Oncology 2 final all

These lymphatic organs are also known as the adenoids:

pharyngeal tonsils

The cisterna chyli is located around what spinal level

L1

(fyi on notes L2)`

This person is primarily responsible for the first controlled clinical trials using radiation therapy to treat Hodgkin's disease in 1962

Kaplan

The median age for Hodgkin’s disease incidence is approximately age:

26

The lecture describes this virus as being associated with Hodgkin's disease:

EBV

List all Hodgkin’s disease cell types

1. Lymphocyte predominant aka Lymphocyte Rich HD- best prognosis

2. Nodular Sclerosing (NSHD)- most common

3. Lymphocyte Depleted- least common + worst prognosis

4. Mixed cellularity - 2nd most common

(new mexico PD)

This Hodgkin's disease cell type has the least favorable prognosis and is the least common

Lymphocyte depleted

The two primary differences between them from a (non-Hodgkin's lymphoma) and Hodgkin's disease are:

HD has:

1. Presence of Reed-Sternberg cell

2. Contiguous Spread

FYI: What type of Staging System is used for Hodgkin’s Disease

Ann Arbor Staging System- 1971

FYI: Ann Arbor Staging System

mesenteric nodes/ splenic nodes down = below the diaphragm

FYI: In the Ann Arbor staging system, a stage 4 lymphoma involves diffuse involvement of 1 or more organs. List those organs

H+ Hepat/o (liver)

L+ Lung

M + marrow

P+ Pleura

O+ Osseous tissue

D+ Dermis

A patient presents with Hodgkin’s Disease in a supraclavicular node and 4 cervical lymph nodes, the patient has also experienced night sweats and a 10% weight loss. What Stage is this patient?

IIB

more than one node and nodes on same side of diaphragm → stage 2

symptomatic → B

This is the name of the typical patient position utilized for treating mantle field/Hodgkin's disease

Akimbo position

In terms of Gy, what would be the best typical dose range for Hodgkins disease?

35-45 Gy

Overall five year survival for Hodgkins disease is approximately:

80%

True/ False: Non-Hodgkin's lymphomas are more common than Hodgkin's disease

True

FYI: Cell types for NHL

1. 40% Follicular (Nodular)- less aggressive

2. 60% Diffuse- more aggressive

T/F: Follicular pathologies for lymphomas are more aggressive than the diffuse types of lymphomas

False, they are less aggressive

Which of the following is not a combination chemotherapy regimen described in use for non-Hodgkin's lymphoma? (list instead)

1. CHOP
   

2. MACOP-B

3. Monoclonal antibodies like Rituximab

The cancer site that most commonly metastasizes to the bones

Prostate

This radiopharmaceutical agent, slow IV push liquid pure beta emitter, has been shown to be effective for treating widespread bony metastases

Strontium 89

A typical adult has this many bones

206

This is the life support sheath providing nutrient blood for bone cells and a source of bone developing cells during growth and after fracture. It is the hard dance covering of the bone

Periosteum

Which of the following is not an etiologic factor described in lecture for primary bone tumors?( list instead)

RGV Dawg

1. Radiation exposure

2. Genetic disorders

3. Viruses

4. Developmental abnormalities

What are the two types of primary bone lesions

1. Osteolytic (destroy bone)- black on film

2. Osteoblastic (create bone)- white on film

These type of primary bone lesions destroy normal bone and show up dark on film

Osteolytic

This is the most common truly osseous cancer

Osteogenic sarcoma (osteosarcoma)

This cancer from this oncology section best represents the classic "moth-eaten pattern" with respect to bone destruction

Multiple Myeloma

FYI: Could also be Ewing’s sarcoma but MM is best answer

Kaposi’s sarcoma is more commonly seen in all of the following population except: (list them instead)

1. Ture Kaposi’s: Mediterranean & North African men

2. AIDS patients

While soft tissue sarcoma can arise anywhere in the body, they most commonly occur in what area?

Lower extremities

Soft tissue sarcomas most commonly metastasize to what organ?

Lung

True or False: The single most important factor in the outcome of soft tissue sarcoma patients is the size of the tumor

False: The most important single factor is the histologic grade of the tumor

grade is more important cuz they are already radioresistant, so grade matters??

Soft tissue sarcomas are best diagnosed using what imaging tool?

MRI

FYI: Cuz it is soft tissue

When treating soft tissue sarcomas with radiation, treat the GTV (gross tumor volume) plus how many centimeter margin?

4 cm

T/F: Sarcomas tend to spread via the hematologic route rather than the lymphatic route

True:

FYI: The periosteum keeps primary bone tumors contained in a manner that generally prevents lymphatic spread.

The most common type of soft tissue sarcoma

Liposarcoma

These are the most lethal type of soft tissue sarcomas

Rhabdomyosarcoma

The most common type of genitourinary sarcoma

Leiomyosarcoma

Which of the following is NOT one of the etiologies described for soft tissue sarcoma? (list instead)

1. Previous RTT- breast & HD

2. Von Recklinghausen or Li-Fraumeni syndrome

What is the most common presentation of Hodgkin’s disease?

enlarged mass in the neck

The peak incidence for Hodgkin’s disease is

adolescence (11-30)

The xiphoid is at the level of:

T-10

How would a stage lll Hodgkin’s disease be treated?

(i.e field arrangement)

Mantel & Inverted Y

(treats stages 3 and 4) at stage 3 there is + nodes in both sides of the diaphgram

T / F HD shows a second "peak" of incidence in old age.

True

T/F: Older Hodgkin disease patients generally have a poorer prognosis than younger patients.

True

Pruritis is

itching

Involvement of two or more lymph nodes on the same side of the diaphragm is classified as what stage of Hodgkins disease?

