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60 Cards in this Set
- Front
- Back
Hodgkins: Bi Modal
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15-24 and after age 50
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Type of cell that differentiates it from non-hodgkins
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Reed-Sternberg Cell: bi- nucleated
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Symptoms of Hodgkins
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painless enlargement of lymph node
fever, night sweats and weight loss. |
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Usually presents where and in what fashion?
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presents above the diaphragm and in a step like fashion, we know where it will go.
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Cause of Hodgkins?
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Unknown and Epstein-barr. Immunocompromised, AIDS, congenital problems, and transplant have higher risk.
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Which gender has better prognosis and which is affected more? What about age for Hodgkins?
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More males than females, and females better prognosis. Gender affects treatment because of sterility. younger fair better than older.
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How to stage with Hodgkins?
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clinically with imaging.
Nodal staging. |
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Nodal Anatomy:
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>80% present with cervical
50% mediastinal involvement Check nodes in book. |
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Ann Arbor:
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Lymph node areas involved
Presence or absence of B symptoms |
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Lymph System:
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spleen, bone marrow, thymus, lymph nodes.
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Why can we treat lower now?
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because it is radiosensitive. good response to chemo and radiation. Rarely do laparotomy now.
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what is oophoropexy:
What about males? |
moving the ovaries out of the way behind another organ or structure to protect them.
Sperm banking before treatment sometimes. |
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hodgkins can occur anywhere but usually:
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chest, neck, and axilla
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Treatment?
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early stage: radiation
chemo or chemo/radiation for advanced. (MOPP chemo) pattern of disease must be considered |
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Where would they block for mantle field?
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larynx and humeral head
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Nodes above the diagram:
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cervical, submandibular, axillary, supraclavicular, infraclavicular, mediastinal, hilar nodes.
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bad effects of the mantle field
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bad effects on the heart.
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technical aspects of hodgkins
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supine, arms above head or on hips or out at 90 degree angle, chin extended, CA generally SSN.
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Blocking for Hodgkins
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lung, humeral head, occipital, Ant. Larynx, post. spinal cord
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Superior Border:
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Lower mandible and mastoid tips
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Inferior Border mantle:
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T9-T10 interspace or insertion of the diaphragm
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Later Border mantle:
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Fall-off to include axillary nodes.
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Why use inverted Y
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retroperitoneal or periaortic nodes, pelvic nodes, spleen (may or may not), splenic hilar nodes, femoral nodes.
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Subtotal nodal=
Total Nodal= |
=mantle + periaortic
=mantle + periaortic + pelvic ports |
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why wait inbetween treatment of each field?
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blood count goes down because of radiation and chemo to sternum.
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Sup. Inverted Y:
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mid T-10, gap from mantle
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Inf. INverted Y:
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L4-L5
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Lateral Inverted Y:
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usually 9-10 cm wide
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Sup. Pelvic Y:
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L5 w. gap from abdominal port
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Inf. Pelvic Y:
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2cm below the ischial tuberosity to include femoral nodes
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Lateral Pelvic Y:
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2 cm beyond pelvic inlet
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Dose for HOdgkins
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36-44 Gy, 1.5-1.8Gy.
Prophylactic: 25-30Gy |
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ACUTE side effects of Hodgkin's treatment:
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Fatigue, hair loss, erythema, sore throat, altered taste, dysphagia, dry cough, nausea, vomiting
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LATE side effects:
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mild radiation pneumonitis, hypothyroidism, xerostomia, radiation carditis, increased risk for breast cancer.
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magnifaction factor equation
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MF=SID/SOD
Image Size/Object Size=SID/SOD |
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C1
C2, C3 C3, C4 C5 C7 |
Mastoid Tip
Gonion Hyoid Bone Thyroid Cartilage Vertebra Prominens |
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T1
T2, T3 T4, T5 T7 T10 |
5cmish above jugular notch
jugular notch, superior scapulae sternal angle inferior angles of scapulae xiphoid process |
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L3
L3, L4 L4 |
Costal margin
umbilicus iliac crest |
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S1
Coccyx |
ASIS
pubic symphysis and greater trochanters |
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Why Isocentric is preferred?
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greater accuracy and reproducability of fields bc patient and table not moved between fields.
greater accuracy of total dose for parallel-opposed greater ease of set-up bc of lasers. built in routine checks of patients IFD on parallel-opposed bc change in IFD changes TSD. |
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GTV
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-Gross Tumor Volume: gross palpable or visible extent and location of tumor growth.
-Cell density is greatest. -primary tumor, lymphs & additional mets. -clinical exams and imaging studies |
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CTV
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-Clinical Tumor Volume: contains a demonstrable GTV &/or subclinical microscopic malignant disease that must be eliminated.
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PTV:
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-Planning Target Volume: contains tissues that are supposed to be irradiated to a specific dose according to a specific time dose pattern.
-contains tumor & adjacent tissue where volume is presumed to be & sometimes adjacent lymph nodes. -need to know tumor behavior. -includes GTV so always bigger. |
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Treated Volume (TV):
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-enclosed by isodose surface
-usually bigger than PTV |
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Irradiated Volume(IR):
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-volume of tissue that receives a dose considered significant to tissue tolerance.
-usually a percentage of prescribed target dose. |
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13 Simulation Steps: 1-5
(according to the document on blackboard) |
1. Explain procedure
2. Position patient and straighten 3. set approximate field size and move to area of interest. 4. measure pt. and set TSD 5. Fluoro with physician to locate port. |
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13 Steps: 6-10
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6. Mark CA and borders on pt., re-measure IFD and TSD.
7. FILM 8. Have physician check and sign. 9. Fill out pt. treatment sheet 10. put set-up instructions and landmarks on sheet. |
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13 steps: 11-13
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11. Photos of treatment area.
12. Tattoo 13. Facial photo or patient ID. |
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Esophageal more common in what gender?
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3x more common in males
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Esophageal what % of cancers?
How many cases, deaths? |
1% of all cancers.
15,560 cases in 2007, 13,940 deaths! |
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Esophageal is more common where?
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N. China, N. Iran, S. Africa. (THEIR DIETS!)
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Factors contributing to Esophageal CA?
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Excessive tobacco, alcohol. 80-90% associated with those.
Also diet low in fruits and veggies. |
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Higher incidence in who?
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50% more in african americans, 55-85 age range
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Most common histology:
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SQUAMOUS: esp. in afr. amer.
Adenocarcinoma: caucasians at junction of stomach and esophagus, transition b/w cells. |
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Barrett's Esophagus:
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acid reflux changes what the cells are in transition area. Long-term reflux. Sometimes from acid, bile salts from duodenum.
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Plummer-Vinson Syndrome:
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Protrusions into the esophagus. difficult to swallow. have anemia, abnormalities of tongue, spleen.
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Prognostic Indicator:
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Tumor Size: less than 5 cm, better survival rate.
still only 19% Stage is still big factor |
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Anatomy of Esophagus:
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hollow tube of squamous 20-25 cm
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Cervical Esophagus:
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cricoid cartilage to thoracic inlet (T1)
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Upper thoracic Esophagus:
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thoracic inlet to the bifurcation of trachea
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