3000-5500cgy

461
Q

HD is determined by the presence of what

A

Reed-sternberg cells (large lymphoid cells that contain multiple nnuclei

462
Q

HD spread

A

spreads in a systemic pattern through the lymph nodes and lymph vessels

463
Q

HD & NHL staging

A

Ann Arbor Lymphoma Staging
numbers I-IV designates the extent of the disease.
the lettes A & B designate the presence (B) or absence (A) of symptoms
B symptoms:unexplained weight loss (10%+), feverrs greater than 101, drenching night sweats

464
Q

major lymph nodes

A
  1. Waldeyers ring (tonsillar lymp tissue that surrounds the nasopharynx and orophrynx) and cervical, preauricular, andoccupital lymph nodes
  2. supraclavicular (near jugular on neck) and infraclavicular lymph node(by collar bone)
  3. axillary lymph nodes (arm pit)
  4. thorax(includes hilar and mediastinal nodes)
  5. abdominal cavity (includes para-aortic nodes[middle of stomach])
  6. pelvic cavity (includes iliac node [side/lower abdomen], an Peyer’s patches in the distal ileum

the spleen, thymus, tonsils, adenoids, and bone marrow are all parts of the lympatics also`

465
Q

risk factor for HD

A

epstein-barr, mono, reed-sternberg cells, HIV

466
Q

most common sin of HD

A

painless mass above the diaphragm

467
Q

route of spread HD

A

contigous pattern of spread that mimics the route of spread of the lymphtic system. if disease ifs found outside the lymphtic system, it is next to the involved site. the rate of progression is not redictable

468
Q

tx tech. for HD

A

chemo

469
Q

RT setup for HD

A

most often delivered to the neck, chest, and axilla or to para-aortic lymph nodes and spleen. sme pt receive also to pelvic nodes.

470
Q

mantle field for HD

A

tx fields to the neck, chest, and axilla (includes cervical,submandibular, axillary, supraclav, infraclav, mediastinal, and hilar nodes)

471
Q

for HD if the pelvic and para-aortic fields are tx together its called

A

inverted Y

472
Q

when all 3 HD fields are tx together (mantle, pelvic and para-aortic[inverted y]) it is called

A

total nodal RT

473
Q

tx areas that only encompass the areas of known disease for HD is called

A

involved field radiation

474
Q

HD tx that includes areas of known disease and contiguous uninvolved lymph nodes

A

Extended field RT

475
Q

mantle field set up

A

large field size. pt is supine with hands above their head or akimbo with their hands on their hipsand elbows turned outwards. with chin extention to prevent exposure to mouth. tx with a AP/PA approach

476
Q

border for mantle field

A

superior: lower mandible or mastoid tip
inferior: T9-T10 interspace
lateral: flash beyond the axillary nodes

477
Q

tx of mantle and abdominal fields w/o pelvic portion is termed

A

subtotal nodal irradiation

478
Q

abdominal or para-aortic field setup

A

the spleen, para-aortic, and retroperitoneal nodes are tx AP/PA abdominal field. (if spleen is tx left kidney must be protected because right kidney receives dose).

479
Q

Borders for abdominal HD tx

A

superior- Mid T10-T11
inferior- L4-L5
lateral- 9cm-10cm wide midline

480
Q

when tx pelvic field for HD when is shielded

A

bone marrow, bowel, bladder, ovaries, testicles

481
Q

borders for pelvic HD tx

A

superior L-5
inferior 2 cm below ischial tuberosity
lateral- 2cm beyond pelvic inlet

482
Q

tx dose for HD

A

35-44 Gy to areas free of disease with 6 MV to 10 MV photon. the area of initial nodal involvement is tx from 25-30 Gy.

483
Q

NHL seperated into 2 groups

A

indolent (slow-growing) and aggressive

484
Q

pathology of NHL

A

B-cell (85% of NHL, arrises from abnormal B lymphocytes)

T-cell 15% NHL, arrises from abnormal T Lymphocytes)

485
Q

primary tx for NHL

A

chemo, rt, immunotherapy, and stem cell transplant. chemo is most affective.

