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Radiation Oncology

Oncology

QuestionAnswer
1. Where is the most common site of metastasis for patients diagnosed with head & neck (H&N) cancer? Lungs are most common. Other sites of metastasis include liver, brain, bones, and mediastinal lymph nodes. (W&L, pg. 693)
2. What is the standard treatment for patients diagnosed with H&N cancer? Surgery with preoperative or, more commonly, postoperative radiation therapy. Another option is primary radiation followed by surgery. (W&L, pg. 693)
3. What are general etiologic risk factors for H&N cancers? Tobacco and alcohol use, ultraviolet (UV) light exposure, viral infection, and environmental exposures. (W&L, pg. 695)
4. What 2 syndromes have been linked to the development of H&N cancers? Bloom syndrome and Li-Fraumeni syndrome. (W&L pg. 697)
5. What is the most common histology of H&N cancers? Squamous cell carcinoma (W&L pg.704)
6. What staging system is used to stage H&N cancer? TNM (W&L pg.705)
7. What chemotherapy drugs are used to treat H&N cancer which has metastasized? Cisplatin and 5-FU. Chemotherapy plays a limited role in the treatment of H&N cancers. (W&L pg. 713)
8. What is the standard treatment schedule for H&N cancers? The standard fractionation schedule includes treatment 5 days per week for approximately 6.5 to 7.5 weeks, with a dose of 200 cGy per day. (W&L pg. 714)
9. The upper lip drains into what 2 nodal groups? Submandibular and preauricular nodal groups. (W&L pg. 716)
10. The mid-lower lip and anterior floor of the mouth drain into what nodal group? Submental nodal group. (W&L pg. 716)
11. What is the most important prognostic factor for CNS tumors? Histopathologic diagnosis (W&L pg. 755).
12. What is the most common clinical presentation associated with rectal cancer? Rectal bleeding. (W&L pg. 768)
13. What is the most common histology of cancer of the small bowel? Adenocarcinoma. (W&L pg. 769).
14. What is the most common staging system for cancers of the digestive system? TNM. (W&L pg. 769).
15. How are cancers of the large bowel diagnosed? Physical examination and radiographic and endoscopic studies. (W&L pg. 769).
16. How do malignancies of the large bowel spread? Direct extension, lymphatics, hematogenous spread. (W&L, pg. 770).
17. What is the initial lymph node group involved when a person has rectal caner? Perirectal nodes. (W&L pg. 770).
18. What is the most common type of distant metastasis for tumors of the gastrointestinal system? Blood-borne spread to the liver. (W&L, pg. 770).
19. For tumors of the gastrointestinal system what is the treatment modality of choice? Surgery. (W&L, pg. 770).
20. Adjuvant treatment for rectal cancer includes? Preoperative or postoperative radiation therapy in conjunction with chemotherapy. (W&L, 771).
21. What chemotherapy drug is most often used in the treatment of rectal and colon cancer? 5-fluorouracil (5-FU). (W&L, pg. 771).
22. What are the etiologic risk factors for the development of anal cancer? Genetic warts, genital infection, human papillomaviruses (HPV’s), anal intercourse before age 30, and immunosuppression.
23. What are the initial lymph node groups involved when a person has anal cancer? Perirectal and anorectal lymph nodes. (W&L, pg. 779).
24. What is the most common presenting symptom for anal cancer? Rectal bleeding. Other symptoms include: pain, change in bowel habits, and the sensation of a mass. (W&L, pg. 780).
25. What is the most common histology of anal cancer? Squamous cell carcinoma, which accounts for approximately 80% of all anal tumors. (W&L, pg. 780).
26. How do tumors of the anal canal most frequently spread? Direct extension. (W&L, pg. 780).
27. What is the preferred method of treatment for anal cancer? Radiation therapy and chemotherapy. (W&L, pg. 780.)
28. What chemotherapy drugs are used to treat anal cancers? 5-FU and mitomycin C. (W&L, pg. 780).
29. When treating anal cancer with radiation alone what is the dose delivered to the treatment area? 6000 to 6500 cGy. The field is usually reduced at 4500 cGy to reduce the dose to the small bowel. (W&L, 781).