Stage II

A benign tumor made of fat cells would be called a/an:

lipoma

A patient presenting with HD in the cervical, axillary and para-aortic lymph node groups would be what clinical stage?

stage lll

Cuz it’s in both sides of the diaphragm

Clinically, what anatomical landmark may be used as the inferior border of a mantle field?

xiphoid

Kaposi’s sarcoma is commonly associated with all of the following demographic groups EXCEPT: (list instead)

North African

Mediterranean

AIDS patients

The lymphatic organs are the

spleen, tonsils, thymus, and lymph nodes

STTL

Structures in Waldeyers ring are seldom involved in patients with HD. However, with such involvement, what nodes must be treated in the Waldeyers ring field?

pre-auricular

The most commonly occurring soft tissue sarcoma is:

liposarcoma

A typical dose for HD would be how many Gray?

35-45

Sarcomas tend to spread via:

hematologic route

T / F Radiation therapy is the definitive treatment modality for most soft tissue sarcomas.

False because most sarcomas are radioresistant

The single most important factor in the outcome (prognosis) of soft tissue sarcoma patients is:

histological grade (degree of cellular differentiation)

Though soft tissue sarcomas can arise anywhere in the body, they are most likely to occur in what area?

lower extremities

Why may mantle fields may require extended SSD calcs?

Need field sizes larger than the maximum field size of the machine.`

Subdiapgragmatic fields are most commonly used to treat what stage(s) of HD?

3 & 4

FYI: cuz after stage 3 and 4 there is positive lymph nodes in both sides of the diaphragm

The Cisterna Chyli is located at the level of

L2

A "mini-mantle" might be used to treat patients with involvement of all of the following nodes except: (list them instead)

cervical

supraclav

axilla

Treatment fields used to treat Hodgkins disease (TNI) are known as

Mantel and inverted Y

Which of the following is most clearly associated with the etiology of soft tissue sarcomas: (list it)

1. Previous RTT: breast cancer and HD

2. Von Recklinghausen disease Li-Fraumeni Syndrome

Multiple myeloma is a neoplastic proliferation of

Plasma cells

The lateral borders of a mantle field must include the: (just list all instead)

Superior:

Inferior:

Lateral:

Superior: a line from mental point to mastoid tip

Inferior: xiphoid tip; spinal level: T10

Lateral: must include axilla

FYI: What structures does mantle field block

1. throat block

2. humoral heads

3. lungs

4. safety block/ cord block

5. Some places add: heart block

What tumors appear almost anywhere fat is present?

Liposarcoma

T / F MM is invariably an incurable disease but it can usually be controlled for long periods of time.

True

T / F Multiple Myeloma (MM) occurs most commonly in childhood/adolescence.

False: Most occur after age 40

T / F Chondrosarcoma is common in childhood, but rare in adulthood.

False: Chondrosarcoma is rare in childhood but becomes more prevalent with advancing age.

FYI: chondrosarcoma is cartilage sarcoma

i guess adults cartilage deteriorates or something

What is the most frequent site of metastatic involvement of a soft tissue sarcoma?

Lung

What is the most common presenting symptom of multiple myeloma?

back pain

What is the primary modality in the treatment of multiple myeloma?

chemotherapy

FYI: makes sense, since it goes everywhere

Which of the following is the least common site of incidence for Ewing’s sarcoma and osteogenic sarcoma? (list it instead)

A proximal tibia

B distal femur

C ribs

D humerus

C ribs

osteosarcoma- distal femur & proximal tibia (bones around knee), fast growing bones

Ewing’s: diaphysis on lower half of body

A possible late effect of MOPP chemotherapy for HD would most likely be:

secondary malignancy (particularly acute leukemia)

The overall 5 year survival rate for HD is about ___%.

80%

Mycosis fungoides is a type of

T cell lymphoma

(nothing is lympoid)

The prognosis of lymphoma is least influenced by (list them instead)

1. stage- biggest prognostic factor, tumor size

2. age

3. histology

What ethnic group is multiple myeloma most common in?

African descent

The most common site of primary bone tumors is near the:

epiphyseal line (the growth plate)

The staging system for Hodgkins disease is

Ann Arbor staging

A staging system for lymphoma is the

Rappaport system

Hodgkins disease patients with “A” symptoms are

asymptomatic

A Hodgkins patient presents with a 4 cm. mass in the left supraclavicular area, what is the clinical stage?

IA

I- single node

A- no symptoms: weight loss, fever, nigh sweats

Which of the following primary bone tumors is most radiosensitive?

Ewing’s sarcoma

This is the life support sheath providing nutrient blood for bone cells and a source of bone developing cells during growth and after fracture:

periosteum

What is the most common site of presentation for soft tissue sarcomas?

lower extremity

Most primary bone cancers are:

A carcinomas

B sarcomas

C lymphomas

D melanomas

sarcomas

The incidence of primary bone tumors is highest in what age group:

adolescent

What study best shows a soft tissue sarcoma?

MRI

With what type of bone tumor do radiographs show a classical "moth-eaten" pattern to the cortex of a the bone?

Multiple Myeloma

What sarcoma originates in connective tissue of nerve sheaths?

Fibrosarcoma

What will therapeutic doses of radiation to growing bone and cartilage result in for children:

A marked retardation of bone growth

What is the most frequent primary bone tumor?

Osteosarcoma

Which is the most radiosensitive of the soft tissue sarcomas?

liposarcoma

FYI: while Ewings can appear in soft tissue, it most commonly appears in the bone so that is why liposarcoma is the best answer

T / F There is thought to be a viral etiology for NHL.

True

Which of the following is NOT a common site for NHL? (list instead)

1. lymph nodes

2. Waldeyer’s ring

3. GI tract (most common extranodal location)

What lesions are the most lethal of the soft tissue sarcomas?

Rhabdomyosarcoma