Chapter 30 WS

Question 1

What are the three most significant variables that affect prognosis for patients with lung cancers of the respiratory system?

Answer 1

1) Stage or extent of the disease
2) clinical performance status as measured with the Karnofsky performance scale,
3) weight loss, especially greater than 5% of the total body weight over 3 months.

Question 2

Mesothelioma is associated with exposure to what carcinogen.

Answer 2

asbestos

Question 3

How long is the latent period between exposure and the development of mesothelioma?

Answer 3

20-40 years

Question 4

what is the carina and radiographically at what vertebral level is it located?

Answer 4

bifurcation of the trachea

T4/5

Question 5

Where do oxygen and carbon dioxide exchanges take place?

Answer 5

Aveoli and capillaries

Question 6

What is the area of the lung called where the blood, lymphatic vessels, and nerves enter and exit the lungs?

Answer 6

hilum

Question 7

What is the significance of the carina and hilum with regards to distant spread?

Answer 7

This is where tumor cells gain access to the circulatory system.

Question 8

What is the mediastinum and what structures/organs are located in it?

Answer 8

The anatomy between the lungs and contains the:

• heart,
• thymus,
• large vessels,
• trachea,
• esophagus,
• lymph nodes and
• other structures.

Question 9

List three of the earliest symptoms of lung cancer?

Answer 9

Weight loss, cough, hemoptysis (coughing up blood)

Question 10

Describe three criteria related to an individual’s tobacco exposure that appear to increase the risk of development of lung cancer.

Answer 10

1) An increase duration of smoking
2) An increased use of unfiltered cigarettes
3) an increased number of cigarettes consumed

Question 11

What is superior vena cava syndrome and what are some of the signs?

Answer 11

Symptoms/signs due to the compression of the superior vena cava (can be caused by lesions in the right lob that extend into the mediastinum)

Signs include: dyspnea; facial, neck and arm edema; orthopnea; cyanosis.

Question 12

List the criteria for a tumor to be considered a Pancoast tumor.

Answer 12

• Resides in superior sulcus with the following clinical presentation
• Pain around the shoulder and down the arm
• Atrophy of the hand muscles
• Horner syndrome
• Bone erosion of the ribs and sometimes the vertebrae

Question 13

What are the manifestations of Horner Syndrome?

Answer 13

• Ipsilateral miosis (contracted pupil),
• ptosis (drooping eyelid),
• enophthalmos(recession of the eyeball into the orbit), and
• anhidrosis (loss of facial sweating).

Question 14

What is hypertrophic pulmonary osteoarthropathy and how does it manifest?

Answer 14

A frequently seen phenomenon associated with lung cancer.

Manifests by clubbing of the distal phalanges of the fingers.

Question 15

What is a thoracentesis?

Answer 15

A surgical procedure in which a needle is inserted into the pleural space to remove excess fluid.

Also called a pleurocentesis

Question 16

Prior to planning treatment, a CT scan of the brain is usually done for which two types of lung cancer.?

Answer 16

Small cell lung cancer and adenocarcinomas.

Also undifferentiated carcinomas

Question 17

What is the most common pathological type of lung cancer in the U.S.?

Answer 17

Adenocarcinoma

Question 18

Where in the lung do Squamous cell carcinomas most commonly arise?

Answer 18

Centrally in the proximal bronchi

Question 19

Where in the lung do Adenocarcinomas most commonly arise?

Answer 19

Peripherally

Question 20

List three patterns of spread for lung cancer.

Answer 20

Direct, Lymphatic, & hematogenous

Question 21

Name the two groups of lymphatics that are primarily responsible for the regional spread of bronchogenic carcinoma.

Answer 21

Mediastinal and intrapulmonic

Question 22

Lymph is drained from the left side of the body into the _________________ before entering the circulatory system via the __________________.

Answer 22

thoracic duct

left subclavian vein

Question 23

Lymph is drained from the right side of the body into the __________ before entering the circulatory system via the ___________

Answer 23

right lymphatic duct

right subclavian vein

Question 24

Where do lung cancers most commonly metastasize to? (7)

Answer 24

• Cervical lymph nodes,
• liver,
• brain,
• bones,
• adrenal glands,
• kidneys, and
• contralateral lung

Question 25

How do tumors spread from one lung to the other?

Answer 25

Cells break away from the tumor and move to the area of the carina. Pressure changes as a result of respiration or gravity may transport the cell into the other hilum and then eventually into a resting place in the other lung

Question 26

List 4 critical structures that are of primary concern when treating lung cancer and list complications of each if tolerances are exceeded.

Answer 26

• Spinal cord: myelopathy
• Esophagus: Difficulty swallowing
• Heart: pericarditis (constrictive form due to scar formation resulting in restriction of cardiac motion, rather than fluid buildup type)
• Health lung; radiation pneumonitis (1-3 months after radiation) and fibrosis (2-4 months after radiation)

Question 27

Describe what boost fields are.

Answer 27

Smaller field sizes used to deliver a high dose to a smaller volume. Generally delivered to the GTV only, excluding lymph nodes

Question 28

List two reasons it is important to know the depth of the spinal cord in the treatment of lung cancers.

Answer 28

Tumorcidal doses exceed tolerance dose of the spinal cord. Because the depth of the spinal cord varies along the vertebral column, the dose calculated to one point on the spinal cord is not the same for other points.

Question 29

How are patients arms usually positioned during treatment for lung cancer?

Answer 29

above the head

Question 30

What dose is used for conventional fractionation?

Answer 30

180 – 200 cGy one a day

Question 31

List some signs that radiation therapists should be aware of that might indicated the patient’s lung cancer has spread to the brain?

Answer 31

Headaches, changes in personality, and visual changes shaded box on

Question 32

List some signs that radiation therapists should be aware of that might indicated the patient’s lung cancer has spread to the spinal column or cord.

Answer 32

Neck or back pain, incontinence, leg or motor weaknesses, changes in gait, or unusual difficulty in getting on and off the treatment table. shaded box on

Question 33

List some signs that radiation therapists should be aware of that might indicate the patient has developed pleural or pericardial effusion.

Answer 33

Dyspnea, chest pain, changes in cough, or fever shaded box on