Principles And Practice Ouhsc Exam 2

Front 1

Between what years was TNM classification developed?

Back 1

1943-1952

Front 2

When was UICC and AJCC unified?

Back 2

1987

Front 3

Define tumor staging. When is determined?

Back 3

-a means of defining tumor size and extension at the time of diagnosis
-during clinical examination, before definitive therapy begins

Front 4

What are the three classifications of staging?

Back 4

1. Clinical (T,N,M)
2. Surgical/Pathological (pT, pN, pM)
3. Recurrent (rT, rN, Rm)

Front 5

During clinical classification (acquired before primary tx), what types of exams are used to assist with staging?

Back 5

1. physical exam
2. imaging
3. endoscopy
4. biopsy
5. surgical exploration

Front 6

Define pathological classification.

Back 6

uses evidence acquired before treatment, supplemented or modified by the additional evidence acquired during and from surgery; particularly from pathological examination.

Front 7

T or F. During surgery, if the tumor cannot be removed but the tumor can be confirmed microscopically, pathological classification has still been accomplished?

Back 7

True.

Front 8

T or F.
For a pathological TNM requirement, pT entails resection of the primary tumor sufficient to evaluate the highest pT.

Back 8

True.

Front 9

What type of classification is assigned when further treatment is planned for cancer after a disease-free interval?

Back 9

Retreatment (Recurrent) Classification
- rT, rN, rM

Front 10

What type of classification occurs during postmortem examination?

Back 10

Autopsy classification
- aT, aN, aM

Front 11

How are staging classifications for special cases of subdivisions measured on a single breast?
Hint: T1a, T1b, T1c

Back 11

T1a: > 0.1-0.5cm
T1b: > 0.5-1.0cm
T1c: > 1.0-2.0cm

Front 12

How are histological grades of tumor expressed?

Back 12

GX: cannot be assessed
G1: undifferentiated
G2: poorly differentiated
G3: moderately differentiated
G4: well-differentiated

Front 13

What specialty staging system is used for Hodgkin's lymphoma? Describe each stage?

Back 13

Ann Harbor Staging System:
Stage 1: single lymph region
Stage 2: two or more sites, same side of diaphragm
Stage 3: both sides of diaphragm, or w/spleen
Stage 4: diffuse involvement of extralymphatic sites

Front 14

What are the characteristics of cancer cells?

Back 14

-come from normal cells
-abnormal in function
-have mutations
-clonal
-hyperproliferative
-metastatic

Front 15

T or F.
Hyperproliferation is important in most anticancer agents.

Back 15

True.

Front 16

Define terminal differentiation. Give example.

Back 16

Final stage of cell differentiation where the cell may stay in G0 phase and no longer proliferate
-brain cells

Front 17

What is the relationship between the degree of differentiation to proliferation of cancer cells?

Back 17

Very low (undifferentiated) to very high proliferation (fast, wild)

Front 18

What leads to gene transcription of several proteins that are involved in cell cycle proliferation, chemotherapy resistance, anti-apoptosis, angiogenesis and metastasis?

Back 18

Dimers (EGFR, p185, ErbB3, ErbB4)

Front 19

What promotes cell cycle progression from the G1 to the S phase?

Back 19

Cyclin D1

Front 20

What type of tumors can be treated with chemotherapy alone?

Back 20

Hematologic diseases:
-leukemia, Hodgkin's lymphoma

Front 21

What type of tumors have little or no effect with chemotherapy?

Back 21

Hepatocellular cancer, renal cell carcinoma, thyroid cancer

Front 22

What type of chemo agent work during the S-phase?

Back 22

Anti-metabolites
-5FU, methotrexate, gemcitabine

Front 23

Which cell cycle is most resistant to chemo?

Back 23

G0
-chemo doesn't work with non-dividing cells, like liver cancer

Front 24

What tumor characteristics are most sensitive to chemotherapy?

Back 24

small, fast growing

Front 25

Why is chemo most effective in the early period of growth (Gompertzian Kinetics)?

Back 25

-Rapid doubling time and large growth fraction occurs during the early phase

Front 26

At what tumor burden is considered detectable? Lethal?

