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163 Cards in this Set
- Front
- Back
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Tumors are classified by
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their anatomic site, cell of origin, and biological behavior
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What accounts for the large variety of tumor origination
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They can arrise from any cell
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These are tumors that closely resemble the cells of origin and can be easily classified according to their histology
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well differentiated tumor cells
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These tumors are those that do not resemble normal cells and the classification is more difficult.
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undifferentiated tumor cells
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anaplastic tumor cells are well differentiated or undifferentiated
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undifferentiated
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Tumors are grouped into what 4 classifications
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benign, malignant, sarcoma (mesenchymal cells), and carcinoma (epithelial cells)
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what cells do sarcomas arise from
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mesenchymal cells
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what cells do carcinomas arise from
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epithelial cells
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These are tumors that are generally well differentiated and do not metastasize.
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benign tumors
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These tumors are often encapsulated and slow growing.
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benign tiumors
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These tumors may be noted by their suffix –oma, (Note: there are some tumors that end in –oma that are malignant, such as melanoma)
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benign tumors
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These tumors range from well differentiated to undifferentiated. They have the ability to metastasize.
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malignant t umors
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These tumors often invade and destroy normal surrounding tissue, and if left untreated can cause the death of the host.
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malignant tumors
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These tumor arise from the mesenchymal cells (such as stem cells that give rise to bone, cartilage, fat, blood, lymph, etc)
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sarcomas.
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These tumors arise from connective tissue such as cartilage and bone.
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sarcomas
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give an example of benign and malignant Glandular Epithelium neoplasm
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Adenoma (benign)
Adenocarcinoma (malignant) |
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give an example of benign and malignant Squamous Epithelium neoplasm
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Papilloma (benign)
Squamous Cell Carcinoma (malignant) |
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give an example of benign and malignant Connective Tissue Smooth Muscle neoplasm
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Leiomyoma (benign)
Leiomyosarcoma (malignant) |
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give an example of benign and malignant Hematopoietic neoplasm
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none (benign)
Leukemia (malignant) |
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give an example of benign and malignant Lymphoreticular neoplasm
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none (benign)
Lymphoma (malignant) |
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give an example of a benign and malignant Neural neoplasm
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Neuroma (benign)
Blastoma (malignant) |
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This is a means of defining the tumor size and extension at the time of diagnosis. It provides a means of communication about tumors, helps in determining treatment, aids in predicting prognosis, and provides a means of continuous research
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staging
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why do common tumors have detailed staging classifications and those that are rare have primitive staging systems.
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because staging has changed with advancing technologies
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What is the common staging system adopted by the and the (AJCC)
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The TNM.
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What does UICC stand for
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International Union Against Cancer (UICC)
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What does AJCC stand for
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American Joint Committee on Cancer
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In the TNM staging system, what does the T stand for
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The T defines the size or extent of the primary tumor and is assigned number 1 - 4 or x. A T1 tumor is small and confined to a small area, whereas a T4 tumor is extremely large and has spread and/or extends to other tissues
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In the TNM staging system, what does the N stand for
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The N is designated the status of lymph involvement and is assigned a 0 – 4 or x. With N0 indicating no lymph involvement whereas N4 indicates lymph involvement with distal node sites. Nx indicated that node involvement was not assessed.
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In the TNM staging system, what does the M stand for
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The Mcategory that defines the presence of metastasis and is generally categorized by 0, 1, or x. M0 indicates no mets were found, M1 indicated disease distant from the primary tumor, and Mx indicates that the presence or absence of mets was not assessed. Specific tumors with detailed staging criteria have an expanded M designation.
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What type of staging technique offers the most accurate info about the tumor and about the disease spread. why?
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Surgical / pathalogical staging. Because during surgery the physician has the opportunity to biopsy suspicious looking tissue and obtain lymph samples for microscopic examination, as well as observe the tumor along with surrounding tissue and organs.
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This provides information about its aggressiveness and is based on the degree of differentiation. This is determined by examining cells obtained though a biopsy under a microscope
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the grade of a tumor
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what are some examples of cancer types where grade is more important that staging
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high grade astrocytoma,
bone and muscle tumors |
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What type of biospy is used to determine histology of tissue in areas such as a breast mass. Samples are collected from several areas inside the mass
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fine needle aspiration
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what are the disadvantages of fine needle biopsies
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Disadvantage is that the cells are examined without the benefit of their neighboring cells to determine the mass architecture. There is also a possibility that malignant cells will be seeded when the needle is removed
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What type of biopsy uses a 14 to 16 gauge needle is inserted into the mass and the tissue is collected. Using this method the architecture is preserved allowing the tumor tissue of origin to be identified.
