1
Q
What percentage of new cancer diagnoses in women does breast cancer account for?
A
31% of new diagnoses in women.
2
Q
What are the two most common types of invasive breast cancer?
A
Infiltrating ductal carcinoma (IDC) - 80% of cases; Infiltrating lobular carcinoma (ILC) - <10%.
3
Q
What breast structure is commonly affected by ductal carcinoma?
A
The lactiferous duct.
4
Q
What lymph nodes provide primary drainage for the breast?
A
Axillary, internal mammary, supraclavicular.
5
Q
What is the most common symptom of breast cancer?
A
A painless, palpable, mobile mass.
6
Q
What are three major risk factors for breast cancer?
A
Early menarche, late menopause, BRCA1 & BRCA2 mutations.
7
Q
What lifestyle factors increase breast cancer risk?
A
Excessive alcohol consumption, tobacco use, obesity, night shifts.
8
Q
How does childbirth impact breast cancer risk?
A
Childbirth before 35 is protective; nulliparity (not giving birth) increases risk.
9
Q
What is the primary imaging method for breast cancer screening?
A
Mammography.
10
Q
What additional imaging methods can be used to evaluate breast abnormalities?
A
Ultrasound and MRI.
11
Q
What biopsy method is most commonly used to differentiate between invasive and in situ cancers?
A
Core needle biopsy.
12
Q
What is the clinical staging system for breast cancer?
A
cTNM: Tumor size (T), lymph node involvement (N), distant metastasis (M).
13
Q
What is the most common subtype of DCIS?
A
Comedo type, characterized by prominent necrosis in the center of involved spaces.
14
Q
What is the most common invasive breast cancer?
A
Invasive ductal carcinoma (IDC).
15
Q
What are the main breast cancer treatment options?
A
Surgery, systemic therapy (chemotherapy, endocrine therapy), radiation therapy.
16
Q
What is the purpose of adjuvant radiation therapy?
A
To eradicate subclinical disease after surgery and reduce recurrence risk.
17
Q
What are the two main types of mastectomy?
A
Total mastectomy and modified radical mastectomy.
18
Q
What surgery removes only the tumor while preserving the breast?
A
Breast-conserving surgery (lumpectomy).
19
Q
What drug is used for HER2-positive breast cancer?
A
Trastuzumab.
20
Q
What endocrine therapy is used for ER-positive breast cancer?
A
Tamoxifen (for premenopausal women) and aromatase inhibitors (for postmenopausal women).
21
Q
What are the field borders for a standard tangential irradiation setup?
A
Superior: First costal interspace, Inferior: 1.5 cm below the inframammary fold, Medial: Midline of sternum, Lateral: Mid-axillary line.
22
Q
What is the total dose range for breast tangents in radiation therapy?
A
46.8 - 50.4 Gy at 1.8 to 2 Gy per fraction.
23
Q
What technique is used to reduce heart dose in left-sided breast cancer radiation therapy?
A
Deep Inspiration Breath Hold (DIBH).
24
Q
What are common early side effects of radiation therapy to the breast?
A
Skin erythema, dry desquamation, moist desquamation, pain, swelling, nipple tenderness, fatigue.
25
How should skin erythema from radiation therapy be managed?
Lukewarm water, mild soap, moisturizing lotion (100% aloe, Aquaphor, Eucerin), avoid perfumes and powders.
26
What dressing should be used for moist desquamation?
Nonstick wound dressings.
27
What are common late side effects of radiation therapy?
Fibrosis, hyperpigmentation, telangiectasia, lymphedema, cardiac effects, pneumonitis, secondary cancers.
28
How can patients manage radiation-induced fatigue?
Frequent rest, light physical activity, hydration, balanced meals, consistent sleep schedule.
29
How much does adjuvant whole-breast radiation reduce disease recurrence at 10 years?
From 35% to 19%.
30
How much does post-mastectomy radiation therapy (PMRT) reduce local recurrence risk?
By 73%.
31
What should radiation therapists assess on day 1 of treatment?
Patient’s medical condition and needs.
32
What are key patient education points before radiation therapy?
