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89 Cards in this Set
- Front
- Back
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name of the cell normally associated with HL?
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Reed-Sternberg Cell
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Describe the significance of the Reed-Sternberg Cell
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this is the cell that is associated with HL, it is large and has 2 nuclei
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Identify the common locations for lymph node involvement in HL.( slide 5)
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Waldeyer’s ring
Supraclavicular and infraclavicular Axillary Thorax Abdominal cavity Pelvic Cavity Inguinal femoral |
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Why is HL known as a bimodal disease?
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Because it occurs in young adults as well as people over the age of 55 (two age specific risk factors)
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List what B symptoms of HL are?
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Fever
Night Sweats Weight Loss (10% within a 6 month period) |
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Identify the various staging systems for HL presented diseases.
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Ann Arbor Staging System
A or B symptoms present (B=worse prognosis) |
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Identify the treatment fields associated with HL.
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Mantle field
Inverted ‘Y’ field -Abdominal portion -Pelvic portion |
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Describe the characteristics of multiple myeloma
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Abnormality of plasma cells
Improper cell replication Malignant cells also crowd out and inhibit the production of normal blood cells and antibodies in the bone marrow Large quantities of an abnormal immunoglobulin called monoclonal (M) protein formed |
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What are the two types of mm.
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Active (Symptomatic)
Smoldering (Asymptomatic) |
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Identify the 5 steps of the Autologous Transplant Process.
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1.Collection- stem cells are collected from the patient’s bone marrow or blood
2.Processing- blood or bone marrow is processed in the lab to purify and concentrate the stem cells 3.Cryopreservation- blood or bone marrow is frozen to preserve it 4.Chemotherapy- high dose chemotherapy and/or radiation therapy is given to the patient 5.Reinfusion- thawed stem cells are reinfused into the patient |
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What is the primary risk factor for developing lung cancer.
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Smoking is the primary risk factor, second hand smoke, air pollution, asbestos, chemicals such as uranium, beryllium ,coal dust, diesel exhaust
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Explain where the 3 histology/pathology classification of NSCLC are found in the lung. Non-small cell cancer is divide into three sub groups:
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Adenocarcinoma- usually found in the outer regions of the lung
Squamous cell carcinoma- usually found in the center of the lung next to the bronchus Large cell carcinoma- can occur anywhere in the lung and tends to spread faster than the other two |
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Identify three primary critical structures in treating lung cancer and their tolerances.
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Spinal Cord (<50 Gy) (5000cGy)
Lung (both lungs <20 Gy-40Gy) (2000-4000 cGy) Esophagus (<75 Gy) (7500 cGy) Heart (40 Gy) (4000 cGy) Brachial Plexus (<60 Gy) (6000 cGy) Liver (30 Gy) (3000 cGy) Kidney (20 Gy) (2000 cGy) also dependent if patient has two kidneys |
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List the treatment options for NSCLC.
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IMRT-intensity-modulated radiation therapy
SBRT-stereotactic body radiation therapy IGRT- image guided radiation therapy Surgery Chemo |
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Explain where the endometrium is located in the body.
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Sits between the bladder and rectum
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What are the three parts of the endometrium (uterus)?
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Fundus- superior portion
Body- middle portion Cervix- Inferior portion |
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What are the staging systems used for endometrial cancer?
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TNM and FIGO
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Name 3 ways to manage endometrial cancer.
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Surgery (hysterectomy)
Radiation therapy Chemo Hormone therapy |
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Match the tolerance doses to the critical structures involving the treatmetn of endometrial cancer
Bladder Rectum Intestines Ovarian Failure Sterilization |
Bladder= <75 Gy
Rectum= <70 Gy Intestines= <45-50 Gy Ovarian failure= 5-10 Gy Sterilization= 2-3 Gy |
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• Describe the function, location and physical anatomy of the kidney.
