FINAL EXAM STUDY GUIDE

Question 1

Which gynecologic cancer is the most common?

Answer 1

Endometrial cancer

Tumors arise in the uterine lining and are most frequently diagnosed among the gynecologic malignancies.

Question 2

Which gynecologic cancer is the most deadly?

Answer 2

Ovarian cancer

Despite representing 25% of diagnoses, ovarian cancer accounts for 50% of gynecologic cancer deaths in the U.S.

Question 3

What is the most common histologic subtype of endometrial cancer?

Answer 3

Endometrioid adenocarcinoma

Other subtypes include clear-cell, mucinous, papillary serous, and carcinosarcoma.

Question 4

Which gynecologic cancers are the rarest?

Answer 4

Vaginal and vulvar cancers

Together they account for about 7% of gynecologic malignancies.

Question 5

Which gynecologic cancers are commonly treated with both EBRT and brachytherapy?

Answer 5

Endometrial, vaginal, and cervical cancers

These modalities are often combined for adjuvant, definitive, or palliative treatment.

Question 6

What is the role of EBRT in gynecologic cancer treatment?

Answer 6

Treats regional lymph nodes and larger tumor volumes

IMRT and 3D-CRT help reduce dose to normal tissues while targeting involved areas.

Question 7

When is brachytherapy preferred in gynecologic cancer?

Answer 7

For small, well-delineated tumors near sensitive structures

Allows high-dose localized radiation with rapid fall-off beyond the target.

Question 8

Which gynecologic cancer is treated with whole-abdomen irradiation in certain cases?

Answer 8

Advanced ovarian cancer

Total abdominal irradiation is used to treat widespread peritoneal disease.

Question 9

What radiation dose range is used for whole-abdomen irradiation in ovarian cancer?

Answer 9

30 Gy in fractions up to 170 cGy

Helps minimize toxicity to normal abdominal organs.

Question 10

What advanced RT technique is used to minimize dose to bowel, bladder, and bones in gynecologic RT?

Answer 10

IMRT (Intensity-Modulated Radiation Therapy)

Reduces toxicity in patients receiving pelvic or para-aortic fields.

Question 11

What are the three tissue layers of the uterus?

Answer 11

Endometrium, myometrium, perimetrium

These layers line the lumen, form the muscle wall, and cover the outer surface, respectively.

Question 12

What are the uterine appendages collectively called?

Answer 12

Adnexa

Includes fallopian tubes, ovaries, and supporting ligaments.

Question 13

What is the typical function of the endometrial stratum functionale?

Answer 13

It is shed during menstruation

Then regenerated by the stratum basale.

Question 14

What tissues compose the vaginal wall?

Answer 14

Mucosa, tunica muscularis, tunica adventitia

Includes epithelium, smooth muscle, and connective tissue layers.

Question 15

What is the most common histologic type of vaginal and vulvar cancers?

Answer 15

Squamous cell carcinoma

Can also include adenocarcinoma, melanoma, or sarcoma.

Question 16

How is the patient typically positioned for vulvar radiation treatment?

Answer 16

Frog-leg position

Provides optimal exposure of the perineum and vulva for accurate beam delivery.

Question 17

What is a common positioning instruction when treating the uterus or cervix with EBRT?

Answer 17

Supine with a full bladder

A full bladder displaces the small bowel out of the field and reduces toxicity.

Question 18

What area is included in extended-field radiation therapy for involved lymphatics?

Answer 18

Pelvic and para-aortic lymph nodes

Especially used when nodal involvement is suspected or confirmed.

Question 19

What is a key structure to monitor for dose during pelvic RT in gynecologic cancers?

Answer 19

Small bowel

Highly sensitive to radiation and prone to complications such as strictures.

Question 20

What imaging modality is preferred for staging endometrial cancer and determining tumor depth?

Answer 20

MR imaging

Offers superior soft-tissue resolution and myometrial invasion evaluation.

Question 21

What are the three primary male reproductive organs where cancer can develop?

Answer 21

Prostate, Testes (Testicles), Penis.

These organs are associated with different cancer types and have unique staging, spread patterns, and treatments.

Question 22

What is the anatomical location of the prostate?

Answer 22

Below the bladder, surrounding the urethra, anterior to the rectum.

This location influences setup and imaging (e.g., rectal balloons, bladder filling) during treatment.

Question 23

What is the function of the testicles?

Answer 23

To produce sperm and testosterone.

