GI (anal, pancreas, liver) Flashcards
(148 cards)
1
Q
which of he following nodal areas wouldn't be included in T3N1 rectal cancer? A: pre sacral B: in IL C: Ext IL d: MESORECTUM
A
C
2
Q
for T2N1 gastric cancer which of the following regions may be excluded from RT tx fields A: gastric remnant B: splenic hilum LN C: celiac axis D: porta E: pancreatic duodenal nodes
A
E
3
Q
Many LN areas are treated in both rectum and anal cancer except which of the following: A: ING B: MESORECTUM] C: EXT IL D: Presacral
A
A
4
Q
which of the following are appropriate tx for adjuvant Tx for pancreatic cancer? A: Adjuvant cx B: adjuvant chemoradiation C: clinical trial D: all of the above
A
D
5
Q
OARS for anal cancer
A
fem heads, bladder, genitals, sm bowel, lg bowel and iliac crests
6
Q
bladder dose constraint
A
<50% 35 gy
7
Q
genitals dose constraint
A
<50% 30Gy
8
Q
iliac crests constrraint
A
<50% 40 Gy
9
Q
pt tx setup anal
A
supine with legs in foreleg position with patient with full bladder
Pt gets IV and oral contrast
10
Q
Target volumes in anal cancer
A
GTV= tumour + LN
CTV= GTV +2-2.5cm
CTV ln= GTV+1.5cm
PTV= CTV + .7-1CM
11
Q
what LN areas are at risk for anal cancer
A
mesorectum, pre sacral, int and ext IL & ING LN
12
Q
anal XRT dose chemo+XRT vs XRT alone
A
45-50.4/25-28 for chemorads
60-65/33-35 XRT alone
13
Q
boost plan doses in anal cancer
A
PTV=50.4-54GY for T1-2 PTV=54-59GY for T3-4 PTV LN PTV ln >3 cm 54-59.4GY PTV <3 cm 50.4-54Gy
14
Q
most common anal presentation
A
bleeding and anal discomfort
15
Q
proximal anal tumours present with ____ symptoms
A
obstructive
16
Q
small anal tumours have what type of appearance
A
nodular plaque like tumour
17
Q
large anal tumurs havre what type of appearance
A
ulcerated and infiltrative
18
Q
IS ANAL CANCEL COMMON OR UNCOMMON
A
V UNCOMMON
2% of all GI cancers- 600 dx/ yr
19
Q
age for anal cancer
A
50-70 yo
20
Q
is ana and perianal l cancer mor common in men o women
A
anal is more common in women
perianal area is same in m and w
21
Q
factors that + risk of anal cancer
A
HPV, HIV, chlamidya, anal sex, smoking
22
Q
how long is the anal canal
A
3-4cm
23
Q
what is the tim for where the squamous cells turn into the columnar cells in the anal canal
A
the dentate / pectinate line
24
Q
lymphatics above dentate line
A
perirectal, int Il & lat sacral LN
25
lymphatics below dentate line
ING LN
26
LN spreads _____ in anal cancer
early
27
what LN spread is most common and second most common in anal cancer
perirectal then ING LN
28
is anal canal or anal margin more common
85% anal canal
| 15% anal margin
29
how many ptr present with distant mets anal cancer
10% have distant mets at dx
30
what % pelvic LN and iNG LN are + at dx in anal cancer
pelvic 30%
| ing 15-35%
31
sites of distant mets in anal cancer
liver and lungs
32
APR for anal cancer
used for very early cancer or for salvage treatment
33
treatment for anal cancr
typically chemorads - surgery for salvage treatment
| chemo 5FU +MMC (mitomycin C) on week 1-4 of XRT which is 45-50.4Gy
34
most common SE of anal cancer
SCC- 80%
35
what subtypes of anal cancer occur most commonly near dentate line
basaxoid snd callogenic sybtypes
36
what subtype of anal cancer has worse prognosis
basaloid - it is located near dentate lin
37
SCC anal cancer is usually proceeded by
AIN
38
What blood level is a prognostic indicator for anal cancer
hemoglobin levels
39
what blood levels can be used in diagnosing liver cancer
serum alpha fetaprotein`
40
in early stages what are the symptoms of liver cancerq
they are asymptomatic
41
later stage liver cancer S&S
abdominal pain, N&V, wt loss, Diahrrea, weakness welling of limbs , hepatic encepalopATHY
42
Hepatic ncepalopathy S&S
breath with sweet musty doors
confusion, forgetfulness
coma, shaking '
nervousness, anxiety, personality/ mood changes
43
where is abode pain most common in liver cancer
upper right quadrant
44
what countries is HCC most common in
asia and africa
45
age for HCC
40-60 in developed countries and 20-40 yo in developing countries
46
is the incidence of HCC +/-
its increasing due to hepatitis C , B and HIV
47
Hepatitis C is associated with ____ disease
ulticenteric
48
chirosiss of the liver and the development of cancer
1-4%/year risk of HCC diagnosis
49
western world HCC is most commonly associated with
Hepatitis C
50
Is liver cancer more common in Mor W
2-3 X more common in M than women
51
what causes cholangiocarcinoma
UC, liver flukes, exposure to thrum dioxide
52
gallbladder cancer occurs in what ages
50-70
53
what is required to cure gallbladder cancer
surgical
54
how many lobes of the liver
4
55
what are th lobes of the liver
rt and lt and caudate and quadrate lobes
56
what is the falciform ligament
demarcates the lt and rt lobes of he liver
57
most of the blood in the liver comes from where?