Simulation & treatment procedures, skin care, side effects, nutrition, support services.
33
How can therapists provide emotional support to breast cancer patients?
Active listening, validating emotions, respecting patient autonomy.
34
What is a scar boost, and why is it used?
An additional dose of radiation to the surgical scar area, typically using electrons.
35
What is the purpose of a post-axillary boost (PAB) in radiation therapy?
To increase the midaxillary dose to the prescribed level.
36
What are the two primary components of the CNS?
The brain and spinal cord.
37
What is the most common type of primary brain tumor?
Gliomas, which arise from glial cells.
38
What is the most aggressive form of astrocytoma?
Glioblastoma multiforme (GBM), classified as Grade IV.
39
Which primary brain tumor has the worst prognosis?
GBM, with a 5-year survival rate of only 2.2%.
40
What are common sources of metastatic brain tumors?
* Lung
* Breast
* Melanoma
* Colon
* Kidney cancers
41
What is the 5-year survival rate for malignant primary CNS tumors?
Approximately 34%.
42
What is the 5-year survival rate for benign brain tumors?
92%.
43
What factors influence a patient’s brain tumor prognosis?
* Age
* Tumor histology
* Performance status (KPS)
* Neurological symptoms
44
Which environmental exposures are linked to brain tumors?
* Ionizing radiation
* Rubber manufacturing toxins
* Pesticides
* Herbicides
45
Which genetic disorders increase the risk of brain tumors?
* Li-Fraumeni syndrome
* NF1/NF2
* Turcot syndrome
* Von Hippel-Lindau syndrome
46
What imaging modality is preferred for brain tumor diagnosis?
MRI due to its ability to detect chemical changes and soft tissue contrast.
47
Why are PET scans sometimes used for brain tumor assessment?
To detect tumor metabolism and differentiate between tumor recurrence and radiation necrosis.
48
What is the standard whole-brain radiation therapy (WBRT) dose?
30-37.5 Gy in 10-15 fractions.
49
What is the standard dose for high-grade gliomas?
60 Gy in 1.8-2.0 Gy fractions.
50
What are the advantages of IMRT over conventional radiation therapy?
* Better tumor targeting
* Reduced dose to healthy brain tissue
* Lower toxicity
51
What is the most common acute side effect of brain radiation therapy?
Fatigue.
52
At what dose does temporary hair loss occur?
20-40 Gy.
53
At what dose does permanent hair loss occur?
Greater than 40 Gy.
54
What medication is used to manage cerebral edema caused by radiation?
Dexamethasone (Decadron).
55
What are common acute skin reactions to brain radiation?
* Erythema
* Dry desquamation
* Moist desquamation
56
What are some long-term complications of brain radiation therapy?
* Cognitive decline
* Radiation necrosis
* Vascular damage
57
What is radiation necrosis, and when does it occur?
Irreversible damage to brain tissue, occurring 6 months to years after treatment.
58
Which cognitive functions are most affected by brain radiation therapy?
* Processing speed
* Memory
* Attention
59
What is superior vena cava syndrome (SVC syndrome)?
Compression of the superior vena cava, causing swelling and difficulty breathing.
60
What is the first-line treatment for SVC syndrome due to malignancy?
Radiation therapy and/or chemotherapy.
61
What is spinal cord compression (SCC), and why is it an emergency?
Tumor pressure on the spinal cord, leading to paralysis if untreated.
62
What is the preferred treatment for spinal cord compression?
Surgery followed by radiation therapy.
63
How can radiation therapists help patients manage treatment-related fatigue?
Encourage adequate rest, hydration, and small frequent meals.
64
What dietary strategies help patients undergoing radiation therapy?
* High-calorie, high-protein meals
* Small portions
* Nutritional supplements
65
Why do some patients experience emotional distress at the end of treatment?
Loss of daily support from the therapy team and fear of recurrence.
66
Which tumors are most commonly treated with craniospinal irradiation?
* Medulloblastoma
* Other embryonal tumors
67
Why is chemotherapy less effective for brain tumors?
The blood-brain barrier prevents many drugs from reaching the tumor.