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Function – to filter out waste in the blood and reabsorb nutrients needed to maintain homeostasis in the body
Location – upper abd, retroperitoneal, @ level T12 – L3 |
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What is Bowman’s capsule.
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At the end of the nephron. This is where the afferent artery brings blood to the nephron and where the efferent vein takes it away
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Describe the functionality of the following:
Proximal convoluted tube Loop of Henle Distal convoluted tube Collecting tube |
Proximal convoluted tube- (which drains Bowman’s capsule) is where almost all of the absorption of nutritionally important substances takes place.
o Loop of Henle- absorbs water and ions from the urine and plays a role in controlling the concentration of urine o Distal convoluted tube- potassium, sodium, and pH. This is where further dilution of the urine takes place. o Collecting tube - joins several tubules to collect the filtrate. This is where final sodium regulation takes place |
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List three hormones kidney releases and their functions.
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Erythropoietin (EPO)
Renin Calcitrol |
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• What is GFR and how does it work.
Can be used to describe “renal function.” how to test the old way how to test the new way |
To test the old way - Iohexol is injected, 4 hours later blood is drawn and tested to see how well the kidney s are filtering out the chemical
To test the new way - requires only a measurement of the creatinine in a blood sample, which is weighed against the individual’s age, sex, and race. This is normally what we use to judge kidney function |
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What is creatinine and how is it useful to the body.
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Creatinine is made from creatine, a supplier of energy to the muscle.
The chemical waste (creatinine) is a by-product of normal muscle contractions. |
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What is BUN and how is it useful to the body.
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Blood carries protein to cells throughout the body. After the cells use the protein, the remaining waste product is returned to the blood as a substance called urea (which contains nitrogen). Healthy kidneys take urea out of the blood and put it in the urine
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• What are the two major areas that Kidney cancer spreads to via the blood.
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Lungs
Liver |
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What is the most common type of kidney cancer and how does it grow.
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Renal Cell Carcinoma
Develops in the kidney tubules, typically as a single mass |
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what is another name for a nephroblastoma
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wilm's tumor
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Define and describe IVP.
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Contrast media is injected into the body
As the waste is filtered out from the blood the contrast collects in the kidneys and moves down the ureters and into the bladder allowing visualization of the urinary system with an x-ray machine |
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List the 4 most common treatments for kidney cancer.
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o Surgery
o Biological therapy o Radiation therapy o Chemotherapy |
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Define arterial embolization and how it is done.
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Catheter inserted from femoral artery to the renal artery.
Chemical is injected into the artery to block the flow of blood to tumor. The blockage prevents the tumor from receiving blood (and therefore the nutrients it needs to grow) |
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Analyze the doses delivered in the treatment of kidney ca.
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Dose ranges from 45 to 55Gy at 18Gy fractions
Can do boost of 54Gy in 3 fractions to a smaller volume Opposite kidney should not receive doses above 18Gy High energy photons of 10 mV or higher should be used |
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The bladder is made of what three layers
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urothelium
lamina propria, peritoneum. |
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The two most common invaded nodes involving the bladder are the
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internal and external iliac nodes.
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which cancer is known as one of the most common work related cancers
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bladder cancer
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what is the major cause of bladder cancer
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smoking
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smoking contributes to _____% of bladder cancer
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50%
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Bladder cancer arises primarily from the .......
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transitional cells of the bladder mucosal epithelium.
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What are the signs and symptoms of bladder cancer.
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Typical symptoms that a patient may encounter are(hematuria).
Other symptoms may include pain with urination, also known as dysuria, and possibly an increase in the frequency of urination. |
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Why does the patient need a full bladder during treatment?
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The patient needs to have a full bladder so that the other surrounding critical structures are not in the way of the treatment fields
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Pre-operative therapy for bladder caner consits of what kind of dose and fractions
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Anywhere from 45Gy to 50Gy and a fraction rate of 18Gy per fraction.
