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Radiation Therapy > Test 2 Study Guide: Lung, H&N, CNS > Flashcards

Test 2 Study Guide: Lung, H&N, CNS Flashcards

1
Q

What seven warning signs of cancer does CAUTION stand for?

A

Change in bowel or bladder habits.

A sore that does not heal.

Unusual bleeding or discharge.

Thickening or lump in the breast or elsewhere.

Indigestion or difficulty in swallowing.

Obvious change in a wart or mole.

Nagging cough or hoarseness.

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2
Q

What is the purpose of grading systems?

A

determine cell differentiation and aggressiveness of the tumor

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3
Q

What is the purpose of field gaps and feathering?

A

Ensure even dose distribution; prevention of hot spots

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4
Q

What lung tumor occurs centrally in the lung?

A

squamous cell (non small cell lung cancer)

also large cell

Small cell lung cancer

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5
Q

What lung tumor occurs superiorly in the lung?

A

Pancoast tumor

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6
Q

What lung tumor occurs peripherally in the lung?

A

adenocarcinoma (non small cell lung cancer)

also large cell

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7
Q

What is the most common histology of primary lung tumors?

A

adenocarcinoma (NSCLC)

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8
Q

What are the common presenting symptom of local disease in lung tumors?

A

Persistent cough

Hemoptysis (blood in septum)

Dyspnea

Fatigue and weakness

Weight loss

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9
Q

What are the common presenting symptom of regional disease in lung tumors?

A

Chest pain/ nerve entrapment

Vascular obstruction

Dysphagia from esophageal
compression

Hoarseness

Pleural effusion

SVC syndrome (pooling of blood by obstruction of SVC)

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10
Q

What are the signs of distant metastasis in lung tumors?

A

Headaches

Visual changes

Neurological deficit

Personality changes from brain metastases

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11
Q

What are the signs and symptoms of non specific paraneoplastic syndrome in lung cancers?

A

Pancoast tumor

Pain in shoulder

Atrophy of hand muscles

Erosion of ribs or vertebrae

Or Horner syndrome

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12
Q

What are paraneoplastic syndromes?

A

syndrome (problems from hormone like substances traveling to other parts of the body through blood from the original cancer site.

Hypercalcemia

Hypertrophic osteoarthropathy
Clubbing of fingers, blood clots, gynecomastia

Syndrome of inappropriate
antidiuretic hormone secretion

Adrenocorticotrophic hormone production syndrome

Paraneoplastic syndromes associated with SCLC!

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13
Q

What are the etiologic factors of lung cancer?

A

Smoking

Radon

Asbestos

Certain metals

Radiation

Air pollution

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14
Q

What is the location of most mesothelioma and what are its most significant risk factors?

A

Primary risk factor is asbestos

Usually occur in the pleura of the lung (surrounding tissue)

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15
Q

What is the common radiation dose for primary lung cancer?

A

60-75Gy

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16
Q

What is the treatment of choice for NSCLC?

A

surgery

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17
Q

What is the treatment of choice for SCLC?

A

Chemotherapy -
CISPLATIN

Concurrent hyperfractioned radiation therapy commonly delivered

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18
Q

Identify lymph node routes of spread for lung tumors in order.

A

Intrapulmonary to

hilar to

mediastinal to

supraclavicular

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19
Q

List side effects of radiation treatment to the thorax region.

A

Pneumonitis
Esophagitis
Dysphagia
Odynophagia
Esophageal stricture
Pericarditis
Radiation fibrosis
Transverse myelitis

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20
Q

What is the staging system used for lung tumors?

A

AJCC or TNM

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21
Q

Where dose the trachea bifurcate (carina)?

A

T5

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22
Q

What is the most common diagnostic tool for lung cancer?

A

chest x ray

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23
Q

What is the chemotherapy commonly used to treat lung tumors?

A

Cisplatin

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24
Q

What is a wedge resection?