486
Q

tx field dose NHL

A

35-45 Gy and includes involved site and related drainage nodal clusters

487
Q

indolent NHL in stages I and II can be tx with

A

RT alone

488
Q

NHL accounts for what portion of pediatric cancers (undr 20 years old)

A

7%

489
Q

side effects NHL RT tx

A

can vary because tx sites can be found all along he body. can tleast expect fatigue, alopecia, and skin erythema

490
Q

what is multiple myeloma

A
  • malignant disease of the plasma cells . arrises in the B-cell lymphocytes of the bone marrow
  • makes up approx. 10% of all hematologic malignancies.
  • usually seen in middle-aged or older adults
  • more common in men and blacks than women and whites
491
Q

mycosis fungoides

A

disease of the lymphocytes that can resemble eczema or other inflammatory conditions and tends to remain localized to the skin for long periods. tx using TBI

492
Q

tomotherapy

A

tx delivery system where tx is given slice by slice

493
Q

bone marrow transplant

A
  • harvesting of healthy marrow from matched donor
  • diseased marrow must first be destroyed or ablated by chemo or TBI
  • harvested marrow then injected back into patient
  • transplanted marrow then finds its way into bone marrow cavities and begins supplyingthe pt w/ normal, helthy hematopoietic cells.
  • failues in transplant are leukemia and graft-versus-host disease
494
Q

tumors of the primary bone include

A

osteosarcoma, chondrosarcoma, fibrosarcoma, malignant histiocytoma, malignant giant cell tumors, multiple myeloma, and metastatic bone disease.

495
Q

what 3 cancers affect bone and soft tissue

A

[fibrosarcoma and malignant histiocytoma(both these tumors are considered malignant fibrous histiocytoma MFH)], ewing sarcoma (not an MFH)

496
Q

most common osseous malignant bone tumor in children(56% of all pediatric primary skeletal tumors)(more common in males than females)

A

osteosarcoma

497
Q

2nd most common type of primary bone tumor in adults, involves the long bones of the extremities (knee joint), and jaw

A

osteosarcoma

498
Q

most common primary bone tumor in adults but is rare in children (6%pediatric primary bone tumors and 40% of adult)

A

chondrosarcoma

499
Q

primary bone tumor that involves the pelvis, ribs, vertebrae, long bones (proximal part), usually diagnosed at 60 years or older

A

chondrosarcoma

500
Q

most malignant bone lesion

A

metastatic bone disease, occurs mostly in spine and pelvis (lesions are less common farther from the trunk)

501
Q

most common primary site to met to bone

A

lung, followed by prostate, breast, lung, kidney, and thyroid

502
Q

risk factors for osteosarcoma

A

genetics (RB! and TP53), higher birth weight, tall, rapid bone growth in fetal and adolescence, Pagets disease, Werner syndrome, Bloom syndrome, and hereditary retinoblastoma.

503
Q

most common site of primary bone sarcoma is near

A

growth plates

504
Q

typical long bone consists of

A

diaphysis (main shaft of the bone), 2 epiphyses (knoblike portions at either end of the bone), the cartilage cap (covers the articular surface), and the periosteum (hard, dense covering of the bone)

505
Q

bone tumor found commonly is the distal femur, followed by the proximal tibia and proximal humerus

A

osteosarcoma

506
Q

chondrosarcomas are commonly found in the

A

pelvis and femur

507
Q

fibrosarcomas 9MFH) and GCTBs typically arise in the

A

metaphysics and epiphysis of the long bone, including the distal femur, proximal tibia, an distal radius.

508
Q

ewing sarcoma is most freq. seen in the

A

appendicular skeleton. 25% in the pelvis, 17% in the femur. can occur in any part of the bone most most commonly seen in the diaphysis

509
Q

most common oncological disease of bone

A

multiple myeloma, can occur in any bone and is characterized by osteolytic lesions

510
Q

metastatic bone disease often involves the

A

spine, pelvis, femur, humerus (it is not uncommon for met. disease to affect ribs and skull)

511
Q

the most common cancers to mets to bone ate advanced diseases of the

A

lung, breast, prostate. (nearly 40% of pt. w NSCLC and 70% with prostate are affected, 20-30% with breast cancer)

512
Q

multiple myeloma causes

A

bone loss, which results in painful bony lesions (can cause fractures)