portal vein
58
function of the liver
- makes bile
- filters substances from blood
- stores vitamins & releases them as needed
- metabolized carbohydrates
59
what LN are most commonly involved in Liver cancer
hilar and portal Ln
60
what are areas of distant mets in liver cancer
bone skin, brain and lung
61
what is child push score
is a prognostic indicator used for liver cancer and takes into consideration:
-ascities, bilirubina Lvl, albumin lvl, photothrombotin time hepatic encephalopathy
62
typical treatment for liver cancer
surgery (however not typically possible) then chenorads (21/7) with doxorubicin +5 FU every other day
63
what liver treatment gives the best outcomes
liver transplant/ resection
64
liver resection indications
small tumours with preserved liver function with no chirrosis and a childs put score of A
65
Liver transplant indications
its with chirossis, single HCC <5cm in 1 nodule or3 nodules <3cm
66
percutaneous ablative procedures list
ethanol injection, RFA, TACE
67
Ethanol injection indications
small tumours with preserved liver function <5cm several injections are required
68
RFA proceeder
high frequency radio waves are given to tumour by sticking thin needle like probe into the tumour is best for tumour <4 cm not good if its close to the GI mucosa, diaphragm, large vessels
69
TACE
transarterial chemoembolization lipid is injected in liver cancer through the blood supply of liver with or without chemo agents: 5FU, cisplatin, doxorubicin, mitomycin C and epirubicin used for palliation and unresectable tumours
70
HCC is radio ______.
sensitive
71
what liver cancer is most common in children
hepatoblastoma
72
what is the most common live tumour type
HCC (hepatocelular carcinoma)
73
what are HCC subtyps
HCC conventional and HCC fibrolamellar variant
74
What HCC has the best prognosis
HCC FIBROLAMELAR Variant has best prognosis
75
what SE for liver cancer
N&V, fever and pancytopenia (n.b. pancytopenia is - in all blood levels platelets, WBC, RBC)
76
What is the only curative treatment for biliary and gallbladder cancer
surgery
77
how often is biliary gallbladder cancer unresectable? why?
60-80% of cases due to comorbidities, nets, vascular involvement etc.
78
main cancer of the bile ducts is called
cholangiocarcinoma
79
lN dos commonly involved in cholangiocarcinoma
pericholedochal, peripancreatic, hilar
80
distant mets in cholangiocarcinoma
to liver and peritoneum
81
which cholangiocarcinoma is moreresectable
distal is more resectable than perihilar
82
gallbladder cancer usually presents at ____ stage
advanced
83
therapies for resectable vs unresectable cholangiocarcinoma
if resectable pt will get surgery followed by chemorads
| for unresectable pt may be radiation alone +/- Cx
84
tx plan for biliary duct cancer
3-4 field arrangement
| AP and lats or AP.PA and lats
85
most common S&S of gallbladder ca
pain then anorexia and N&V
86
pts with intrahepatic cholangiocarcinoma presentation
jaundice and abdominal S&S
87
What levels may be elevated in liver cancer and cholangiocarcinoma
CA19-9 >100U/ml
88
how common is cholangiocarcinoma
155 of all liver cancers
89
gallbladder cancer gender
more common in women 2.5:1`
90
cholangiocarcinoma risk factors western vs eastern countries
in general the risk factors are similar to that of liver cancer
western countries: IBD, hepatitis C and UC
Easton countriesL chronic infections of the biliary tract and liver flukes
91
gallbladder cancer causes
porcelain galbladder, obesity, smoking and alcohol and its with polyps >10mm
92
cholangiocarcinoma LN drainage
hepatoduodenal ligament ->paraaortic nodes -> retropancreatic nodes
93
tagret volume cholangiocarcinoma
GTV tumour made visible by the CT
CTV =GTV+1.5cm expansion
PTV=CTV +.5cm- 1cm margin
94
Dose cholangiocarcinoma
45-50
95
most common hepatobiliary tract tumour
gallbladder in 2.3 of cases the remaining 1/3 is the bile duct
96
most bile duct tumours are what pathology
adenocarcinoma
97
subtypes of adenocarcinoma in bile duct cancers
- sclerosing (most common)
| - nodular and papillary
98
what adenocarcinoma subtype is the best prognosis for biliary tumours
papillary
99
what adenocarcinoma subtype is the worst prognosis for biliary cancers
nodular
100
pt positioning for pancreas
supine with arms above head
101
liver constrain for pancreas tx
70% liver <30Gy
102
field borders for pancreas
Superior: T11 but may extend more superiorly with body lesions to obtain an adequate margin on the primary lesion