A

Partial resection of the lung (removal of part of a lobe)

Triangle removal of gross tumor and small amount of surrounding healthy tissue

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25
Q

What is a pneumonectomy?

A

Removal of the entire lung

Done if tumor is in the airway

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26
Q

What is the lung cancer with the worst prognosis?

A

Small cell lung cancer (SCLC)

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27
Q

What is the importance of respiratory management?

A

tumor tracking

limits dose to OARS

(breathing can cause 1 cm movement in thoracic cavity)

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28
Q
A
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29
Q

What are the lab studies used for detection and diagnosis of lung tumors?

A

Lab studies:

CBC

Serum calcium
Elevation indicates bony disease

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30
Q

What is the radiation dose generally for head and necks?

A

50-70 Gy

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31
Q

What are the organs of the oral cavity?

A

lips

floor of mouth

oral (anterior) tongue

buccal mucosa

gingiva

hard palate

retromolar Trigone

oropharyngeal wall

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32
Q

What are the organs of the hypo pharynx?

A

Pyriform sinus

Post cricoid area

Posterior pharyngeal wall

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33
Q

What are the sections of the larynx?

A

supra glottis, glottis, subglottis

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34
Q

What are the presenting symptoms of the oral cavity?

A

Swelling
Ulceration
Trismus

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35
Q

what are the presenting symptoms of the oropharynx?

A

dysphagia

otalgia

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36
Q

what are the presenting symptoms of the hypo pharynx?

A

dysphagia

swollen lymph nodes in the neck

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37
Q

what are the presenting symptoms of the larynx?

A

hoarseness
change in voice
stridor

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38
Q

What are the presenting symptoms of the nose/sinus?

A

Nasal obstruction
Facial pain
Diplopia

39
Q

What are the presenting symptoms of the nasopharynx?

A

Epistaxis
Difficulty hearing
Otitis media
Cranial nerve palsies
Headaches

40
Q

what are the presenting symptoms of the salivary glands?

A

Painless mass
Swelling under chin

41
Q

What is the node of rouviere?

A

Lateral retropharyngeal nodes at base of skull (lymph node)

42
Q

What is the vertebral level of the larynx?

A

Lower border of C3 to cricoid cartilage at C6

43
Q

What is the vertebral level of the hypo pharynx?

A

C3-C6

44
Q

What is the vertebral level of the carina?

A

T4-T5

45
Q

Which H&N cancer commonly does not have lymph node involvement, giving that* cancer a better prognosis?

A

Glottis Cancer

46
Q

Identify ducts in the parotid gland and its location *

A

Stenson’s duct (horizontal toward teeth) its near the second molar

47
Q

What are the locations of the anterior and posterior papillae of the tongue?

A

Circumvallate papillae separate the

anterior 2/3

posterior 1/3 of the tongue

48
Q

What is the most common form of larynx cancer?

A

glottis

49
Q

what is the most common paranasal sinus cancer?

A

maxillary sinus

50
Q

What is the most common histologic type of head and neck cancer?

A

squamous cell carcinoma

51
Q

What are the lymph nodes of the head and neck region?

A

submental nodes, submandibular nodes
upper and lower jugular nodes
posterior triangle nodes
anterior compartment nodes
superior mediastinal nodes

52
Q

what lymph node is most commonly used to determine prognosis of head and neck cancers by clinical examination?

A

cervical node

53
Q

What is the purpose of wax on lead?

A

absorbs electron backscatter

54
Q

what is the treatment of choice for head and neck cancers?

A

surgery

55
Q

What are the most common histology of head and neck tumors?

A

SQUAMOUS CELL CARCINOMA

56
Q

What is the inferior border of the the larynx port?

A

cricoid cartilage

57
Q

What is the inferior border of the nasopharynx port?

A

mastoid tip

58
Q
A
59
Q

what is the inferior border of the salivary gland port?

A

thyroid notch

60
Q

what is the inferior border of the oropharyngeal port?