Back 26

-10^9 (1g mass; tumor regrowth exceeds cell kill)
-10^12 (1kg mass; tumor cell kill exceeds regrowth)

"9 doubling time to detect and 3 to kill"

Front 27

Why does chemo dosing have specific scheduling?

Back 27

-Tumors with high growth fraction respond better
-surgery (debulking or radiation) can stimulate cells to grow so chemo is given afterwards
AND
-combination chemo is given every 20-28 days to allow bone marrow to recover

Front 28

What radioprotectant is given to H&N patients to protect against cisplatin nephrotoxicity?

Back 28

Amifostine (Ethyol)
- binds to free radicals produced by radiation and chemotherapy from doing damage

Front 29

Define antigen.

Back 29

any substance that raises alarm in the body, causing the immune system to react an attack

Front 30

What are the three categories lymphocytes can be broken down to?

Back 30

B Lymphocytes
T Lymphocytes
Natural killer cells (NK)

Front 31

Define antigen-presenting cells (APCs)

Back 31

are not lymphocytes, but bind to foreign cells so the immune system can “tag” it as a foreign substance and stimulate the immune reaction
2 main groups:
-monocytes and macrophages
-dendrite cells

Front 32

Define antibodies.

Back 32

are large sticky proteins produced by B cells that attach to specific antigens

Front 33

Describe the B-cell process.

Back 33

Contact w antigen → starts making antibodies → turns into a plasma cell → plasma cells release antibody → antibody binds to antigen → antibodies kill all the cells with that specific antigen

Front 34

List three main types of T-cells.

Back 34

-Killer T cells: directly kill
-Helper T cells: tag cells for killer T or B lymphocytes
-Suppressor T cells: make sure our immune doesn’t over-react to foreign body

Front 35

Describe natural killer cells (NK).

Back 35

-drawn to areas of cancer cells by substances given off by other cells
-attach to cancer cells and release substances that split the cells open, killing them
-look for other cancer cells to attack

Front 36

Describe the role of monocytes and macrophages.

Back 36

-Monocytes are made in the bone marrow and are released in the blood stream where they become macrophages
-Macrophages-surround and “eat” unwanted cells
-They then present antigens from the devoured cells on their surface so that lymphocytes can recognize the foreign antigen if they are found in the body later on.

Front 37

What is the role of dendritic cells?

Back 37

-Find unwanted cells within the body, engulf them, and present there antigen on their surface.
-They are not common but are the most powerful type of antigen presenting cell

Front 38

What the two main types of immunotherapy.

Back 38

1.Active Immunotherapies
-Cancer Vaccines
2. Passive Immunotherapy
-Monoclonal Antibodies

Front 39

What immunotherapy is the most widely used?
Which antibodies is safer and more effective in the human body?

Back 39

monoclonal antibodies (MABs)
-Chimeric antibodies

Front 40

What is the role of naked MABs? Which drugs are FDA approved? What are the side effects

Back 40

-they can attach to specific antigens on cancer cells that aid cancer cell growth and stop them from working
-Herceptin, Vectibix, Erbitux, Avastin
-allergic-like and flu-like symptoms (fever, chills, weakness, N/V/D, rashes, low BP, headaches)

Front 41

What is the role of conjugated MABs?

Back 41

-attach to drugs, toxins or radioactive substances: chemolabled, immunotoxins, radioimmunotherapy

Front 42

What are the two basic kinds of cell vaccines?

Back 42

-autologous (taken from the same person to be re-injected shortly after surgery)
-allogenic (from someone other than pt being treated)

Front 43

What is the purpose of the antigen vaccines?

Back 43

Boost the immune by using only one antigen rather than whole tumor cells

Front 44

What is obtain during diagnostic surgeries?

Back 44

tissue biopsies to confirm the diagnosis and identify the type of cancer

Front 45

What occurs during staging surgeries?

Back 45

determine the extent of disease of tumors that are inaccessible, difficult to evaluate or are incorrectly staged by any other means

Front 46

T or F. Clinical staging to determine the extent of the disease should be completed before definitive surgery.

Back 46

True.

Front 47

What is the goal of definitive surgery?

