Washington and Leaver- Ch. 1, 30, 33 Review Questions

Question 1

How would a theory of cancer as an initially diffuse disease affect the treatment and outcome

Answer 1

When cancer is thought to be diffuse at the time of diagnosis, surgery and radiation therapy are not treatment options. Chemotherapy is not effective when the tumor burden is high. When the theory is that the cancer is already beyond control at diagnosis, less treatment is offered and the outcome is not good.

Question 2

Where are the characteristics of benign and malignant cells?

Answer 2

Benign tumors are not malignant. They are usually well differentiated and do not invade neighboring tissue. They are often encapsulated and do not harm the host unless their location is such that the tumor expansion will affect the host. Malignant cells have a range of differentiated: some are slow growing, and others are fast growing. Malignant cells have the ability to leave the primary tumor and spread to distant sites. Malignant cells will infiltrate and destroy neighboring cells.

Question 3

What would a primary tumor of the bone be called

Answer 3

Osteosarcoma

Question 4

What would a tumor arising from cells lining the oral cavity be called

Answer 4

Squamous Cell Carcinoma

Question 5

What are the roles surgery plays in the overall management and treatment of cancer

Answer 5

Diagnosis, primary treatment, multidisciplinary treatment, palliation, local treatment only

Question 6

What is the role of chemotherapy in the treatment of cancer

Answer 6

Primary treatment, multidisciplinary treatment, palliation. Local treatment only

Question 7

What is the role of chemotherapy in the treatment of cancer

Answer 7

Systemic treatment, primary and multidisciplinary

Question 8

What is the difference between etiology and epidemiology?

Answer 8

Etiology looks for the cause of disease. Epidemiology looks for the incidence of disease in specific groups.

Question 9

What roles does the radiation therapist play in patient care and treatment

Answer 9

The radiation therapist is the one individual in the cancer center who sees the patient on a daily basis. Radiation therapist provide comfort, education, referral as needed and accurate treatment. To ensure the patient receives accurate treatment, the radiation therapist is involved in continuous quality improvement and quality assurance.

Question 10

Microscopically, diffusion of oxygen and carbon dioxide takes place at the:

a. bifurcation of the trachea
b. right and left primary bronchi
c. bronchiolar ducts
d. alveolar-capillary membrane

Answer 10

d. alveolar-capillary membrane

Question 11

Symptoms associated with local disease include:
I. hemoptysis
II. dyspnea
III. orthopnea

a. I only
b. II only
c. I and II only
d. I, II and III

Answer 11

a. hemoptysis only

Question 12

Symptoms associated with regional disease include:
I. dysphagia
II. superior vena cava syndrome
III. orthopnea

a. I only
b. II only
c. I and II only
d. I, II and III

Answer 12

d. dysphagia, superior vena cava syndrome and orthopnea

Question 13

In what part of the lung are primary squamous cell carcinomas usually found

a. superiorly
b. centrally
c. laterally
d. peripherally

Answer 13

b. centrally

Question 14

Critical structures frequently located in the treatment fields are for lung cancer include:

a. liver and trachea
b. esophagus and trachea
c. spinal cord and heart
d. heart and esophagus

Answer 14

a. liver and trachea

Question 15

Describe three criteria related to an individuals tobacco exposure that appear to increase the risk of development of lung cancer.

Answer 15

Increased duration of smoking, increased use of unfiltered cigarettes, increased cigarette consumption

Question 16

What are three variables that appear to affect significantly the prognosis of patients with lung cancer

Answer 16

Stage, performance (Karnofsky) status, weight loss

Question 17

Name the two groups of lymphatics that are primarily responsible for the regional spread of bronchogenic carcinoma

Answer 17

Mediastinal and intrapulmonic

Question 18

With conventional fractionation, what is the commonly accepted definitive dose range for localized bronchogenic carcinoma

Answer 18

6000-6600 cGy

Question 19

List at least three common acute side effects a patient may experience during the course of treatment

Answer 19

Dermatitis, erythema, esophagitis, dysphagia, coughing

Question 20

Which of the following methods may reduce dose to the small bowel during pelvic radiation therapy

a. supine position
b. prone position
c. treatment with a full bladder
d. both b and c

Answer 20

d. prone position & treatment with a full bladder

Question 21

The principal advantage of intensity-modulated radiation therapy over conventional 3D conformal in the treatment of rectal, anal or pancreatic cancer is:

a. fewer long-term radiation side effects
b. better dose conformity to target volumes
c. more sparing of healthy structures (OARs)
d. all of the above

Answer 21

d. All of the above

Question 22

The principal lymph node group involved in patients with rectal cancer is the:

a. common iliac nodes
b. inguinal nodes
c. para-aortic nodes
d. internal iliac nodes

Answer 22

d. internal iliac nodes

Question 23

The principal etiologic factor in the development of squamous cell carcinoma of the esophagus in North America is:

a. a diet high in fat and high in nitrate content
b. a diet low in fat and high in vegetables and fruits
c. excessive alcohol and tobacco use
d. achalasia and plummer-vinson sydrome

Answer 23

c. excessive alcohol and tobacco use

Question 24

A common site of blood-borne metastasis from rectal pancreatic or esophageal malignancies is the:

a. brain
b. bone
c. adrenal gland
d. liver

Answer 24

d. liver

Question 25

For radiation treatment to the thorax for esophageal cancer, the dose-limiting structure of most concern is the:

a. spinal cord
b. heart
c. esophagus
d. trachea

Answer 25

a. spinal cord

Question 26

The radiation-field design most commonly used to avoid the critical structures in question 6 (for radiation treatment to the thorax for esophageal cancer, the dose limiting structure of most concern is the) is:

a. AP/PA fields
b. conformal 3D or IMRT
c. lateral- opposed fields
d. wedge pair

Answer 26

b. conformal 3D or IMRT

Question 27

Which of the following are common presenting symptoms of pancreatic cancer?
I. jaundice
II. nausea and vomitting
III. 10% weight loss 
IV. Anorexia 

a. I and II only
b. II and III ]
c. I, II, and IV
d. I, III, and IV
e. all of the above

Answer 27

d. jaundice, 10% weight loss and anorexia

Question 28

Which of the following statements regarding pancreatic cancer is not correct.

a. It is locally invasive into surrounding structures
b. Hematogenous spread to the liver at the time of diagnosis is common
c. The 5 year survival rate is 80%
d. most tumors are unresectable

Answer 28

c. the 5 year survival rate is 80%

Question 29

For irradiation of the upper abdomen for pancreatic cancer, the most radiosensitve dose-limiting structure is the:

a. kidney
b. liver
c. small bowel
d. spinal cord

Answer 29

a. kidney