513
Q

one of the few emergency procedures in RT

A

partial or complete spinal cord blockage-must be tx early to prevent paralysis and sensory loss

514
Q

osteosarcoma histopathology

A

poorly differentiated, subtypes include osteoblastic, chondroblastic, fibroblastic, or mixed chondroblastic

515
Q

tumor that arises from the mesenchymal elements of the bone

A

chondrosarcoma

516
Q

originate in te mesenchymal tissue and osten have the appearance of normal fibroblasts but are malignant

A

fibrosarcoma

517
Q

cell of origin for MFH tumors

A

histiocyte or the macrophage, usually undifferentiated pleomorphic

518
Q

multiple myeloma is characterized by

A

neoplastic proliferation of a single clone of plasma cells. these cells produce a monoclonal protein that, along with the proliferation of plasma cells , leads to the destruction of bone

519
Q

bone sarcoma staging and grading

A 
stage IA-grade low=<8cm
stage IB-grade low =>8cm
stage IIA-grade high=<8cm
stage IIB-grade high=>8cm
stage III any tumor grade, skip mets
stage IV- any tumor grde, any tumor size, distant mets
520
Q

tumors are classified based on

A

grade, tumor size, presence or absence of mets

521
Q

route of spread sarcomas

A
  • most sarcomas met. hematologically to lungs. occasionally, osteosarcoma, MFH, and chondrosarcoma met to other sites like bone, liver, brain
  • lymphatic spread is not usually of concern
  • *90% of pt. w high-grade osteosarcoma have lung mets**
522
Q

osteosarcomas may also have what kind of met

A

skip mets (a second-smaller focus of the cancer in the same bone or a 2nd bone lesion on the opposing side of the joint face)

523
Q

osteosarcoma tx

A

surgery. very chemo and rad. resistant

524
Q

primary tx for chondrosarcoma

A

sx

525
Q

primary tx for fibrosarcoma

A

aggressive surgery with wide or radical excision. post op RT can be done 66-70 Gy wit ha shrinking field technique

526
Q

MFH tx

A

surgery, if inoperable 46-66 Gy external beam and single fractions of 15-20 Gy intraoperatively

527
Q

tx for multiple myeloma

A

chemo w/ RT usually 30 Gy in 10-15 treatments

528
Q

Ewing sarcoma tx

A

sx, RT, chemo (very sensitive to chemo) tx w/55-60 Gy with a 2 cm margin around the soft tissue component and entire bone

529
Q

part of the classification of solid tumors that arise from the mesenchymal cells

A

soft tissue sarcomas (STS), rare but more common than bone

530
Q

`STS locations

A

connective tissue, including adipos, muscle, nerve, nerve sheath, and blood vessels

531
Q

most common STS in kids

A

rhabdomyosarcoma

532
Q

most common STS adults

A 
pleomorphic sarcoma (malignant fibrous histiocytoma), gastrointestinal stromal tumor (Gist)
liposarcoma (malignant)
leiomyosarcoma (malignant)
synovial sarcoma (malignant)
peripheral nerve sheath tumor
533
Q

local growth pattern of STS

A

follows the lines of least resistance in the longitudinal axis of the primary site compartment

534
Q

primary site compartment

A

consists of the natural anatomic boundaries that surround the STS primary-composed of common fascia planes of muscles, bone, joint, skin, subcutaneous tissues, and major neuromuscular structures.

535
Q

as STS progress and grow, they push away other structures andform

A

pseudocapsules (areas of compressed healthy and fibrotic tissue

536
Q

STS tumors of this area are generally high grade and end to invade adjacent muscle groups

A

trunk, head, neck

537
Q

extremity STS tend to invade how

A

spread along the longitudinal axis of muscular compartments.