30. When treating anal cancer with chemoradiation what is the dose delivered to the treatment area? 3060 to 4500 cGy. (W&L, 781).
31. What are the most common etiologic risk factors in the development of squamous cell carcinoma of the esophagus? Excessive alcohol and tobacco use. (W&L, pg. 781).
32. What are the 2 medical conditions that are associated with the development of adenocarcinoma of the esophagus? Barrett’s esophagus and Gastroesophageal reflux disease (GERD). (W&L, pg. 782).
33. The upper third (cervical area) of the esophagus drains into which lymph nodes? Internal jugular, cervical, paraesophageal and supraclavicular lymph nodes.
34. The upper and middle thoracic portion of the esophagus drains into which lymph nodes? Paratracheal, hilar, subcarinal, paraesophageal, and paracardial lymph nodes. (W&L, pg. 783).
35.The lower third of the esophagus drains into which lymph nodes? Left gastric nodes, and nodes of the lesser curvature of the stomach.
36. What are the most common presenting symptoms for esophageal cancer? Dysphagia and weight loss. (W&L, pg. 784).
37. What are the 2 most common pathologic types of esophageal cancer? Squamous cell carcinomas and adenocarcinoma. (W&L, pg. 785)
38. What are the most common sites of distant metastasis for esophageal cancer? Liver and lungs. (W&L, 785).
39. What are the methods of spread for esophageal cancer? Direct extension, Lymphatics, and hematogenous. (W&L, pg. 785).
40. What are the 2 combined modality techniques most often used to treat esophageal cancer? Definitive chemoradiation therapy and neoadjuvant preoperative chemoradiation therapy. (W&L, pg. 785.)
41. What chemotherapy drugs are used to treat esophageal cancer? 5-FU and cisplatin. (W&L, pg. 786.)
42. When treating esophageal cancer with radiation alone what is the prescribed dose? 6500 cGy. (W&L, pg. 788).
43. When treating esophageal cancer with combined chemotherapy and radiation what is the prescribed radiation dose? 50.4 Gy. (W&L, pg. 788).
44. What are the 4 most common presenting system of pancreatic cancer? Jaundice, abdominal pain, anorexia, and weight loss. (W&L, pg. 793).
45. What is the most common histology of pancreatic cancer? Adenocarcinoma accounts for approximately 80% of all pancreatic tumors. (W&L, pg 794).
46. What are the primary methods of spread for pancreatic cancer? Lymphatics, direct extension, and hematogenous spread. (W&L, pg. 794).
47. What is the most common site for distant metastasis of pancreatic cancer? Liver. (W&L, pg. 794.)
48. What is the treatment of choice for pancreatic cancer? Surgery. (W&L, pg. 794).
49. What is the most common curative surgical procedure for pancreatic cancer? Pancreaticoduodentectomy (Whipple procedure). (W&L, pg. 794.)
50. What is the most common chemotherapy drug used in the treatment of pancreatic cancer? Gemcitabine (W&L, pg. 795).
51. What is the dose range for the treatment of pancreatic cancer? 45 to 50 Gy delivered in 1.8 Gy per fraction. (W&L, pg. 796).
52. What staging system is used for staging gynecological tumors? FIGO (W&L, pg. 804).
53. What is the most common type of gynecologic malignancy? Endometrial which accounts for approximately 50% of all gynecologic malignancies. (W&L, pg. 804).