68
What is cytoreduction surgery, and why is it performed?
Partial tumor removal to relieve symptoms but does not improve survival.
69
What type of brain tumor is associated with hormone imbalances?
Pituitary adenomas.
70
What is the Karnofsky Performance Scale used for?
Assessing a patient’s neurological and functional status.
71
What are gliomas, and where do they arise?
Gliomas are tumors that arise from glial cells in the brain and spinal cord.
72
What is the most aggressive type of astrocytoma?
Grade IV astrocytoma, also known as glioblastoma multiforme (GBM).
73
What type of brain tumor primarily affects children and originates in the cerebellum?
Medulloblastoma.
74
Where do ependymomas commonly develop?
In the lining of the brain's ventricles or the spinal cord.
75
What type of glioma originates from oligodendrocytes?
Oligodendroglioma.
76
What type of tumor is a vestibular schwannoma?
A benign tumor affecting the nerve connecting the brain to the inner ear, often seen in neurofibromatosis type 2.
77
What is the most common histology of head and neck cancers?
Squamous cell carcinoma (SCC)
## Footnote
SCC is the predominant type of cancer found in this region.
78
What are the major etiologic risk factors for head and neck cancer?
Tobacco use, alcohol consumption, UV light exposure, viral infections (HPV, EBV), and environmental carcinogens
## Footnote
These factors significantly increase the risk of developing head and neck cancers.
79
What is the role of Epstein-Barr Virus (EBV) in head and neck cancers?
EBV is strongly associated with nasopharyngeal carcinoma in all races
## Footnote
EBV infection is a critical factor in the etiology of this specific type of cancer.
80
What is the most common presenting symptom of oral cavity cancer?
Ulceration
## Footnote
Ulceration is often the first noticeable sign of oral cavity malignancies.
81
What is the gold standard for treatment of neck disease?
Radical neck dissection (RND)
## Footnote
RND involves the removal of lymph nodes, sternocleidomastoid muscle, internal jugular vein, and cranial nerve XI.
82
What is the primary lymphatic drainage for the lower lip?
Submental nodes
## Footnote
These nodes are crucial for understanding the metastatic spread of lower lip cancers.
83
What is the most commonly involved lymph node group in oropharyngeal cancer?
Jugulodigastric nodes
## Footnote
This group is typically the first site of metastasis in oropharyngeal malignancies.
84
What is the first lymphatic station involved in floor of mouth cancers?
Submandibular nodes
## Footnote
These nodes are critical in the staging and management of floor of mouth cancers.
85
Which lymph nodes are involved in the spread of nasopharyngeal cancer?
Retropharyngeal nodes, deep cervical nodes, and supraclavicular nodes
## Footnote
Understanding these nodes helps in planning treatment and assessing prognosis.
86
Which structures are most at risk when treating the maxillary antrum with radiation therapy?
The eye and optic structures
## Footnote
Special care must be taken to protect these critical structures during radiation treatment.
87
A glottic tumor confined to the larynx with cord fixation is staged as:
T3
## Footnote
This staging indicates a more advanced local disease.
88
What anatomical landmark does the cricoid cartilage indicate?
Inferior border of the larynx
## Footnote
This landmark is essential for understanding laryngeal anatomy.
89
The nasopharynx extends from the posterior nares to what structure?
The soft palate
## Footnote
This defines the anatomical boundaries of the nasopharynx.
90
What nerve is involved in facial paralysis due to head and neck cancer involvement?
Cranial nerve VII (Facial nerve)
## Footnote
Damage to this nerve can lead to significant functional impairment.
91
What cranial nerve controls talking and vocal sounds?
Cranial nerve X (Vagus nerve)
## Footnote
This nerve plays a critical role in voice and swallowing functions.
92
Why is IMRT preferred over conventional radiation techniques for head and neck cancer?
It allows better tumor dose escalation while sparing surrounding normal structures
## Footnote
IMRT improves treatment precision and reduces side effects.
93
Why is a mouth stent or tongue blade used during EBRT?