Back 47

to excise or remove as much of the tumor as possible
-a margin of normal tissue must be excised to assure an adequate resection

Front 48

What type of cancers can be curative with surgery alone?

Back 48

Early staged cervical cancers
Breast cancer
Skin cancers
Vulvar cancers

Front 49

What is the purpose of reconstructive surgeries?

Back 49

repair anatomic defects and improve function and cosmetic appearance after radical surgery
-examples: breast reconstruction, restoration of H&N surgeries, fracture fixation, penile implants

Front 50

What are the advantages of surgery?

Back 50

-Tumor may be totally removed
-Treatment time is shorter compared to radiation therapy, immunotherapy and/or chemotherapy
-Slow-growing cancers are the most amenable to surgical treatment
-Initial surgery for malignancy is more successful than a secondary operation for recurrence.

Front 51

When and who discovered x-rays?

Back 51

1895 by Wilhelm Roentgen

Front 52

What year was the first linear accelerator developed?

Back 52

1952

Front 53

What is the energy potential, HVL, and SSD for superficial therapy?

Back 53

50-150kv
1-8mm of Al
15-20cm SSD

Front 54

What is the energy potential, HVL, and SSD for orthovoltage therapy?

Back 54

150-500kV
1-4mm of Copper
50cm SSD

Front 55

What was the major drawback of the Orthovoltage Unit?

Back 55

limited to lesions deeper than 2-3cm

Front 56

Higher energies using 1st generation LINAC can now provide what?

Back 56

greater skin sparing, sharper field borders with less penumbra at depth

Front 57

What are the improvement made with 3rd generation LINACs?

Back 57

improved accelerator guides, magnet systems, and beam modifying systems to accommodate a wider range of energies, dose rate, field and size

Front 58

What is the role of the klystron?

Back 58

Is a special type of electron tube that is used to provide microwave power* to accelerate electrons.

Front 59

What component of the LINAC is responsible for carrying microwave power from the klystron to the tanding wave accelerator guide?

Back 59

waveguide

Front 60

Which component of the LINAC is responsible for protecting and extending the life of the klystron?

Back 60

circulator

Front 61

What is the responsibility of the electron gun?

Back 61

produce electrons and inject them into the accelerator structure

Front 62

Where in the LINAC do microwaves and electricity combine to accelerate electrons?

Back 62

accelerator structure

Front 63

Bending magnet bends the electrons how many degrees towards the patient?

Back 63

270

Front 64

What component of the LINAC uses x-rays to treat and have a conical metal absorber that absorbs more dose in the center of the beam and fewer from the perimeter?

Back 64

flattening filiter

Front 65

What component of the LINAC is used for electron treatment and placed in the path of an electron beam causing the pencil beam to broaden the width to produce a flat treatment field?

Back 65

scatter foil

Front 66

What does the ion chamber measure in a LINAC?

Back 66

integrated dose
field symmetry
dose rate

Front 67

What can be placed just below the secondary collimation to provide additional beam shaping?

Back 67

MLCs, wedges, treys for blocking

Front 68

What is the goal of radiation therapy?

Back 68

to sterilize a targeted tumor completely while preserving the integrity of surrounding normal structures

Front 69

Are cells damaged more directly or indirectly by ionizing radiation? How?

Back 69

indirectly affected
-ionizing rays or particles penetrate the cell's nucleus and interact with the water content of the nucleus to form free radicals

Front 70

What types of tumors work best with electron beam therapy? Why?

Back 70

-tumors near the surface of the skin or within a few cm of the skin
-dose of radiation delivered by electrons diminishes rapidly with tissue depth

Front 71

What are the advantages of intraoperative radiation therapy?

Back 71

Single, high-dose (13-15Gy) treatment to the organ/tissue of interest
-it decreases the dose of the radiation delivered to normal tissues which reduce the toxicity to the patient

Front 72

Which tumors are treated best with neutron beam therapy?

Back 72

Large, slow-growing tumors
Un-resectable salivary gland tumors
Well-differentiated prostate tumors
Soft tissue sarcomas

Front 73

Brief description of proton therapy. What are the advantages?