Boost for bladder is set at an additional 20Gy A patient will have a total of 35 treatments |
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Post-operative therapy for bladder cancer consits of what kind of dose and fractions
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Post-operative
Dose will be 40-50Gy at a fraction rate of 20Gy per fraction. Boost is an additional 20Gy. |
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Why does the patient need a full bladder during treatment?
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The patient needs to have a full bladder so that the other surrounding critical structures are not in the way of the treatment fields
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Know the TD 5/5 and endpoint for 3/3 of the
bladder |
65 Gy Endpoint= symptomatic bladder contracture and volume
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Pre-operative therapy for bladder cacner consits of what kind of dose and fractions
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The dose will be set anywhere from 4500 cGy to 5000 cGy and a fraction rate of 180 cGy per fraction.
Boost for bladder is set at an additional 2000cGy A patient will have a total of 35 treatments |
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Know the TD 5/5 and the endpoint for the rectum
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60 Gy Endpoint=Severe proctitis/necrosis/fistula/stenosis
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Post-operative therapy for bladder cacner consits of what kind of dose and fractions
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Post-operative
Dose will be 40-50Gy at a fraction rate of 20Gy per fraction. Boost is an additional 20Gy. |
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Know the TD 5/5 and the endpoint for small intestine
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40 Gy Endpoint= Obstruction/perforation/fistula
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Know the TD 5/5 and endpoint for 3/3 of the
bladder |
65 Gy Endpoint= symptomatic bladder contracture and volume
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Know the TD 5/5 and endpoint for the colon
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45 Gy Endpoint=Obstruction, perforation/ulceration/fistula
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Know the TD 5/5 and the endpoint for the rectum
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60 Gy Endpoint=Severe proctitis/necrosis/fistula/stenosis
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Know the TD 5/5 and the endpoint for small intestine
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40 Gy Endpoint= Obstruction/perforation/fistula
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Know the TD 5/5 and endpoint for the colon
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45 Gy Endpoint=Obstruction, perforation/ulceration/fistula
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The left testicle drains mostly into the _______, while the right testicle drains into the _______ lymph nodes. There can be cross over drainage between the right and left testicle.
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paraaortic lymph
interaortocaval |
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Name 3 major risk factors for seminoma
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Cryptochidism
Age Ethnicity / race |
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________= The main risk factor for seminoma; this is when the testicle fails to move into the scrotum before birth.
Age= men between the age ______ and ______ Ethnicity and race= white men have a ______ increase in incidence of seminoma |
Cryptochidism
30-40 5% |
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What is another name for seminomas and how are they arranged at the celluar level.
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Germ cell tumors; large polyhedral seminoma cells with well defined borders, a plethora of clear cytoplasm, and large nuclei. The cells are arranged in solid sheets and have the ability to form tubular, papillary, or glandular structures.
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• What are the top three signs and symptoms of seminoma.
Usually seminoma is painless if there is signs and symptoms the top three would be: |
1.Heaviness and tenderness present in the scrotum
2. Back or abdominal pain 3. breast swelling (due to increase in human gondadotropin hormone) |
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Explain what roman numerals and letters mean in staging.
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Roman numerals is the cancer indicate they increase in severity (I-III)
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Involving a seminoma, what is the pathologist looking for when blood work is performed.
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Increase in alpha-feto protein (AFP) and human gonadotropin hormone (HCG)
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What is an orchiectomy and when is it performed.
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Orchiectomy=the surgical removal of one or both testicles, depending on the location of the seminoma. It is the first thing done in the treatment of seminoma.
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Describe the radiation treatment fields for a seminoma.
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The field is known as hockey stick shape or dog field
Superior border= The top of T10 Lateral= edge of illium includes ipsilateral iliac nodes, and medial border extends one centimeter over midline Inferior= bottom of ischial tuberosity Lateral= usually 9-10 cm wide except at the renal hila where it may be slightly wider |
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• Identify short and long term affects of treatment for seminoma.
