Oncology 2 Section 3 Final

area of the lung in which the blood lymphatic vessels and nerves enter and exit each other

hilum

anatomy between the lungs that includes the heart, thymus, major blood vessels, etc. that help position the lungs

mediastinum

This condition is characterized by clubbing of the distal fingers, as well as arthritic conditions in the bones and joints of the wrists and ankles:

hypertrophic pulmonary osteoarthopathy

mediastinal nodes

• superior mediastinal

• tracheal

• aortic

• carinal/subcarinal

• pulmonary ligament

total dose for hyperfractionated lung fields

68-70 Gy, 6960 cGy

dose to the lung is typically what % higher than what is normally expected

15-20%

dose of esophagitis

2500 cGy

dose of dysphagia

3000 cGy

length of esophagus

25cm

locations of parts of esophagus relative to anatomy

• upper third - cricoid cartilage (C6) to manubrium (T2)

• middle third - manubrium (T2) to hilum (T8)

• lower third - hilum (T8) to GE junction (T10/11)

presentation of esophageal cancer

• dysphagia - most common

• weight loss

• odynophagia

• GERD

etiologic factors for esophageal cancer

• alcohol/tobacco - major factor

• achalasia - failure of the sphincter to relax with swallowing, loss of normal peristaltic activity

• Plummer-Vinson syndrome - iron deficiency anemia which usually occurs in women

• tylosis - inherited condition characterized by epidermal thickening in the palms and soles of the feet

• diet low in fruits/veggies and high in nitrates (smoked/cured meats)

• caustic injury to the esophagus

• Barrett’s esophagus - distal esophagus is lined w/ columnar epithelium instead of stratified squamous usually due to chronic acid reflux

location of most esophageal cancers

lower/distal third

cell types of esophageal cancer

squamous cell carcinoma: upper third (most common)

adenocarcinoma: distal third and Barrett’s esophagus

lung cancer cell types treated with “postage stamp” boost

adenocarcinoma and large cell

most important factor in selection of the modality of treatment of an esophageal tumor

tumor site

definitive treatment used for upper vs lower third of esophagus

upper AKA cervical esophagus - RTT > surgery (not surgically accessible)

lower AKA thoracic esophagus - surgery > RTT

margins given to superior and inferior border of esophageal tumor field

5 cm

inflammation of the entire hard

pancarditis

GI tract/lung cancer with worst prognosis

esophageal cancer - 6-8%

% of lung cancer patients that get SVC

5%

locations where most gastric carcinomas are found

distal stomach on the lesser curvature

Karnofsky performance rating that is considered poor prognostic factor

<70%

chromosome linked to lung cancers

chromosome #6

leading cause of cancer mortality

• lung - #1

• colorectal - #2

radioprotectant for healthy lung tissue

Amifostene (ethiol)

segments of small intestine and lengths

• duodenum - 25 cm

• jejunum - 30 cm

• ileum - 40 cm

carcinoma of the small bowel usually involves

duodenum

most common symptom of small bowel cancer

obstruction

symptoms of colorectal cancer

• bloody stool/rectal bleeding - most common

• change in bowel habits

• change in caliber of stool

• constipation/diarrhea

• tenesmus

• abdominal pain if lesion is on right side

best single chemo agent for treating lung carcinoma

Cytoxan AKA Cyclophosphamide

cell types of colorectal cancers

colon: adenocarcinoma

rectal: squamous or carcinoid

lymphatic spread tendency of rectal cancer

• perirectal nodes

• internal iliac nodes

• presacral nodes

metastasis of colorectal cancer most commonly involves

liver

staging system used for colorectal classification

• Modified Astler-Coller (MAC)

• Duke’s

  • stage I/A - invasion into the submucosa

  • stage II/B - invasion into the serosa

  • stage III/C - invasion into the serosa w/ positive nodes

  • stage IV/D - any invasion w/ distant mets

painful spasmodic contractions of the anal sphincter, “straining at the stool”

tenesmus

colorectal staging depends on

depth of tumor invasion into the bowel

most common anatomical site for colorectal lesion

rectum

most commonly used modality to treat colorectal cancer

surgery

colonoscopy is recommended every 10 years beginning at what age

50

most commonly used conventional field arrangement giving the best dose distribution for colorectal lesions