They reside in the scrotum and are very radiosensitive, requiring protective measures during RT.

Question 24

What tissue makes up most penile cancers?

Answer 24

Squamous cell epithelium.

Most penile cancers occur on the glans or foreskin.

Question 25

What are the primary lymphatic drainage sites for prostate cancer?

Answer 25

Obturator, Internal iliac, External iliac, Common iliac, Para-aortic nodes. ## Footnote Spread follows a predictable pelvic chain path.

Question 26

What is the most common treatment for early-stage prostate cancer?

Answer 26

Radiation therapy (EBRT or brachytherapy) and/or surgery (radical prostatectomy). ## Footnote Hormone therapy may be added in intermediate/high-risk cases.

Question 27

What are the two main forms of prostate brachytherapy?

Answer 27

Permanent seed implantation (LDR) and temporary HDR afterloading. ## Footnote I-125 and Pd-103 are most used isotopes.

Question 28

What is the treatment of choice for testicular cancer?

Answer 28

Orchiectomy (surgical removal of the testicle). ## Footnote Followed by surveillance, RT, or chemotherapy depending on histology and stage.

Question 29

What chemotherapy is commonly used for testicular tumors?

Answer 29

BEP regimen (Bleomycin, Etoposide, Cisplatin). ## Footnote Used in seminomas and non-seminomas with nodal/distant spread.

Question 30

What is a standard radiation setup for penile cancer?

Answer 30

Water bath or tissue-equivalent bolus to even out surface irregularities. ## Footnote Bolus ensures adequate dose to irregular surfaces.

Question 31

What is the most common site of distant metastasis for prostate cancer?

Answer 31

Bone. ## Footnote Detected via bone scan, often in spine, pelvis, and ribs.

Question 32

What is the most common site of distant metastasis for testicular cancer?

Answer 32

Lung. ## Footnote Testicular germ cell tumors frequently metastasize to lungs.

Question 33

What is the most common site of distant metastasis for penile cancer?

Answer 33

Lung and liver. ## Footnote Spread is hematogenous after regional lymph nodes are involved.

Question 34

What is the typical total dose for prostate cancer with EBRT?

Answer 34

7560–8100 cGy in 180–200 cGy/fx. ## Footnote Higher doses improve biochemical control in intermediate/high-risk patients.

Question 35

What is the dose for prophylactic treatment of testicular cancer post-orchiectomy?

Answer 35

2500 cGy in 160 cGy fractions. ## Footnote For stage I seminoma to the para-aortic field.

Question 36

What is the total dose for penile cancer treated with radiation?

Answer 36

Around 6000–7000 cGy. ## Footnote Usually delivered with bolus/water bath or interstitial implants.

Question 37

What is the standard dose to the whole bladder in bladder cancer?

Answer 37

4500–5000 cGy. ## Footnote If included as part of pelvis RT or incidental irradiation.

Question 38

What patient position is commonly used for prostate RT?

Answer 38

Supine with full bladder and empty rectum. ## Footnote Minimizes rectal dose and stabilizes prostate position.

Question 39

What fields are typically used in conventional prostate radiation therapy?

Answer 39

4-field box (AP, PA, and laterals) or IMRT/VMAT. ## Footnote IMRT/VMAT improves conformality and spares rectum/bladder.

Question 40

What nodes are included in RT for right-sided testicular cancer?

Answer 40

Para-aortic ± ipsilateral iliac nodes. ## Footnote Infradiaphragmatic nodes; not usually SCV unless extensive disease.

Question 41

How is the penis positioned during RT?

Answer 41

Extended away from the body, often submerged in a water bath. ## Footnote Ensures homogenous dose and avoids hotspots on curved surfaces.

Question 42

Why is a water bath used for penile RT?

Answer 42

To compensate for irregular surface and improve dose uniformity. ## Footnote Acts as tissue-equivalent material.

Question 43

What is overdiagnosis in prostate cancer screening?

Answer 43

Detection of cancers that would not cause symptoms or death. ## Footnote Often a consequence of PSA testing.

Question 44

What are the two main screening tools for prostate cancer?

Answer 44

PSA test and digital rectal exam (DRE). ## Footnote Used together for improved detection rates.

Question 45

What lymph node is not commonly treated prophylactically for testicular cancer?

Answer 45

Supraclavicular nodes. ## Footnote Not part of routine nodal field unless widespread disease.

