Simulation

Front 1

Hodgkins: Bi Modal

Back 1

15-24 and after age 50

Front 2

Type of cell that differentiates it from non-hodgkins

Back 2

Reed-Sternberg Cell: bi- nucleated

Front 3

Symptoms of Hodgkins

Back 3

painless enlargement of lymph node
fever, night sweats and weight loss.

Front 4

Usually presents where and in what fashion?

Back 4

presents above the diaphragm and in a step like fashion, we know where it will go.

Front 5

Cause of Hodgkins?

Back 5

Unknown and Epstein-barr. Immunocompromised, AIDS, congenital problems, and transplant have higher risk.

Front 6

Which gender has better prognosis and which is affected more? What about age for Hodgkins?

Back 6

More males than females, and females better prognosis. Gender affects treatment because of sterility. younger fair better than older.

Front 7

How to stage with Hodgkins?

Back 7

clinically with imaging.
Nodal staging.

Front 8

Nodal Anatomy:

Back 8

>80% present with cervical
50% mediastinal involvement
Check nodes in book.

Front 9

Ann Arbor:

Back 9

Lymph node areas involved
Presence or absence of B symptoms

Front 10

Lymph System:

Back 10

spleen, bone marrow, thymus, lymph nodes.

Front 11

Why can we treat lower now?

Back 11

because it is radiosensitive. good response to chemo and radiation. Rarely do laparotomy now.

Front 12

what is oophoropexy:
What about males?

Back 12

moving the ovaries out of the way behind another organ or structure to protect them.
Sperm banking before treatment sometimes.

Front 13

hodgkins can occur anywhere but usually:

Back 13

chest, neck, and axilla

Front 14

Treatment?

Back 14

early stage: radiation
chemo or chemo/radiation for advanced. (MOPP chemo)
pattern of disease must be considered

Front 15

Where would they block for mantle field?

Back 15

larynx and humeral head

Front 16

Nodes above the diagram:

Back 16

cervical, submandibular, axillary, supraclavicular, infraclavicular, mediastinal, hilar nodes.

Front 17

bad effects of the mantle field

Back 17

bad effects on the heart.

Front 18

technical aspects of hodgkins

Back 18

supine, arms above head or on hips or out at 90 degree angle, chin extended, CA generally SSN.

Front 19

Blocking for Hodgkins

Back 19

lung, humeral head, occipital, Ant. Larynx, post. spinal cord

Front 20

Superior Border:

Back 20

Lower mandible and mastoid tips

Front 21

Inferior Border mantle:

Back 21

T9-T10 interspace or insertion of the diaphragm

Front 22

Later Border mantle:

Back 22

Fall-off to include axillary nodes.

Front 23

Why use inverted Y

Back 23

retroperitoneal or periaortic nodes, pelvic nodes, spleen (may or may not), splenic hilar nodes, femoral nodes.

Front 24

Subtotal nodal=
Total Nodal=

Back 24

=mantle + periaortic
=mantle + periaortic + pelvic ports

Front 25

why wait inbetween treatment of each field?

Back 25

blood count goes down because of radiation and chemo to sternum.

Front 26

Sup. Inverted Y:

Back 26

mid T-10, gap from mantle

Front 27

Inf. INverted Y:

Back 27

L4-L5

Front 28

Lateral Inverted Y:

Back 28

usually 9-10 cm wide

Front 29

Sup. Pelvic Y:

Back 29

L5 w. gap from abdominal port

Front 30

Inf. Pelvic Y:

Back 30

2cm below the ischial tuberosity to include femoral nodes

Front 31

Lateral Pelvic Y:

Back 31

2 cm beyond pelvic inlet

Front 32

Dose for HOdgkins

Back 32

36-44 Gy, 1.5-1.8Gy.
Prophylactic: 25-30Gy

Front 33

ACUTE side effects of Hodgkin's treatment:

Back 33

Fatigue, hair loss, erythema, sore throat, altered taste, dysphagia, dry cough, nausea, vomiting

Front 34

LATE side effects:

Back 34

mild radiation pneumonitis, hypothyroidism, xerostomia, radiation carditis, increased risk for breast cancer.

Front 35

magnifaction factor equation

Back 35

MF=SID/SOD
Image Size/Object Size=SID/SOD

Front 36

C1
C2, C3
C3, C4
C5
C7

Back 36

Mastoid Tip
Gonion
Hyoid Bone
Thyroid Cartilage
Vertebra Prominens

Front 37

T1
T2, T3
T4, T5
T7
T10

Back 37

5cmish above jugular notch
jugular notch, superior scapulae
sternal angle
inferior angles of scapulae
xiphoid process

Front 38

L3
L3, L4
L4

Back 38

Costal margin
umbilicus
iliac crest

Front 39

S1
Coccyx

Back 39

ASIS
pubic symphysis and greater trochanters

Front 40

Why Isocentric is preferred?

Back 40

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.

Front 41

GTV

Back 41

-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

Front 42

CTV

Back 42

-Clinical Tumor Volume: contains a demonstrable GTV &/or subclinical microscopic malignant disease that must be eliminated.

Front 43

PTV:

Back 43

-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.

Front 44

Treated Volume (TV):

Back 44

-enclosed by isodose surface
-usually bigger than PTV

Front 45

Irradiated Volume(IR):

Back 45

-volume of tissue that receives a dose considered significant to tissue tolerance.
-usually a percentage of prescribed target dose.

Front 46

13 Simulation Steps: 1-5
(according to the document on blackboard)

Back 46

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.

Front 47

13 Steps: 6-10

Back 47

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.

Front 48

13 steps: 11-13

Back 48

11. Photos of treatment area.
12. Tattoo
13. Facial photo or patient ID.

Front 49

Esophageal more common in what gender?

Back 49

3x more common in males

Front 50

Esophageal what % of cancers?
How many cases, deaths?

Back 50

1% of all cancers.
15,560 cases in 2007, 13,940 deaths!

Front 51

Esophageal is more common where?

Back 51

N. China, N. Iran, S. Africa. (THEIR DIETS!)

Front 52

Factors contributing to Esophageal CA?

Back 52

Excessive tobacco, alcohol. 80-90% associated with those.
Also diet low in fruits and veggies.

Front 53

Higher incidence in who?

Back 53

50% more in african americans, 55-85 age range

Front 54

Most common histology:

Back 54

SQUAMOUS: esp. in afr. amer.
Adenocarcinoma: caucasians
at junction of stomach and esophagus, transition b/w cells.

Front 55

Barrett's Esophagus:

Back 55

acid reflux changes what the cells are in transition area. Long-term reflux. Sometimes from acid, bile salts from duodenum.

Front 56

Plummer-Vinson Syndrome:

Back 56

Protrusions into the esophagus. difficult to swallow. have anemia, abnormalities of tongue, spleen.

Front 57

Prognostic Indicator:

Back 57

Tumor Size: less than 5 cm, better survival rate.
still only 19%
Stage is still big factor

Front 58

Anatomy of Esophagus:

Back 58

hollow tube of squamous 20-25 cm

Front 59

Cervical Esophagus:

Back 59

cricoid cartilage to thoracic inlet (T1)

Front 60

Upper thoracic Esophagus:

Back 60

thoracic inlet to the bifurcation of trachea