3 fields with wedges

borders of colorectal field

• superior: L4/L5 interspace

• lateral: 2 cm lateral to pelvic sidewall/brim

• inferior: just below obturator foramen, 2 cm or more margin from tumor

• anterior: symphysis pubis, ensuring treatment of external iliac nodes

• posterior: 1.5-2 cm behind anterior bony sacral margin

primary dose limiting structure for colorectal cancer treatment

small bowel

chemotherapy drug most likely to bused to treat colorectal cancer

5FU

overall survival for colorectal cancer

50-60%

lymphatic spread to Virchow’s node is a classic sign of inoperability of

stomach/gastric cancer

diarrhea developing during pelvic irradiation is most likely secondary to radiation induced injury to the

small bowel

symptoms of lung cancer

• cough - most common

• chest pain

• rust-streaked sputum

• hemoptysis

• dyspnea

pathology of lung cancers

• squamous cell carcinoma AKA epidermoid

  • most related to smoking

  • centrally located - prone to invade the mediastinum

  • most common in men

• adenocarcinoma

  • most arise from surface epithelium

  • least related to smoking

  • most common lung cancer

  • most common in women

  • peripherally located - tend to involve thep leura,c hest wall, and diaphragm

• small cell AKA oat cell

  • worst prognosis

  • most anaplastic

  • most radiosensitive but not very radiocurable

  • centrally located

• large cell

  • unknown origin

  • aggressive

  • peripherally located

• mesothelioma

  • related to asbestos exposure

• pancoast AKA superior sulcus tumor

  • located in the apex of the lung

  • rib destruction is common

  • may involve the brachial plexus

  • may present with severe pain in the shoulder and the arm

  • possible sensory or motor disturbances

diagnostic procedure that is essential for oat cell carcinoma

bone marrow biopsy

chemo agents used for anal cancer

5FU and Mitomycin C

etiologic factors for lung cancer

• tobacco/smoking - most dominant/significant

• Radon gas exposure - 2nd leading cause

• asbestos exposure

• atmospheric pollution

• Nickel, Cadmiu, Arsenic, Chromium, coal

type of lung cancer seen in uranium workers

small cell

lymph nodes that lung cancer most commonly spreads to

mediastinal and supraclavicular

type of lung cancer that surgery plays no important role

small cell

hilar nodes AKA

intrapulmonary nodes

most serious complication that a patient can have from primary lung cancer irradiation

radiation transverse myelitis (RTM)

surgery is not indicated when a lesion is how close to what structure

within 2 cm of carina

smoking is responsible for approximately what percentage of all cancer deaths

28%

trachea extends from

larynx at C6 to carina at T5/T6

major complication of lung irradiation

pneumonitis

trachea branches into the left and right bronchi at what level

T5/T6

lung cancer cell type that could have prophylactic whole brain irradiation as part of treatment

small cell

tolerance dose of spinal cord

4700 cGy

etiologic factors for colorectal cancers

• familial adenomatous polyposis (FAP)

  • hereditary polyps which virtually always results in colon cancer if left untreated

• diet high in animal fat and low fiber

• first degree relative that develops colorectal cancer or FAP before age 60

• chronic ulcerative colitis

• hereditary nonpolyposis colon cancer (HNPCC)

• inflammatory bowel disease such as Chron’s disease

definitive treatment modality for early state lung cancer

surgery

doses for lung cancers

SCLC: 45-54 Gy

NSCLC: 60-75 Gy

C-wedge

compensating wedge, used to compensate for sloping chest

end portion of GI tract

anus

patient with middle lobe posterior lung tumor may be positioned prone to facilitate

easier alignment of off-cord obliques and boost fields directed posteriorly

used to manage area of increased dose regions in upper mediastinum due to natural slope of the chest

custom compensator, C-wedge

A radiation treatment field with and upper border above both clavicles and lower border approximately 5 cm below the Carina, including mediastinal lymphatics and blocking most of the left lung would likely be:

An initial field for treatment of an upper lobe right lung tumor

most common histologic type for small bowel cancer

adenocarcinoma

curative treatment of choice for gastric carcinoma

surgery

symptoms patients receiving radiation to the lower esophagus will likely experience

nausea

order of layers of the intestine in which tumors grow progressively

• mucosa

• submucosa

• muscularis

• serosa

formula for calculating appropriate electron energy beam

1/3 rule: depth in cm x 3

vermiform process AKA

appendix

carina

bifurcation of the trachea

left supraclavicular nodes AKA

Virchow’s node or scalene node

Barrett’s esophagus

change of the lining of the esophagus from stratified squamous to columnar epithelium due to chronic acid reflux

FTT meaning

false table top