To displace the palate to spare it from radiation, move the tongue out of the treatment field, hold the tongue in place within the field, and act as a shield to reduce radiation dose to teeth
## Footnote
These devices help optimize treatment delivery.
94
When should dental work be performed for a patient undergoing oral cavity irradiation?
Before treatment
## Footnote
This timing is crucial to prevent osteoradionecrosis.
95
What dose range is typically prescribed for T1 glottic cancers?
6000–6600 cGy in 180–200 cGy fractions
## Footnote
This dosing regimen is standard for early-stage glottic cancers.
96
What fractionation schedule improves local control for NPC (Nasopharyngeal Carcinoma)?
Hyperfractionation: 7440 cGy in twice-daily fractions
## Footnote
This approach has been shown to enhance treatment outcomes.
97
What is the most common acute side effect of radiation therapy to the oral cavity?
Mucositis
## Footnote
Mucositis can significantly impact patient quality of life during treatment.
98
What dietary changes can help with radiation-induced xerostomia?
Frequent sips of water, sugar-free gum, saliva substitutes, and avoiding caffeine/alcohol
## Footnote
These changes can alleviate dry mouth symptoms.
99
What is the best management for radiation-induced skin erythema and dryness?
Use mild soaps, avoid friction, and apply Aquaphor or Eucerin
## Footnote
These measures help manage skin reactions effectively.
100
What should a patient avoid to prevent worsening of skin reactions during radiation therapy?
Sun exposure, harsh soaps, tight clothing, and scratching the area
## Footnote
Avoiding these factors helps protect irradiated skin.
101
How can radiation-induced odynophagia (painful swallowing) be managed?
Cold foods, topical anesthetics, and high-calorie shakes to maintain nutrition
## Footnote
These strategies can help patients cope with swallowing difficulties.
102
What is osteoradionecrosis and what causes it?
Bone death due to radiation-induced hypovascularity, often in the mandible
## Footnote
This condition can lead to severe complications in irradiated patients.
103
What is a major late complication of bilateral parotid gland irradiation?
Severe xerostomia (dry mouth)
## Footnote
This complication can significantly affect a patient's quality of life.
104
What dose limitation helps reduce laryngeal edema post-radiation?
Keeping the whole organ dose under 4400 cGy
## Footnote
This threshold is crucial for minimizing edema.
105
Why is dental extraction recommended before head and neck radiation?
To prevent osteoradionecrosis (ORN) of the jaw
## Footnote
Preventive measures are essential for avoiding severe complications.
106
What dose threshold is associated with radiation-induced myelopathy of the spinal cord?
6000 cGy or higher
## Footnote
Exceeding this dose can lead to irreversible spinal cord damage.
107
What is leukoplakia?
Small, white raised patches on the mucous membrane, which can be pre-malignant
## Footnote
Monitoring leukoplakia is important for early cancer detection.
108
What is erythroplasia?
Red, velvety patches on mucous membranes, often an early sign of malignancy
## Footnote
Erythroplasia is a significant indicator for potential cancer development.
109
What is the leading cause of high-grade parotid tumors?
They are often aggressive and can invade the facial nerve, causing paralysis
## Footnote
Understanding tumor behavior is crucial for treatment planning.
110
What fractionation schedule can improve outcomes in hypopharyngeal cancer?
Hyperfractionation or accelerated fractionation to 7000-7900 cGy
## Footnote
This approach has shown better control of hypopharyngeal cancers.
111
What are early symptoms of oropharyngeal cancer?
Persistent sore throat, painful swallowing, referred ear pain (otalgia), and hoarseness
## Footnote
Recognizing these symptoms can lead to earlier diagnosis and treatment.
112
Why is SCC an emergency?
It can cause permanent neurological damage if untreated.
113
What is the most common cause of SCC?
Metastasis to the spine.
114
Which primary tumors most commonly cause SCC?
Lung, prostate, breast, lymphomas.
115
What are the four most common symptoms of SCC?
* Pain
* Weakness
* Autonomic dysfunction
* Sensory loss
116
How is SCC diagnosed?
* Neurological exam
* CT
* MRI
117
What medication is commonly used for SCC?
Corticosteroids (Dexamethasone).