538
Q

incidence of STS is _____, but mortality rate is ____

A

low incidence, high mortality

539
Q

etiology of STS is

A

unknown

540
Q

embryonic origin of STS begins in the

A

primitive mesoderm

541
Q

sarcomas are classified by

A

histology and named according to the tissue in which they arise (more than 50 types of STS are known)

542
Q

most common STS in adults

A

MFH 28% (arise in bone and soft tissue), leiomyosarcoma (12%), liposarcoma (15%), synovial sarcoma (10%), and malignant peripheral nerve sheath tumors (6%)

543
Q

most common pediatric STS

A

rhabdomyosarcoma

544
Q

primary staging system for STS

A

French Federation of Cancer Centers Sarcoma Group (FNCLCC) and National Cancer Institute System

545
Q

STS spread pattern

A

aggressive and invade along local, anatomically defined planes composed of neuromuscular structures, fascia, and muscle bundles. lymphatic extension is NOT common.
-hematologic pathway are the primary routes of spread

546
Q

STS common met site

A

lung, followed by the bones, liver, and skin

547
Q

Tx for STS requires

A

multidisciplimary approach (sx, chemo, and RT)

  • surgical resection
  • Rt may be delivered w/ external beam radiation, brachytherapy, IORT, or a combo of those. more common approach is either pre or post-op
548
Q

carcinoma

A

75-85% of tumors

  • originate in the epithelium
  • SCC, glandular cell (adenocarcinoma)
  • generally spread via lymphatics
549
Q

sarcomas

A

-10-15% of tumors
-originate in bone, connective, or soft tissue
most common met site is lungs

550
Q

benign tumors

A
  • non cancerous
  • normal to slightly increased growth
  • encapsulated
  • well differentiated
  • not usually life threatening
551
Q

malignant tumors

A
  • cancerous
  • normal to increased mitotic rate
  • can met.
  • well differentiated to anapestic (undifferentiated)
  • life threatening
552
Q

tumor classifications

A

benign or malignant

553
Q

etiology

A

study of the cause of the disease

carcinogens, genetic, etc

554
Q

epidemiology

A

study of the incidence of the disease (age, gender, race, occupation, geographic location)

555
Q

TNM described

A

T-describes the size and invasiveness of the primary tumor (the numerical value(1-4) is added to the T and increases w/ the extent of the normal
T1-small lesion confined to the organ of origin
T2-larger tumor size or deeper extention
T3-extention beyond the organ of origin, but confined tothe region
T4-invasion into another organ or viscera

N-describes the presence or absence of nodal involvement
M-describes the presence or absence of met.

556
Q

transverse plan or axial

A

cuts body into upper and lower through belly bottom

              O
              \|/ 
-----------------------------
               |
            /   \
557
Q

sagittal plane or longitudinal

A

cuts body in half into left and right portions

558
Q

frontal plane or coronal plane

A

cuts body into front and back options

559
Q

contrast media may be given

A

oral, iv, intrathecally, intraarteriorly

560
Q

types of contrast

A

barium (not water-soluble)

Iv contrast is usually iodine-based

561
Q

Scan field of view (SFOV)

A

area for which projection data are collected for a CT scan

562
Q

first image acquired during CT

A

tomogram (scouts, etc)

563
Q

isocenter localization procedure

A
  1. external skin fiducially
  2. computing isocenter based on field border placement
  3. placement of isocenter based on Tx volume or contour info
564
Q

2 main body cavities

A

posterior/dorsal and anterior/ventral (front and back)

565
Q

dorsal cavity can be divided into

A
  1. spinal or vertebral city (contains spine)

2. cranial cavity (contains brain)

566
Q

thoracic cavity is devided into

A
  1. pericardial cavity (contains the heart)

2. two pleural cavities (includes left and right lung)

567
Q

abdominopelvic cavity has 2 sections

A
  1. upper absomincal cavity
  2. lower pelvic cavity
    (abdominopelvic cavity iis large and divided into 4 quadrants; right upper, left upper, right lower, left lower)
568
Q

principle structures in the abdominal cavity

A

peritoneum, liver, gallbladder, pancreas, spleen, stomach, most of the large and small intestine

569
Q

structures in the pelvic cavity

A

rest of the large intestine, rectum, urinary bladder, internal reproductive system

570
Q

how many cervical vertebrae

A

7

571
Q

how many thoracic vertebae

A

12

572
Q

how many lumbar vertebrae

A

5

573
Q

an electron has a negative charge and a mass……

A

approx. 2000x smaller than that of a proton

574
Q

for water, energy loss by collission is approx

A

2mev/cm in the energy range of 1-100 MeV

575
Q

the dose at the surface begins at approx.