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core needle biopsy
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This type of biopsy is a procedure such as a bronchoscopy or colonoscopy where tissue can be collected with a flexible biopsy tool. Tissue samples can be frozen or imbedded in paraffin, sectioned off, and examined under a microscope
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endoscopic biopsy
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With this type of biopsy a sample of the mass is removed with no attempt to remove the entire mass. This method is often used with larger tumors or those that are more advanced
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incisional biopsy
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With this type of biopsy an attempt is made to remove the entire tumor and any possible local spread, like in the case of malignant melanoma. When a mole or nevus (a sharply circumscribed and/or chronic lesion of the skin) becomes suspicious by changing colors or growing larger, this type of biopsy is preformed. The nevi and surrounding tissue are removed en bloc (as one piece)
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excisional biopsy
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This aims at killing the cells of the primary tumor and those that may be circulating through the body. It may be administered as a primary treatment or as a multidisciplinary treatment plan. As with either treatment, it works best when the tumor is small
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chemo
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Tumors that are rapidly dividing provide (more or less) opportunity for the cytotoxic effect to take place. Why?
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More. Because more cells are in the cell cycle.
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What are the 4 types of chemo administration?
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Oral
Intra-arterial injections Intrathecal injection Intravenous injection |
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Chemo agents are classified by what
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their action on the cell
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This was the first chemo drug to be identified as having anti cancer activity. This class of drugs is related structurally to mustard gas; they are not cell cycle specific, but rather work throughout the cell cycle. The mechanism of action is to bond with nucleic acids, thereby interfering with their action. Side effects include bone marrow depression, amenorrhea in women and azoospermia in men, and carcinogensis
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Alkylating agents
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This type chemo acts by interfering with the synthesis of new nucleic acids. They are cell cycle specific and are much more toxic to proliferating cells but are not associated with delayed bone marrow suppression or carcinogens. Side effects include GI toxicity and acute bone marrow suppression.
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Antimetabolites
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This kind of chemo is derived from microbial fermentation. It acts on the DNA to disrupt DNA and RNA transcription. They are not cell specific, the effects are more pronounced in the S or G2 phase.
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Antitumor Antibiotics
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This type of chemo acts to eliminate of displace natural hormones. It is used to clinically manipulate cells by binding a specific intracellular receptor and interacting with DNA to change cellular function. the most common use is with the treatment of breast cancer when a tumor is positive for estrogen and progesterone receptors.
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Hormonal agents
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This type of chemo is not cell cycle specific, but is lipid soluble and able to cross the blood brain barrier. Their action is similar to that of the alkylating agents in that they interfere with DNA synthesis
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Nitrosoureas
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This type of chemo is derived from the periwinkle plant. By binding to a substance that is needed for mitosis and solute transplant, it stops cell replication in metaphase. Neurotoxicity, severe ulceration of the skin (if extravasation occurs), and myelosupressants are the dose limiting side effects.
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Vinca alkaloids
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Benfits of rad therapy include preservation of _____ and better_____ . It plays a major role in _____, as in the base of bone metastasis.
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function
cosmetic results palliation |
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Two broad categories of radiation therapy delivery are ______ and _______ .
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external beam
brachytherapy |
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External beam therapy includes the use of what 4 types of radiation
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external beam x-rays, electrons, protons, and gamma rays
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Linear accelerators are capable of producing x rays within a specific energy range. Some treatment machines can produce multiple ____, or ____, energies in addition to a range of _____energies
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x-rays
photon electron |
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Cyclotrons or similar equipment is needed for ______ treatment
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proton
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__________ are produced by colbalt-60 machines; although they were the primary treatment machine 35 years ago, but their numbers are limited today
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Gamma rays
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The difference between x-rays and gamma rays is the _____________ . ______are produced by the interaction of electrons striking a target, whereas _______ are produced through radioactive decay
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method of production
X-rays gamma rays |
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___________ is delivered directly to the tumor using a sterilized cone that is positioned during surgery. The cone is then attached to the accelerator, treatment is given, and the patient is returned to surgery for incision closure
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Intraoperative radiotherapy
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What kind of rad therapy uses radioactive material such as cesium-137, iridium-192, palladium-103, or iodine-125. Through the use of this type of therapy, the radioactive source can be next to or directly into the tumor. Because the energy of the radioactive source is low, a high energy is delivered to the tumor, with the nearby normal tissues receiving very little dose
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Brachytherapy
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What type of rad therpay does this describe? Radioactive material is placed within the body tube such as the esophagus or bronchial tree. The radioactive material is positioned in the lumen at the tumor site and removed once the prescribed dose is delivered.