A

level of hyoid

61
Q

what is the inferior border of the hypo pharyngeal port?

A

cricoid cartilage?

62
Q

What staging system is used for head and necks?

A

TNM staging/AJCC/UICC
cTNM-clinical staging
pTNM-pathologic staging

63
Q

what are the side effects of radiation for head and necks and at what doses do they occur?

A

Mucositis/stomatitis (inflammation of oral mucous membranes with edema and tenderness
30 Gy

Xerostomia
Begins 10 Gy, permanent 40 Gy

Cataract formation
10 Gy

Lacrimal glands- dry painful eye
More than 57 Gy

Taste changes
10 Gy

Skin reactions

64
Q

what is the dose range for primary CNS tumors?

A

50-54 Gy

65
Q

What is the dose range for metastatic CNS treatments?

A

30-40 Gy

66
Q

what is the most common histology of primary and metastatic brain tumors?

A

gliomas

67
Q

what are the associated risk factors for CNS cancer?

A

Age,
family history,
genetic factors,
radiation exposure,
smoking,
alcohol

68
Q

what are the common presenting symptoms of brain tumors?

A

Headaches
, Seizures,
Blurred vision,
Nausea,
Weakness or numbness of extremities
, Altered mental status,
Coma (rare)

69
Q

what is special about the blood brain barrier?

A

substances have to be lipid soluble to pass through. (such as nitrosoureas)

chemotherapy drugs must be lipid soluble

70
Q

what is the most common type of brain tumor?

A

brain mets

71
Q

what is the most common source of brain mets

A

1st lung, then breast

72
Q

what is the common symptom of childhood brain tumors in the cerebellum?

A

loss of coordination also known as ataxia

73
Q

what is the treatment of choice for brain metastasis?

A

Whole brain palliative radiation therapy or SRS

74
Q

what is the most common CNS tumor location in adults?

A

Adults- supratentorial (cerebrum)

75
Q

what is the most common CNS tumor location in children?

A

Children- infratentorial (cerebellum)

76
Q

what are the late effects of brain irradiation in children?

A

Coordination, necrosis, cataract formation

77
Q

what is the most common grade of glioma?

A

Grade 4 high grade gliomas

78
Q

tumors that arise from glial cells are called:

A

gliomas

79
Q

at what dose is brain tissue necrosis most likely to occur?

A

60 Gy

80
Q

what is the route of spread for medulloblastomas?

A

CSF

81
Q

what is the route of spread for schwannomas?

A

local

82
Q

what is the route of spread for oligodendrogliomas?

A

CSF

83
Q

what is the staging system for brain?

A

No universal staging system

AJCC uses grade, tumor, and metastasis system (GTM)

Kernohan grading system:

Cellularity
Anaplasia
Mitotic figures
Giant cells
Necrosis
Blood vessels
Proliferation

84
Q

what are the radiation field borders for whole brain palliative treatments?

A

Superior – Top of skull

Inferior borders – EAM and lateral orbital canthus

85
Q

what are the layers of the meninges?

A

Dura mater – Outermost layer that protects the brain and spinal cord

Pia mater – Innermost layer that is highly vascular and adheres close to the contours of the brain

Arachnoid – Sits in between dura and pia mater and acts as a shock absorbent for the brain

86
Q

what is the setup for medulloblastoma?

A

Prone position, and treatment fields consist of 2
lateral whole brain fields and one or more posterior spinal fields

87
Q

what is the setup for astrocytoma?

A

supine with mask

88
Q

what is the setup for brain mets?

A

SRS or supine whole brain

89
Q

what is the vertebral level of the hypo pharynx?

A

C3-C6

90
Q

what is the most common paranasal sinus tumor?

A

maxillary sinus

91
Q

what is the most common larynx tumor?

A

glottis

92
Q

what is the most common oropharynx tumor?

A

tonsil

93
Q

what is the most common salivary tumor?

A

parotid

Radiation Therapy (26 decks)

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