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Short term= Skin, fatigue, nausea, and diarrhea
Long term= Diarrhea, impairment of producing sperm, increased risk of secondary malignancies, and increased risk of cardiac disease |
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Identify the 4 sinuses in head region.
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Frontal, maxillary, ethmoid, spheniod
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Explain how maxillary sinuses tumors typically spread.
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Lymphatic spread is rare (usually through direct extension)
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What are the signs and symptoms of MS cancer
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o nasal congestion and stuffiness that does not get better over time or with medication
o pain above or below the eyes o blockage of a nasal passage on one side o nosebleeds or post-nasal drip o pus draining from the nose o decrease in smell o numbness or pain in parts of the face or teeth o growth or mass in the nose or face o constant watery eyes o bulging of the eye o loss or change in vision o pain or pressure in one of the ears o trouble opening the mouth o and lymph node enlargement |
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• What is the major histologic type for MS cancer.
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80% of maxillary sinus tumors have a histopathology of squamous cell
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Define the role of surgical resection in Max sinus cancer
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The general goal with surgery is to remove the entire tumor while maintaining a respectable amount of normal tissue and structures that keeps appearance and function (chewing, swallowing, breathing, and speech) as normal as possible
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Define the role of radiation therapy in Max Sinus cancer
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Radiation therapy aims to kill small cancer cells after surgery or to shrink the tumor before surgery
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Define the role of chemo in Max Sinus cancer
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Chemotherapy drugs may be given before surgery to shrink the tumor and make it easier to remove during surgery or given after surgery to help lower the chances of the tumor reoccurring, is used as a primary treatment or with radiation therapy when the tumor is too large and cannot be completely removed or it has spread to a distant site
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What are the critical structures in the field for max sinus cancer, their tolerance doses and endpoints.
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Eye= 10 Gy, cataracts
Retina= 45 Gy, affects vision Brain= 60 Gy, necrosis Mandible= 60 Gy, osteoradionecrosis Parotid= 26 Gy, xerostomia |
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wilms tumors are most often found in ______
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children
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wilms tumors account for _______% of kidney cancers
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4-5%
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wilms tumors are classified into what 2 major types depending on histological examination
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Anaplastic
Non-anaplastic |
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Know the risk factors for Squamous Cell Carcinoma of the esophagus
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o Vitamin and nutritional deficiencies
o Smoking o Alcohol o HPV |
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Know the risk factors for adenocarcinoma of the esophagus
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o Barrett's esophagus
o Sex o Age o Smoking o Obesity o African American |
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Identify the critical structures and their tolerances when treating esophageal cancer
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Lungs - 70% of both lungs < 20 Gy
Heart - 50% of ventricles < 25 Gy Spinal cord - < 45 Gy Liver - < 30 Gy Kidneys - (if at least 50% of the functional kidney parenchyma is spared) > 20 Gy |
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Define Barrett’s esophagus and GERD.
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Barrett's esophagus is condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to cancer of the esophagus. Gastroesophageal reflux disease (GERD) is the backing up of stomach contents into the lower section of the esophagus. This may irritate the esophagus, and over time cause Barrett esophagus.
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what is the mortality rate with esophageal cancer
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mortality rate of 87%.
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The lymphatics from the proximal third of the esophagus drain into the ________lymph nodes.
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deep cervical
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The lymphatics from the middle third of esophagus drain into the ________ nodes.
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superior and posterior mediastinal
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Lymphatics of the distal third part of the esophagus follow the _____artery to the ________ lymph nodes.
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left gastric
gastric and celiac |
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what are the critical structures when treating the esophagus
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lung
heart spinal cord liver kidneys |
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what is the tolerance of 70% of both lungs
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< 20 Gy
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what is the tolerance of the heart if treating 50% of ventricles
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< 25 Gy
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what is the tolerance of the spinal cord
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< 45 Gy
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what is the tolerance of the liver
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< 30 Gy
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what is the tolerance of the kidneys - (if at least 50% of the functional kidney parenchyma is spared)
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> 20 Gy
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