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Interluminal brachytherapy
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What type of brachytherapy is used to prevent restenosis of blood vessels following angioplasty or stent placement
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intravascular brachytherpay
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This is the study of the cause of the disease
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Etiology
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Cigarette smoke, HPV, alcohol, and sun exposure are examples of etiologic or epidemiologic factors
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etiologic factors
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_________is the study of disease incidence.
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Epidemiology
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National databases providing statistical information about patterns of cancer occurrence and death rates is an example of etiology or epidemiology
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epidemiology
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The incidence of cancer occurrence in a population for factors such as age, gender, race, and geographical location is an example of etiology or epidemiology
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epidemiology
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An epidemiologic or etiologic study could determine trend on disease such as the recent decrease of lung cancer in men and the decline of stomach cancer or the increase in malignant melanoma in the united states.
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Epidemiologic
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This results from abnormal cellular proliferation
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cancer
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Cell proliferation can occur b/c the process in which cellular differentiation takes places is _______, or because normally_______ begin to proliferate
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abnormal
nondividing, mature cells |
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Cell differentiation occurs when a stem cell undergoes.........
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mitosis and divides into daughter cells.
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Researchers say that cancer is a "disease of the____.”
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genes
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What type of cells (aka, nonreproducing cells) contain genes that promote growth and suppress growth. In a tumor cell this balance regulation is missing due to gene mutations. If the mutation is in growth promoter cells it results in forced proliferation. If the mutation is in growth suppressor cells it results in unrestrained proliferation (cellular growth). For many tumors both mutations may be required for progression to full malignancy.
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somatic cells
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What type of cell contains normal genes that play a part in controlling normal growth and differentiation. They are the precursor to oncogenes
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Proto-oncogenes
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The conversion from proto-oncogenes to oncogenes can occur through what 3 things
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point mutations, translocations, and gene amplification (all of which are DNA mutations)
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_______ (aka, cancer cells) are implicated in the abnormal proliferation of cells
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oncogenes
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_________(aka, tumor suppressor genes). The inactivation of it allows malignant process to flourish
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Antioncogenes
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. For patients and family, the ________ provides a timeline to accomplish tasks or goals in preparation for impending death. Factors specific to each tumor determine it
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prognosis
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This type of clinicall trial involves studies that review info from a group of patients treated in the past. The treatment has already been delivered, and the info is collected (often on a national basis) and analyzed. It has had an advantage in that the info can be obtained rather quickly. Disadvantages include the fact that complete info about a treatment is not always easy to obtain and is often incomplete. Outside factors may have influenced the treatment and results are not controlled and may not be accurately documented.
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retrospective studies
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What two photon energies do most Linacs have?
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6MeV
18MeV |
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Most Linacs have 2 photon energies and how many electron energies
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5
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This is a clinical trial that is planned before treatment , with eligibility criteria for patient selection. Investigators have the advantage of knowing info that is essential for the study thus leading to more complete and accurate documentation. This type of study also has more control over external factors that might influence the results of the study. The disadvantage is the length of time needed to observe the results of a particular treatment. Depending on the results, these studies can last up to 5 years or longer. Studies that examine the effectiveness of a treatment are classified by study objectives.
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Prospective studies
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Studies are used to determine the maximum tolerance dose for a specific treatment the end point can be either acute or long term toxicity.
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Phase I studies
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These types of studies are used to determine whether the Phase I treatment is significantly effective (give the acute and/or long tern side effects) to continue further study.
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Phase II studies (no shit!!!)
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These studies are used to compare the experimental treatment with standard treatment using randomized samples.
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Phase III studies
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What type of survival reporting does this describe? patients alive at the end point and those who have died are counted. Patients lost to follow-up are included, but the fact that patients may have died from other factors is not considered
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Absolute survival reporting
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What type of survival reporting does this describe?
It includes patients that have died from other causes and had no evidence of disease (NED) at the time of their death |
Adjusted survival reporting
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What type of survival reporting does this describe?
It involves the normal fatality rate of a similar group of people based of factors such as age, gender, and race. |
Relative survival reporting
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What type of tumors have no enclosing capsule, cells may escape, become emboli, and be transported by the lymphatic circulation or the bloodstream to implant in lymph nodes and other organs far from the primary tumor.
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malignant tumors
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Tumors that are ______ (grow outward) have better prognosis than those that invade and ulcerate underlying tissue because of the communication with blood vessels and lymphatics, which are the highways of cancer cell transport to distant sites.