118
Can chemotherapy be used for SCC?
Yes, for chemo-sensitive cancers like lymphoma and small cell lung cancer.
119
When is surgery performed for SCC?
For non-cancer cases or collapsed vertebrae; laminectomy may be done.
120
What is the typical patient position for SCC radiation treatment?
Prone.
121
What are the two main radiation beam configurations for SCC?
* Single PA field
* Two posterior obliques (LPO & RPO)
122
What are the superior and inferior radiation field borders for SCC?
3-4 cm above and below the compression or 2 vertebral bodies superior/inferior.
123
What is the typical lateral radiation field width for SCC?
7-8 cm, adjusted based on tumor extent.
124
What is the usual treatment depth for SCC radiation therapy?
5 cm (set to 95 SSD).
125
What is the typical dose range for SCC radiation therapy?
30-40 Gy in 2-4 weeks.
126
What fractionation scheme is common for SCC?
3.5-4 Gy for the first 3-4 treatments.
127
What is an alternative dose for SCC patients with a short-term prognosis?
Up to 8 Gy for 1-2 fractions.
128
What are the key steps in SCC radiation setup?
* Set borders
* Position patient prone
* Localize tumor
* Verify SSD
* Treat
129
Why might a supine setup be used instead of prone?
Some patients may not tolerate the prone position.
130
What are long-term side effects of SCC radiation?
Varies, but may include damage to surrounding healthy tissues.
131
Why is SVCS considered an emergency?
It can cause brain edema, reduced cardiac output, and airway obstruction.
132
What are the two most common causes of SVCS?
* Lung cancer (small cell & non-small cell)
* Lymphomas
133
What is a benign cause of SVCS?
Thyroid goiter (2-3% of cases).
134
What are six common symptoms of SVCS?
* Shortness of breath
* Facial swelling
* Neck/thorax vein distension
* Chest pain
* Cough
* Dysphagia
135
How is SVCS definitively diagnosed?
CT with contrast.
136
What medication is commonly used for SVCS?
* Anticoagulants (e.g., Heparin, Warfarin, Rivaroxaban)
* Steroids (Dexamethasone)
137
When is chemotherapy used for SVCS?
For chemo-sensitive cancers like small cell lung cancer, lymphoma, leukemia.
138
When is surgery performed for SVCS?
Mainly to place a stent.
139
When is radiation therapy used for SVCS?
Non-small cell lung cancer or when a stent is not possible.
140
What is the typical patient position for SVCS radiation therapy?
Supine, often inclined on a slant board.
141
What are the two main beam configurations for SVCS radiation?
* Single AP field
* Parallel opposed AP/PA fields
142
What must be included in a traditional clinical SVCS radiation field?
* Entire lung
* Above clavicles
* Great vessels
* Hilar area
* Axillary nodes
143
What is the typical radiation depth for SVCS?
Midline at the Angle of Louis (approx. 5.5 cm).
144
What is the standard radiation dose for SVCS?
30 Gy in 10 fractions or 20 Gy in 5 fractions.
145
What is an alternative dose for emergency SVCS cases?
4-8 Gy every other day for 3 fractions, then standard treatment.
146
What are key setup steps for SVCS treatment?
* Localize tumor
* Set field borders
* Position patient supine
* Adjust SSD
* Treat
Methodologies/Oncology
flashcards
Decks in class (17)
# Cards
-
exam 1 study guide146
-
EXAM 186
-
Quizzes 2nd half45
-
Motion Management in Lung Cancer Reading Quiz26
-
RDTP 102 - Exam 2 (Lymphoma & Bone Marrow, Respiratory, and Digestive Cancers75
-
Digestive system cancers quiz14
-
Esophageal Cancer Quiz16
-
Anal Cancer Quiz30
-
Gynecologic Cancers37
-
lung cancer10
-
Prostate Article Quiz30
-
prostate cancer17
-
Genitourinary Quiz13
-
Malignant Melanoma – Quiz Flashcards25
-
FINAL EXAM STUDY GUIDE81
-
Target Volumes5
-
Pediatric Bone Tumors Quiz Flashcards25