54. What is the most radiosensitive gynecologic structure? Ovaries. (W&L, pg. 805).
55. What is the most common location for cancer of the vulva? Labia majora. (W&L, pg. 805).
56. For cancer of the vulva lymphatic spread is predictable, what are the 3 lymph node groups involved? Superficial inguinal nodes, deep femoral nodes, and pelvic nodes. (W&L, pg. 807)
57. What is the most common histology for vulvar cancers? Squamous cell carcinoma. (W&L, pg. 807).
58. What is the most common histology for vaginal cancer? Squamous cell carcinoma. (W&L, pg. 808).
59. What is the treatment of choice for vaginal cancer? Radiation therapy. (W&L, pg. 808).
60. What are the 3 most common presenting signs for cervical cancer? Postcoital bleeding, increased menstrual bleeding, and discomfort with intercourse. (W&L, pg. 809).
61. What is the most common histology for cervical cancer? Squamous cell carcinoma. (W&L, pg. 811).
62. Patients that are diagnosed with inoperable cervical cancer most often are treated with what radiation technique? Tandem and ovoid. Patients are usually treated to a dose of 45 to 55 Gy. (W&L, pg. 812).
63. For endometrial cancer what 2 lymph node groups are initially involved? Internal and external iliac pelvic nodes. (W&L, pg. 816).
64. What is the most common histology for endometrial cancer? Adenocarcinoma. (W&L., pg. 816).
65. What are common treatment techniques for endometrial cancer? Surgery and/or radiation therapy. The option for treatment is dependent up the stage and grade of the tumor. (W&L., pg. 816).
66. For the treatment of endometrial cancer, when would radiation be used as the lone treatment modality? Irradiation alone may be used for medically inoperable patients and for stages III and IV. (W&L, pg. 816).
67. What is the recommended radiation dose for patients with endometrial cancer? Above 75 Gy. At least 50 Gy is usually delivered with external beam and a pelvic implant brings the dose above 75 Gy. (W&L, pg. 816).
68. Of the gynecologic tumors which is the most deadly? Ovarian cancer. (W&L, pg. 817).
69. What are the most common presenting symptoms for ovarian cancer? Abdominal and/or pelvic pain, abdominal distention or nonspecific gastrointestinal symptoms (nausea, constipation, and heartburn). (W&L, pg. 817).
70. What age range is ovarian cancer the most common? 50 to 70 years old. (W&L, pg. 817).
71. What is the initial treatment for ovarian cancer? Surgical evaluation and debulking. Followed by single agent or combination chemotherapy. (W&L, pg. 819).
72. What is the most common malignancy among males in the United States? Prostate Cancer. (W&L, pg. 823).
73. What is the most common histology for prostate cancer? Adenocarcinoma. (W&L, pg. 826).
74. In which gland do most carcinomas of the prostate develop? Peripheral gland of the prostate. (W&L, pg. 824).
75. What lymph node groups are most frequently involved in carcinoma of the prostate? Periprostatic and obturator nodes are involved first, followed by external iliac, hypogastric, common iliac, and periaoritc nodes.(W&L, pg. 824).
76. What are common presenting symptoms for prostate cancer? Decreased urinary stream, frequency, difficulty starting urination, dysuria, and hematuria. (W&L, pg. 824).
77. What histologic grading system is used for prostate cancer? Gleason score. (W&L, pg. 826).
78. What is the most site of metastatic spread for cancer of the penis? Inguinal nodes. (W&L, pg. 841).
79. What is the most common histologic type of breast malignancy? Infiltrating ductal carcinoma. (W&L, pg. 869).
80. What is the most important prognostic indicator for patients diagnosed with breast cancer? The number of axillary lymph nodes involved. (W&L, pg. 869).
81. What form of breast cancer yields the worst prognosis? Inflammatory carcinoma. (W&L, pg. 870).
82. What are the three main lymph node groups associated with breast cancer? Axillary, Internal mammary, and Supraclavicular lymph nodes. (W&L, pg. 871).
83. In which quadrant do most breast cancers arise? Upper-outer quadrant (Approximately 48%). (W&L, pg. 872).
84. Breast cancer most commonly metastasizes to what locations? Bone, lung, brain, and liver. (W&L, pg. 874).
85. How does breast cancer metastasize? Direct extension, lymphatics, hematogenous spread (embolization). (W&L, pg. 876 & 879).
Created by: st00170
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