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exophytic
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________(tumors that have more than one focus of disease) can be more difficult to treat because of the volume of tissue required for treatment is larger to encompass the entire organ or region.
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Multicentric tumors
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Tumor dissemination (spread) can be accomplished through what 3 mechanisms.
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blood, lymphatic, or seeding
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What is a common metastasis site for lung CA
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Liver, Adrenals, Bone, and Brain
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What is a common metastasis site for breast CA
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Lungs, Bone, and Brain
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What is a common metastasis site for stomach CA
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liver
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What is a common metastasis site for anal CA
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liver and lungs
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What is a common metastasis site for bladder CA
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Lungs, Bone, and Liver
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What is a common metastasis site for prostate CA
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Bone, Liver, and Lungs
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What is a common metastasis site for Uterine / Cervix CA
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Lungs, bone, and liver
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The _______ is responsible primarily for directing the photon (x-ray) or electron beam at a patient’s tumor. It can accomplish this through a single rotational field or multiple fixed fields positioned at the isocenter.
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gantry
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The ________ is the volume of tissue exposed to radiation from a single radiation beam.
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treatment field (portal)
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The A30S beam is.........
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30 degrees superior from the anterior axis.
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The P20R40I beam is .......
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20 degrees right from the posterior axis and 40 degrees inferior.
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Micro-MLC units have a leaf width of less than _____ and provides a greater refinement in field edge effects.
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5 mm
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1Gy = how many cGy
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100
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ODI is the.......
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optical distance indicator (projects a scale onto the patients skin, corresponds to the SSD)
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This is the measure of the angle between `central rays between two intersecting treatment beams. As it decreases, doses delivered to overlapping areas vary significantly, thus creating areas of high and low dose regions in the desired target volume.
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hinge angle
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These are stereoscopic images are two images from different angles focused on the same point. These images are a special case of stereoscopic images with a 90 degree angle between them. These images may be a subset of treatment portals or may be designed specifically for set up verification.
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orthogonal imaging
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This is a material whose interaction with the radiation beam mimic those of tissue. They come in many forms and have different applications. Common materials include paraffin wax, Vaseline gauze, wet gauze, wet towel, and water bags. Commercially available products can be used as well as power forms that can be mixed with water and formed.
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Bolus
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Treatment machines produce a radiation beam that is even across a perpendicular plane. Patients, however, are rarely flat. Skewing of dose distribution caused by irregular surfaces can be compensated by using bolus materials to create a level surface area, however, a loss of skin sparing accompanies this technique. To retain this important effect, _________ may be positioned in the head of the treatment unit, thus modifying the radiation beam to accommodate the contour of the patient
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compensating filters
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Copper, brass, lead, and Lucite are all common material used in making what
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compensating filters
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The _______ is designed to change the angle of the isodose curve relative to the beam axis at a specific depth within the patient. They reduce the dose in areas of overlap between fields that have hinge angles less the 180 degrees
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wedge
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When wedges are used, the _____ are typically positioned together. Standard wedge systems are externally mounted wedges that the therapist must position . standard wedge sizes are __, __, __, and __ degrees
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heel
15, 30, 45, 60 |
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________ are designed to allow the transmission of a predetermined percentage of the treatment beam to a portion of a treatment field and may be used throughout the course of treatment. This allows the physician to treat structures that have varying radiosensitivity in proximity to one another at different dose rates from a single treatment field.
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Transmission Filters
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the 5 things necessary in a Radiation Oncologist’s prescription
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Site
Daily Dose Total Dose Technique Physicians Signature |
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Define isocenter
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the point of intersection of the 3 axes of rotation (gantry, collimator, and base of couch) of the treatment unit. It should be considered a reference point in space, a fixed distance (100 cm) from the focal spot (source of x-ray production). Isocenter can be placed on the surface of the patient (SSD, source to skin distance) or placed at some location within the patient (SAD, source to axes distance).
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What is the difference between and SSD and a SAD
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With SSD the isocenter is on the patients skin or surface area. with SAD the isocenter is deep in the patients body (somewhere all up in there)!
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C-
A- U- T- I- O- N- |
C-change in bowel or bladder habits
A-a sore that does not heal U-unusual bleeding or discharge T-thickening of the skin I-indigestion or trouble swallowing O-obvious change to moles or warts N-nagging couch or hoarseness |
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What are the 4 main types of cancer treatment options.
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Surgery, Chemotherapy, Rad Therapy, Immunotherapy
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This is anything that takes up space and has form or shape
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matter
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matter either exists in a_____, _____, or ______ . All matter is composed of _______.