Back 73

-Positively charged nuclear particles that deliver their radiation dose at a defined tissue depth to small non-infiltrating tumors situated in highly radiation sensitive tissues.
-Same properties as x-rays
-Sparse path…high LET peak (Bragg Peak)
-Possible to confine the dose to the tumor volume with minimal dose to normal tissue (spinal cord)

Front 74

What is the major advantage of brachytherapy?

Back 74

very high dose of radiation therapy delivered locally to a tumor in a short amount of time

Front 75

What are the five ways to administer brachytherapy?

Back 75

Interstitial
Intracavitary
Intraluminal
intravascular
topical

Front 76

Define half-life time period.

Back 76

the activity of which an isotope decays to 1/2 its original value
Commonly used isotopes: radium, cesium 137, iridium 192, cobalt 60, gold 198, iodine 125

Front 77

What is the decay process and the half-life of radium?

Back 77

decays be alpha emission
1622 years

Front 78

What is the most popular brachytherapy isotope used? What is its half-life value?

Back 78

Cesium 137
-30 years
-for uterine and cervical cancer

Front 79

Which isotope is commonly used for breast and tongue? What is its half-life?

Back 79

Iridium 192
-74.2 days

Front 80

What is the most popular permanent implant used for HDRs? Why? What is its half-life?

Back 80

Gold-198
-Gives a very high amount of dose in a short period time and requires no additional surgery to remove the implants due to the short half life
-2.7 days

Front 81

What isotope is becoming more frequent in interstitial seed implants for LDRs? What is its half-life?

Back 81

Iodine-125
-Iodine is deposited over a longer period of time than that of gold making it a low dose rate therapy
-60.2 days

Front 82

What is the main advantage of HDR? What is its dose rate delivery?

Back 82

Can be given on a fractionated OUTPATIENT basis
-12Gy/hr

Front 83

What is the maximum dose rate delivered for LDR? What cancers are commonly used for LDRs?
What is the main disadvantage of LDRs?

Back 83

-2Gy/hr
-oral cavity, oropharynx, sarcomas, prostate cancer
-hospital stays can last several days

Front 84

Give an example of an external application?

Back 84

Eye plaques (Iodine-125)

Front 85

Permanent interstitial applicators can be used for what types of tumors?

Back 85

Prostate, rectal and lung (inaccessible tumors)
-use Iodine 125 or gold 198

Front 86

Temporary interstitial applicators can be used for what types of tumors?

Back 86

Soft-tissue sarcomas of extremities (areas where there is no body cavity or orifice)

Front 87

Dosimetry involved in tandem and ovoids have a shape dose distribution of what?

Back 87

Pear shaped

Front 88

How are the anatomical points laid out for Point A and B on tandem and ovoids applicator?

Back 88

Point A: 2cm lateral and 2cm superior to the external cervical canal
Point B: 2cm lateral to point A and 1 cm to medial aspect of cervical (is a little more out than point A)

Front 89

Dose at Point B is what percentage the dose of point A on tandem and ovoid applicators?

Back 89

33%

Front 90

What type of chemo work better in the G1 phase?

Back 90

cell cycle nonspecific agents
-alkylating agents: ifosfamide, cyclophosphadine
-anthracylines antibiotics: doxorubicin
-antitumor antibiotics
-nitrosoureas
-misc: carboplatin, cisplatin

Front 91

Which chemo agent work better in the M phase of the cell cycle?

Back 91

vinblastine, vincristine, paclitaxel, docetaxel

Front 92

What is considered the best radiosensitizing agent?

Back 92

alkylating agents
-kills anything that is rapidly growing

Front 93

What type of tumors are radio-resistant?

Back 93

osteosarcomas
fibrosarcomas
liposarcomas
myosarcomas
malignant melanoma
large bowel adenocarcinoma

Front 94

What groups of tumor have limited sensitivity?

Back 94

SCC and BCC of skin
carcinoma of mouth, larynx, accessary sinuses, bladder

Front 95

What types of tumors of radiosensitive to radiation?

Back 95

malignant lymphomas
semiinous
medulloblastoma
Wilm's tumor
neuroblastoma
early cervical carcinoma
vaginal carcinoma
most H&N tumors