Tech Rad Therapy Final

What are the risk factors associated with skin cancer?

tanning ,clothing trends, depletion of ozone layer

What is the most significant cause of skin cancer?

exposure to UV light

When treating skin cancer what is the normal tissue margin included in the field?

2cm

Basal cell carcinomas tend to spread by which means?

direct extension

What is Moh’s surgery?

microscopically controlled surgery that is highly effective for common types of skin cancer

What is cryosurgery?

uses extreme cold to treat skin cancer

What is the treatment of choice for basal cell and squamous cell carcinoma that provides the best cosmetic effect?

mohs surgery

What thickness of lead should be used with an electron treatment?

1/32

What is mycosis fungoides?

most common form of cutaneous T-cell lymphoma

What is a melanoma?

a malignant tumor of a melanocyte

What is a Kaposi’s sarcoma?

a type of cancer caused by a virus called human herpes virus 8; related to HIV/AIDS

What is erythema?

reddening of the skin; 2-5Gy about two weeks into treatment

What is telangiectasis?

a condition in which widened blood vessels cause threadlike red lines or patterns on the skin; spider veins

What are the layers of the skin?

epidermis, dermis, subcutaneous tissue

How many layers comprise the epidermis?

5

Be able to name the layers of the epidermis.

stratum corneum (horny layer) the outer layer skin surfaces dead scaly squamous cells filed with keratin; stratum lucidum (clear layer); stratum granulosum (granular layer); stratum spinosum (spiny layer); stratum basale (growth layer)

What is keratin?

type of protein that makes up the hair, skin, and nails

What is melanin?

dark pigment in the skin

What is bolus?

tissue equivalent material that brings the dose to the skin surface and evens out irregular contours

What skin cancer has the highest mortality rate?

malignant melanoma

What are the acute and chronic radiation reactions to treating skin cancer?

acute: erythema, epilation; chronic: skin changes, cataracts

What type of skin cancer is treated using total skin electron treatments?

mycosis fungoides

In Hodgkin’s disease, how does the disease spread within the body

contiguous spread; spread to viscera after spread to adjacent nodes; spleen in later stage; can also spread to lungs and skeletal system

What is the staging system associated with Hodgkin’s disease?

Ann Arbor

Identify the Hodgkin stage: cancer is located in a single region, usually one lymph node and the surrounding area; often will not have outward symptoms

stage I

Identify the Hodgkin stage: indicates that the cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm - that is, both are above the diaphragm, or both are below the diaphragm.

stage II

Identify the Hodgkin stage: indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.

stage III

Identify the Hodgkin stage: indicates diffuse or disseminated involvement of one or more extra lymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

stage IV

What is the histological classification system associated with Hodgkin’s disease?

Rye?; lymphocyte predominant, nodular sclerosis, mixed cellularity, lymphocyte depleted

name the hodgkin classification: more common in males, younger patients, localized disease, has best prognosis

lymphocyte predominant

name the hodgkin classification: most common, mostly adolescents

nodular sclerosis

name the hodgkin classification: under ten years of age, advanced disease, extranodal extension

mixed cellularity

name the hodgkin classification: rare in children, common with HIV, has worst prognosis

lymphocyte depleted

Which histological classification has the worse prognosis/ the best prognosis?

best: lymphocyte predominant, worst: lymphocyte depleted

What are the signs and symptoms associated with Hodgkin’s disease?

painless mass, fever and chills, night sweats, weight loss, itching skin, malaise, coughing, trouble breathing, or chest pain; loss of appetite, increased sensitivity to alcohol

What is the most common presenting symptom for Hodgkin?

painless mass in the neck

Why is a gap calculation important when treating a patient with two abutting fields?

to avoid hot spots

What is the cell specific to Hodgkin’s disease?

reed sternberg

What are B symptoms?

fever & chills, night sweats, 10% of weight loss over 6 months

What is a normal body temperature? In F° and C°

98.6 F, 37 C

When treating the total abdomen what structures need special consideration?

kidney, liver, bone marrow producing pelvis, reproductive organs

What is the dose limit for the small bowel?

45Gy

What is the dose limit for the liver?

30Gy

What is the dose limit for the kidney? What if both kidneys are in the field?

one kidney: 23Gy, both kidneys: 15Gy

What is the dose limit for the spinal cord?

45Gy

What is pruritis?

itchy skin

What does akimbo mean?

hands on hip with elbows out

What is Waldeyer’s ring?

tonsillar lymphatic tissue surrounding the nasopharynx and oropharynx) and cervical, preauricular, and occipital lymph nodes; consists of pharyngeal tonsil, palatine tonsils, lingual tonsils

What is pyrexia?

raised body temperature, fever

What is xerostomia?

dry mouth

What is febrile?

having or showing symptoms of a fever

What is the thoracic duct? Where does it begin and where does it end?

major lymphatic vessel; begins at the cisterna chyli and ends at the junction of the left jugular and subclavian vein

What is the cisterna chyli?

where the lymphatic ducts from the lower limbs and abdomen come together; located at L2

What treatment fields are associated with Hodgkin’s disease?

total nodal irradiation: mantle, inverted Y, paraaortic nodes

What are the anatomical borders for treating a mantle field?

treats nodes above the diaphragm; submandibular, occipital, cervical, supraclavicular, mediastinal, axillary, and hilar nodes; blocking for humeral head, larynx, lungs, and mandible

Where does the aorta divide?