A

85% of maximum and builds up to 100% in the first few CM before the surface

576
Q

iodine-125 half life

A

59.4 days

577
Q

palladium-103 half life

A

17 days

578
Q

cesium-137 half life

A

30 years

579
Q

iridium-192 half life

A

73.8 days

580
Q

strontium-90 half life

A

28.8 years

581
Q

Iodine-131 half life

A

8 days

582
Q

what is the characteristic shape of the electron beam isodose curve

A

it is described as a lateral bulge or ballooning of the isodose curve

583
Q

mean energy of the electron be a in MeV at the surface

A

depth in centimeters of 50% isodose line divided by 2.4

584
Q

the practical range in CM in tissue

A

(mean energy at surface) divided by 2

585
Q

the depth of the 80% isodose line in CM in tissue

A

(mean energy at surface) divided by 3

example: 80%isodose=MeV/3

586
Q

gradient

A

the rate of change of a value (dose) with a change in position

587
Q

the depth of the 90% isodose curve may be approximated by:

A

dividing the energy of the electron beam in Mev by 4

90% isodose=MeV/4

588
Q

electron beam characteristics at the surface

A

-surface dose is 0.5 cm on the central axis of the electron beam
surface dose values for electron beams in the 6 MEv-20MeV rate vary from 75%-100%

589
Q

in megavoltage photo beams, increased energy of the treatment beam results in a

A

decrease in surface dose

590
Q

as the energy of the electron beam increases

A

the surface dose and percent depth dose also increase (because of backscatter)

591
Q

why is the use of bolus materials in electron beam therapy is somewhat more complicated than in photon beam therapy

A

a decrease in dose is possible in an electron beam setup with use of bolus. for this reason “a partial bolus should never be used with electrons”

592
Q

with increasing electron beam energy the ballooning of the isodose lines

A

decrease

593
Q

What percent of cells are killed with a dosage of 5 Gy delivered?

A

50%

  • 100,000 cells with 5 Gy delivered there will be 50,000 killed
594
Q

Why are modern radiation therapy treatments given in fractions during an extended period (6-8 weeks)?

A

so that a high total dose is given to the tumor while ideally sparing normal tissues. known as fractionation

595
Q

What determines the total dose, size, and number of fractions, and treatment duration?

A

The tumor type and tolerance of normal tissue in the tx field

596
Q

What size of fractionation scheme is typical for daily tx?

A

180 to 200 cGy given 5 days a week for 6 weeks

  • this totals a dose ranging in 5400 cGy to 6000 cGy
597
Q

What is hyperfractionated radiation therapy?

A

schedules for radiation include tx BID (twice a day) and TID (3 times a day)

598
Q

What is hypofractionated radiation therapy?

A

involves the use of dose fractions substantially larger than the conventional level of around 2 Gy

599
Q

What are the four R’s of radiation biology?

A
  1. Repopulation
  2. Redistribution
  3. Repair
  4. Reoxygenation

The biologic effects of tissue from fractionated radiation therapy depend on the “four R’s” of radiation biology

600
Q

What does Repopulation from the “four R’s” mean?

A

the hope of repopulating of normal cells during tx. normal cells dividing, thus repopulating is highly desirable because it decreases the risk of late effects

601
Q

What does Redistribution from the “four R’s” mean?

A

known as partial synchronization, results in a redistribution or reassortment of surviving cells after irradiation. the ideal clinical situation for radiation treatment exists when tumor cells have moved into a sensitive phase and normal cells have moved into a resistant phase

602
Q

What does Repair from the “four R’s” mean?

A

repair of sublethal damage occurs within hours of radiation exposure in normal and tumor cells. is oxygen dependent because a portion of tumor cells are thought to be hypoxic therefor making tumors incapable of repairing sublethal radiation damage as efficiently as normal tissues

603
Q

What does Reoxygenation from the “four R’s” mean?

A

applies only to tumor cells, which is the process by which hypoxic cells gain access to oxygen and become more radiosensitive between fractions

604
Q

What are the types of radiation?

A

alpha, beta, neutron, gamma, and x-rays

registry (4 decks)

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