Question 46

What ethnic group in the U.S. has the highest incidence and mortality of prostate cancer?

Answer 46

African Americans. ## Footnote Incidence is ~60% higher, mortality twice as high.

Question 47

What brachytherapy isotope delivers dose fastest?

Answer 47

Cesium-131 (half-life ~9.7 days). ## Footnote Good for aggressive tumors due to rapid dose delivery.

Question 48

What is the most common histology for testicular cancer?

Answer 48

Germ cell tumors (seminoma or non-seminoma). ## Footnote Seminoma is more radiosensitive.

Question 49

What surgery is performed to treat prostate cancer?

Answer 49

Radical prostatectomy. ## Footnote Removes prostate, seminal vesicles, and sometimes pelvic lymph nodes.

Question 50

What is the Gleason score used for?

Answer 50

Grading the aggressiveness of prostate cancer. ## Footnote Ranges from 6 (low-grade) to 10 (high-grade).

Question 51

What is the most common site for urinary cancer?

Answer 51

Bladder

Question 52

What is the most common histological type of urinary tract cancer?

Answer 52

Transitional cell carcinoma (urothelial carcinoma)

Question 53

What is the function of the urinary system?

Answer 53

To remove waste and excess fluids through urine production.

Question 54

Which organs make up the urinary system?

Answer 54

Kidneys, ureters, bladder, and urethra

Question 55

What is the most common treatment for localized bladder cancer?

Answer 55

Transurethral resection (TURBT) followed by intravesical therapy

Question 56

What treatment is used for muscle-invasive bladder cancer?

Answer 56

Radical cystectomy with or without chemotherapy and/or radiation therapy

Question 57

What is the primary surgery for kidney cancer?

Answer 57

Radical or partial nephrectomy

Question 58

What is the role of radiation therapy in urinary tract cancers?

Answer 58

Used as adjuvant, palliative, or bladder-sparing therapy

Question 59

What imaging method is commonly used for urinary tract cancers?

Answer 59

CT with contrast

Question 60

What is a common contrast agent used in urinary imaging?

Answer 60

Iodinated contrast media

Question 61

What mild reactions can occur from contrast media?

Answer 61

Nausea, flushing, warmth, headache, mild urticaria (hives)

Question 62

What are serious allergic reactions to contrast media?

Answer 62

Anaphylaxis, severe bronchospasm, hypotension, cardiac arrest

Question 63

How are allergic reactions to contrast media managed?

Answer 63

Immediate cessation, administration of antihistamines, epinephrine, and supportive care

Question 64

What is the standard patient position for bladder radiation therapy?

Answer 64

Supine with immobilization, bladder comfortably full

Question 65

What is the typical field arrangement for bladder cancer RT?

Answer 65

4-field box (AP, PA, laterals) or IMRT

Question 66

What organs must be protected during bladder radiation therapy?

Answer 66

Small bowel, rectum, femoral heads

Question 67

What nodes may be included in bladder cancer treatment fields?

Answer 67

Internal iliac, external iliac, obturator, and presacral nodes

Question 68

Why is a full bladder often requested during pelvic radiation?

Answer 68

To displace small bowel and reduce exposure

Question 69

What is the benefit of IMRT in urinary tract cancer treatment?

Answer 69

Improved conformality and sparing of healthy tissues

Question 70

What is intravesical therapy?

Answer 70

Bladder instillation of drugs directly, such as BCG or mitomycin

Question 71

What are the critical structures and their TD 5/5 values in prostate cancer treatment?

Answer 71

Rectum: 6000 cGy — risk of proctitis and bleeding if exceeded. Bladder: 6500 cGy — limits are to avoid cystitis and contracture. Femoral heads: 5200 cGy — necrosis risk; avoid hotspots in lateral fields. Small bowel (if in field): 4500 cGy — limits enteritis and perforation. ## Footnote Footnote: Supine positioning with full bladder helps spare bowel and reduce rectal dose.

Question 72

What are the critical structures and their TD 5/5 values in bladder cancer treatment?A:

Answer 72

Small bowel: 4500 cGy — highly sensitive; displacement preferred. Rectum: 6000 cGy — must be contoured and spared in posterior fields. Bladder: 6500 cGy — whole bladder is often irradiated, watch for contracture. Femoral heads: 5200 cGy — lateral fields can exceed tolerance if not blocked. ## Footnote Footnote: Full bladder and IMRT preferred to minimize small bowel exposure.