L2; cisterna chyli

What is Lhermitte’s syndrome?

temporary complication that consists of numbness or electrical sensations that run down the body to the limbs (side effect from RT)

At what vertebral body are the domes of the diaphragm located?

T9-T10

What is the most common pathology associated with colon cancer?

adenocarcinoma

What is the treatment of choice for colorectal cancers?

surgery

If a patient develops diarrhea after the first two weeks of radiation treatments to the pelvis what measures should be taken?

Lomotil, Imodium; low residue diet

What are the layers of the colon?

mucosa, submucosa, muscularis, serosa

What are the segments of the large bowel?

cecum, colon, rectum, and anal canal

What risk factors may attribute to the development of colorectal cancer?

a diet high in animal fat and low in fiber, chronic ulcerative colitis, adenomatous polyps, familial adenomatous polyposis, Gardener’s syndrome, family history

Where is the primary site of distant metastasis from colon cancer?

liver

What are the nodes that are associated with the middle and lower rectal cancer?

middle rectal principal nodal group; internal iliac nodes, perirectal, lateral sacral, and presacral nodes

What is tenesmus?

spasms of the rectum accompanied by a desire to empty the bowel; may indicate locally advanced rectal cancer

What is acute enteritis?

when the small intestine is irritated and inflamed; comes on suddenly and usually only lasts a few days

What is the purpose of laser lights in the treatment room?

to straighten

In treating colon cancer how can dose to the small bowel be minimized?

prone with a full bladder

Where do the majority of cervical cancers originate?

ectocervix; squamocolumnar junction

What is a carcinoma in situ?

cancer cells that are located where they first formed and haven’t spread

What is a rectovaginal examination?

examines the vagina and rectum for abnormalities

What is a hysterosalpingography?

x-ray test to outline the internal shape of the uterus and show whether the fallopian tubes are blocked

What is a Pap smear?

removes cells from the cervix; test for cervical cancer

What is the female hormone responsible for secondary sexual characteristics in the female?

estrogen

What are the layers of the uterus?

endometrium (mucous membrane), myometrium (smooth muscle layer), peritoneum (outer serous membrane)

What is menopause?

decline in a women’s reproductive hormones

What is menarche?

the first menstrual cycle

What is a colposcopy?

a procedure to closely examine the cervix, vagina and vulva for signs of

What is a dilatation and curettage?

an operation to lightly scrape the inside of the uterus

What is an oopherectomy?

removal of one or both ovaries

What area would be most affected by radiation when treating the cervix?

bladder, rectum, small bowel

What is a fistula?

an abnormal connection between organs

What is a probable cause for the development of clear cell adenocarcinoma of the vagina?

diethylstilbestrol (DES)

What is the most common method of spread for ovarian cancer?

disseminated throughout peritoneal cavity, through diaphragmatic lymphatics

The most common pathology associated with vulvar cancer

squamous cell carcinoma

The most common pathology associated with ovarian cancer

ovarian epithelial carcinoma

The most common pathology associated with endometrial cancer

adenocarcinoma

The most common pathology associated with vaginal cancer

squamous cell carcinoma and adenocarcinoma

What is cryotherapy?

freezes a section of the cervix

What is a TAH?

removal of uterus and cervix

What is a TAHBSO?

removal of uterus, ovaries, fallopian tubes, and cervix

25-30 Gy and boost to the pelvis, for a total dose of 45- 50 Gy

total abdominal irradiation

Treat whole abdomen better tolerated by patient, delivers a higher biological dose than the open field

moving strip

Treated frog leg, direct with electrons

enface perineal field

What is the most common pathology associated with endometrial cancer?

adenocarcinoma

What are the means to treat vulva cancers?

surgery and radiation therapy

Signs and symptoms associated with cervical cancer

continuous vaginal discharge, abnormal vaginal bleeding, after intercourse, or after menopause, periods become heavier/last longer than usual, any bleeding after menopause, abnormal vaginal discharge, foul smelling discharge, post coital bleeding, pelvic pain

Signs and symptoms associated with ovarian cancer

“silent killer,” bloating, abdominal enlargement, pelvic or abdominal pain, pain in the back or legs, diarrhea, gas, nausea, constipation, indigestion, heartburn, difficulty eating or feeling full quickly, urinary symptoms (urgency or frequency), pain during sex, abnormal vaginal bleeding, trouble breathing