RT 411 Final Flashcards
Over the past 50 years, the incidence of lung cancer in women has:
Increased
What is the estimated number of lung cancer cases diagnosed each year?
224,000
Aside from smoking, what are risk factors associated with lung cancer?
Chemical exposure (Radon), work environment, secondary smoke exposure
What is the histology of lung cancer linked to smoking?
Squamous Cell
List 4 tests that would beneficial for lung cancer staging
Chest x Ray, brain MRI, pleural tap, core biopsy
what are common signs and symptoms of lung cancer?
Dyspnea, hemoptysis, chest pain
Why might lung cancer cause hoarseness?
Tumor pressing on the left recurrent laryngeal nerve
what are the subtypes of NSCLC
Squamous cell, adenocarcinoma, and large cell
What are rumors located in the apex of the lung called?
Pancoast tumor or a superior sulcus
What is true about small cell lung cancer?
Likely to spread to the brain and commonly found in the central lung region
Common sites for lung Mets
Brain, adrenal and liver
When local extension occurs, lung cancer tumors can be seen in:
Parts of the lungs and ribs
Surgical resection is likely to be the treatment of choice for which operable lung tumor?
Squamous cell carcinoma
Why is it important to evaluate the dvh for lung cancer?
Help minimize normal tissue complications, see the percentage of dose the volume of OAR receives, the data can suggest when to spare normal tissue so it doesn’t exceed dose limit and will allow the doctor to predict the endpoint to surrounding organs
What tumor marker is used to aid in the diagnosis of testicular cancer?
AFP
For carcinomas if the bladder, how is the initial tissue diagnosis made made
Cystoscopy
Most common histology for testicular cancer
Germ cell
Most common histology of bladder cancer
Transitional cell
Bladder cancer spread via direct extension into the
Bladder wall
What lymph nodes are most likely to be treated for testicular cancer?
Para aortic
What are the common sites for spread of bladder cancer?
Lung and bone
Which lymph node chains are most common for drainage of bladder cancer?
External and internal iliac, pre sacral
What is the primary treatment modality for bladder cancer?
Surgery
Standard of care for for the first line of treatment for testicular cancer is
Orchiectomy
The loader is boosted to what dose in a curative setting?
65 Gy
A stage 1 seminoma has a 5 yr survival of
97%
What is a common acute toxicity for RT for seminoma?
Kidney failure
What disease is renal cancer associated with?
Von hipple-Lindau disease
What are the risk factors for breast cancer?
Early menarche, nulliparous, previous radiation to the chest
What is the difference between in situ and invasive breast cance?
In situ has not broken through the basement membrane
What is the most common breast cancer histology?
Infiltrating ductals carcinoma
A mass located in the lower inner quadrant of the breast drains to which lymph nodes?
Internal mammary lymph nodes
Describe the location of the level 1-3 axillary lymph nodes
I-III move from the axillary top toward the clavicle with I being in/around the axilla, just inferior to the pectoralis muscle and level III being most superior and on the pectoralis muscle
what are the most common metastatic sites for breast cancer?
Bone, lung, brain
What is used if Her2Neu is amplified
Herceptin
What is the primary treatment for breast cancer?
Mastectomy or lumpectomy+RT
What treatment modalities are used for the management of breast cancer?
Hormonal treatment, chemo, surgery
What treatment modalities are used for the management of breast cancer?
Hormonal treatment, chemo, surgery
At what approx. dose would an electron boost be prescribed for?
10-15 Gy
What are the borders for a breast tangent field?
2 cm sup and inf of breast tissue, medially to the sternum and laterally to the axilla line or 2cm past breast tissue
What is the total dose delivered to a whole breast without a boost?
45-50 Gy
What field is used to increase the dose to the level III axillary nodes?
PAB, posterior axillary boost
What is the benefit of using a wedge when treating tangential breast?
avoid hot spots
When are electrons used for breast treatments?
Scar boost, IMC fields
At what dose is dry desquamation most likely to occur?
30-40 Gy
In which ethnicity is there a high prevalence of nasopharyngeal cancer?
Chinese
In which ethnicity is there a high prevalence of nasopharyngeal cancer?
Chinese
What virus is associated with nasopharynx cancer?
EBV
What is used for the detection/diagnosis of H and N cancer?
Laryngoscopy, H&P, swallow study
Level I lymphatic chain
Sub mental
Level II lymphatic chain
Sub mandibular
Level III lymphatic chain
Mid cervical
Level V lymphatic chain
Posterior cervical
Level VII lymphatic chain
Lymphatic around the SSN
Level VII lymphatic chain
Lymphatic around the SSN
What is the primary tumor location that would drain to the jugulodigastric node?
Most common lymph node in head and neck cancer
What is the primary tumor location that would drain to the retropharyngeal node?
nasopharyngeal
What is the primary tumor location that would drain to the submental node?
tip of tongue
What is the primary tumor location that would drain to the submental node?
tip of tongue
What structures are removed in a radical neck dissection
Salivary glands, lymph nodes, sternocleidomastoid muscle
What is a treatment option for advanced head and neck tumors?
Treated with surgery followed by concurrent chemoradiation
What is a treatment option for early head and neck tumors?
surgery or radiation alone
What is the most important prognostic factor in had and neck cancers?
involvement of nodes
Osteoradionecrosis
Treating through the mandible and weakening it so it is more likely to break
What dose erythema occur?
20-30 Gy
what dose does skin necrosis start?
> 60 Gy
what dose does temporary alopecia start?
20 Gy
what dose does permanent alopecia start?
43 Gy
what dose do most mouth changes occur and which one is different
20- 30 Gy except laryngitis which starts at 40 Gy
what dose does nausea and vomiting start?
10-20 Gy
what dose does diarrhea start?
20-50 Gy
what dose does cystitis start?
30-40 Gy
Normal WBC
5,000 - 10,000
Platelets
200,000 - 500,000
Hemoglobin
12-16
Hematocrit
36-54%
About how many new cases of primary CNS are diagnosed each year?
23,000
Most adult brain tumors are located in the
cerebrum
Risk factors for brain tumor
p53 mutation, chemical exposure
Intracranial pressure (ICP) symptoms of CNS tumors
Headaches, visual changes, nausea
Focal symptoms of CNS tumors
Seizures, imbalance, weakness, speech problems
What modality is best for brain and spinal tissue?
MRI
What is another name for GBM?
High grade astrocytoma
Histology for brain tumors
GBM, medulloblastoma, meningioma
What are the lymphatics of the brain?
none
How do brain tumors typical spread?
Local invasion, CSF
Craniospinal fields must include
all tissue bathed in CSF
If you need to treat the spine with 2 fields it is preferred to match at or below what vertebral body?
L2
Prognostic factors for primary brain tumors
Age and KPS
Order GYN malignancies in order from most common to least common
Endometrial, ovarian, cervical, vaginal
colposcopy
procedure to closely examine the cervix, vagina and vulva for signs of disease
CA 125 is a tumor marker for
Ovarian and endometrial/uterine
what is D&C
Dilation and curettage - remove tissue from inside of the uterus for diagnostic purposes
what staging is used for GYN cancers?
FIGO
Most epithelial cells are of what cell origin?
Epithelial
ovarian cancer seeds in the ___ cavity
peritoneal
What chemotherapy is used concurrently with cervical cancer treatment?
Platinum based chemo
What type of brachytherapy applicator is used for treatment of vaginal cancer?
cylinder