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solid, liquid, or gas/vapor
atoms |
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______is the constant quantity of matter within a physical object.
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mass
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_______is the unit of mass unrelated to gravity. ________ is the unit of mass that takes into account the effects of gravity
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Kilogram
Weight |
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What are the 7 types of energy
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Potential Energy
Kinetic Energy Chemical Energy Electrical Energy Thermal Energy (heat) Nuclear Energy Electromagnetic Energy |
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This is energy due to virtue of position
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potential energy
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This is energy of motion
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kinetic energy
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This is energy released by chemical reaction
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chemical energy
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This is the work done when an electron or an electronic charge moves through an electric potential
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electrical energy
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This is energy of motion at the molecular level
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thermal energy
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This is the energy contained in the nucleus of an atom
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nuclear energy
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X-rays, radio waves, microwaves, photons, visible light, and UV rays are examples of what kind of energy
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electromagnetic energy
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what is ionizing radiation
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ionizing radiation is any kind of radiation capable of removing an orbital electron from the atom with which it interacts.
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What forms of electromagnetic energy have sufficient energy to ionize
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X-rays and gamma rays
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What are the 4 types of low energy radiation therapy equipment
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Grenz rays
Contact therapy Superficial equipment Orthovoltage equipment |
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What are the 5 types of high energy radiation therapy equipment
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Van de Graaff generator
Betatron Cyclotron Linear Accelerator Cobalt unit |
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This occurs when a stem cell undergoes mitosis and divides into daughter cells. These cells continue to divide until mature cells with a specific function result.
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cellular differentiation
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These are nonreproducing cells that contain the genes that promote growth and suppress growth. In a tumor cell, these grow and don’t grow regulation is missing.
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somatic cells
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these are undifferentiated tumors
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anaplastic tumors
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what kind of tumors are well differentiated, but do not metastasize and do not invade surrounding tissue. They are encapsulated and slow growing.
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benign
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these tumors range from well differentiated to undifferentiated. They have the ability to metastasize, and they invade the surrounding tissues.
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malignant
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tumors arising from mesenchymal cells. Include connective tissue such as cartilage and bone.
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sarcomas
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tumors that originate from the epithelium. Includes tissues that line a cavity
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carcinomas
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this type of tumor arises from epithelial cells that are glandular, such as the tissue lining if the stomach
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adenocarcinoma
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means of defining tumor size and extension at the time of diagnosis
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tumor staging
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provides info about its aggressiveness and is based on its degree of differentiation. Is determined only by examining biopsied cells under a microscope.
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grading
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To do this is to treat a cancer partially, but not cure it completely. It cloaks a disease.
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palliation
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This is the primary drainage of lymph nodes
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Sentinel Node
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This is reffereing to being destructive to tumor cells
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tumoricidal
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X-rays, electron, protons, and gamma rays can be delivered to the tumor in ______ beam treatment
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external
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a small packet of electromagnetic radiation traveling through space at the speed of light (in a vacuum).
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photon
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This has no mass or electrical energy
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photon
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These are negatively charged subatomic particles that can be accelerated by a variety of machines or are emitted from decaying isotopes and used for external beam treatment and brachytherapy
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electrons
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This is a stable subatomic particle occurring in all atomic nuclei, with a positive electric charge equal in magnitude to that of an electron
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proton
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Light with the shortest wavelengths and the highest energies and frequencies in the electromagnetic spectrum. They are produced by the decay of radioactive materials.
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gamma rays
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Cells are most sensitive to radiation during __ phase and __ phases of the cell cycle.
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G2 and M
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What is the difference between x-rays and gamma rays
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The difference between x-rays and gamma rays is the mechanism of production. X-rays are produced by the interaction of electrons striking a target, whereas gamma rays are produced trough radioactive decay.
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x-rays are produced through.........
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the interactions of electrons striking a target
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gamma rays are produced through ........
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radioactive decay
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what atoms make up the human body
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carbon, hydrogen, oxygen, and nitrogen
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in radiation therapy, what kind of energy is used to produce electromagnetic energy
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electrical
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what releases the gamma rays used in a cobalt machine
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nuclear energy (radioavtivity)
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energy emitted and transfered through space is called _______
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radiation
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Matter that intercepts radiation and absorbs part or all of it is said to be ____ or ______
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exposed or irradiated.
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orthovoltage machines are used to treat what type of cancer
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skin and superficial
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59Co becomes 60Co when bombarded with _____ _____
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slow neutrons
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This is the area around the edge of radiation beam where dose rate changes rapidly as a function of distance from the beam axis.
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penumbra
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