Question 73

What are the critical structures and their TD 5/5 values in testicular cancer treatment?

Answer 73

Spinal cord: 4500 cGy — included in para-aortic fields. Kidneys (whole): 2300 cGy — dose limited to preserve function, ideally <1800 cGy to one kidney. Contralateral testicle: ~100 cGy — shielded due to extreme radiosensitivity. ## Footnote Footnote: Use of testicular shields and careful kidney blocking is essential in seminoma fields.

Question 74

What are the critical structures and their TD 5/5 values in penile cancer treatment?

Answer 74

Skin and subcutaneous tissue: 5500–6000 cGy — avoid necrosis and ulceration. Femoral heads (if inguinal nodes are included): 5200 cGy — lateral scatter management required. Scrotum/Testes (if not removed): ~100 cGy — avoid due to fertility risk. ## Footnote Footnote: A water bath provides dose homogeneity and tissue equivalence to even surface dose.

Question 75

What are the critical structures and their TD 5/5 values in rectal cancer treatment?

Answer 75

Small bowel: 4500 cGy — displacement critical to reduce enteritis. Bladder: 6500 cGy — anterior proximity requires careful planning. Femoral heads: 5200 cGy — block or avoid during lateral beams. Anal canal (if treated): ~6000 cGy — high-dose region can lead to pain or incontinence. ## Footnote Footnote: Belly board, prone positioning, or IMRT helps reduce small bowel dose.

Question 76

What are the critical structures and their TD 5/5 values in kidney cancer (if treated with RT)?

Answer 76

Liver (whole): 3000 cGy — hepatic function can decline with overdose. Contralateral kidney: 1800–2300 cGy — must be spared to avoid renal failure. Small bowel: 4500 cGy — affected in abdominal field overlap. Spinal cord: 4500 cGy — in para-aortic or flank fields. ## Footnote Footnote: RT is used rarely, usually for palliation or non-surgical candidates.

Question 77

What are the TD 5/5s and critical structures to monitor when treating endometrial cancer?

Answer 77

Bladder: 6500 cGy Rectum: 6000 cGy Small bowel: 4000–4500 cGy Femoral heads: 5200 cGy Ovaries (if preserved): Highly radiosensitive; dose depends on age/fertility preservation Vaginal cuff: Often included in field, with attention to mucosal toxicity ## Footnote Endometrial cancer treatment often includes EBRT to pelvis ± brachytherapy, so bladder, bowel, and vaginal mucosa are priority OARs.

Question 78

What are the TD 5/5s and critical structures for cervical cancer radiation therapy?

Answer 78

Rectum: 6000 cGy Bladder: 6500 cGy Small bowel: 4500 cGy Femoral heads: 5200 cGy Ovaries (if not surgically removed): Functional loss occurs at doses as low as 200–300 cGy Spinal cord (if para-aortic fields): 4700 cGy ## Footnote Both EBRT and brachytherapy are used. Point A dose often reaches >8000 cGy. Bowel and rectum are limiting for brachy boost.

Question 79

What are the TD 5/5s and critical structures to consider for ovarian cancer?

Answer 79

Liver (whole): 3000–3200 cGy Kidneys (1/3 of each): 2300 cGy Small bowel: 4000–4500 cGy Stomach: 5000 cGy Spinal cord (if para-aortic coverage): 4700 cGy ## Footnote Whole abdomen RT historically used (30 Gy in 170 cGy/fx). Modern practice may target pelvic/para-aortic nodes. Kidney sparing is critical.

Question 80

What are the TD 5/5s and critical structures in vaginal cancer treatment?

Answer 80

Bladder: 6500 cGy Rectum: 6000 cGy Small bowel: 4500 cGy Vagina: Mucosal tolerance becomes limiting for high brachytherapy doses Femoral heads: 5200 cGy ## Footnote MRI used to stage depth of invasion. Advanced disease often includes EBRT + brachytherapy with inguinal or pelvic node irradiation.

Question 81

What are the TD 5/5s and key organs at risk for vulvar cancer?

Answer 81

Skin (perineum): ~5000–5500 cGy (erythema and moist desquamation occur earlier) Bladder: 6500 cGy Rectum: 6000 cGy Femoral heads/necks: 5200 cGy Small bowel: 4500 cGy ## Footnote Field may include bilateral inguinal and pelvic nodes. Bolus used for skin surface dose, increasing skin toxicity risk.