Anterior: 1.5-2 cm beyond gross disease
Posterior: 1.5 cm behind the anterior portion of the vertebral body
103
LN included in tx of the pancreatic head
pancreaticoduodenal, porta hepatis, celiac and superior mesenteric
104
tx fields for pancreatic head
The entire duodenal loop + margin is included
Sup: T11
Inf: L2-L3
Lats: 1.5-2 cm beyond gross disease
The dose to the lats is limited to 15-18Gy as the kidney is in the lat fields
105
IMRT for resectable pancreatic cancer
45 Gy in 1.8 Gy/fraction followed by a 5.4 GY in 1.8 Gy/fraction boost to the tumour bed with a 2 cm margin
106
IMRT of unresectable pancreatic cancer
Treat gross tumour with a smaller 1 cm margin to 54-59.4 GY in 1.8 Gy/fraction
107
most common presentation of pancreatic cancer
Most common: jaundice, abdominal pain, anorexia , weight loss
108
pancreatic cancer usually presents ____
late
109
urine/ stool presentation on pancreatic cancer what does this indicate?
Dark urine, light stool system resulting in excess bilurubin to excrete in the urine and less bilrubin to be excreted in the stools
Indicates obstruction of the bilary
110
what part of the pancreas is most likely to get tumours
head and neck is more common than body and tail of the pancreas
111
tumours of the body and tail of the pancreas typically has wha presentation
back pain and weight loss
112
tumour of the head and neck of the pancreas s&s
jaundice by invading or compressing the bile duct , they also are associated with steatorrhea, weight loss and pain
113
what other s&s are accompanied by jaundice
itching and pruritis
114
what imaging is the best in the diagnosis of pancreatic cancer
CT is the best
115
what blood test can detect pancreatic csncer
CA-19-9 but it is not used in diagnosis as it is also elevated in other GI cancers, ovarian cancer
116
what is an elevated ca19-9 level
>37 ml
117
ethnicity of pancreatic cancer
more common in blacks than whites
118
age pancreatic cancer
50-80 yo
119
what mutations is pancreatic cancer associated with
BRCA1-2
120
What other cancers diagnoses are associated with + risk of pancreatic cancer
breast and colorectal
121
what dietary/ lifestyle factors are associated with pancreatic cancer
smoking, obesity type 2 diabetes + fat and red meat intake
122
what syndromes are pancreatic cancer associated with
FAP, Lynch syndrome, Peutz-Jeghers syndrome, Li fraumeni and helicobacter pylori infections
123
LN drainage of the head of the pancreas
pancreaticduodenal, porta hepatic, celiac and superior mesnteric
124
Body and tail of the pancreas LN drainage
splenic artery, inferior pancreatic, celiac, superior mesenteric and para-aortic nodal basins
125
t level of the pancreas
between the L1-L2 levels
126
pancreas divisions
head tail, body and neck
127
lt side of pancreas drains to what LN
splenic hilar LN
128
RT side of the pancreas drains o what
post and ant pancreatic duodenal LN and RT par aortic Ln
129
pancreatic head and body and neck spread to ____ and the tail spreads o____
head body and neck spread to to duodenum and the tail spreads to the spleen
130
what stage is pancreatic cancer usually diagnosed at
metastatic disease
131
what prt of the pancreas most commonly has metastatic disease
body and tai more commonly has mets than the head and neck
132
most common sites of distant mets for pancreatic cancer
liver, peritoneum, lungs and bone
133
COD for pancreatic cancer
result of hepatic failure, secondary to biliary obstruction
134
median survival resectable vs unrsectable pancreatic tumours vs metastatic
resectable: 13-20 months
unresectable: 8-14 months
mets: 4-6 months
135
what tumour is whipple procedure used to treat
pancreatic head and sometimes gallbladder cancer
136
whipple procedure description
The removal of the head of the pancreas, duodenum, proximal jejunum (first 15 cm), gallbladder and part of the (distal) stomach and common bile duct, the rest of the pancreas, dil ducts and stomach is reanamastosed
137
what surgery is used for head of pancreas? tail?
head is whipple procedure
| tail is distal pancreatectomy with splenectomy
138
main pathology of pancreatic cancer
adenocarcinoma
139
side effects of XRT for pancreatic cancer
Most common is nausea and vomiting ( antiemetics may be given)
Less common side effects are leukopenia ( low white blood cell count), thrombocytopenia (low thrombocytes), diarrhea and stomatitis
140
typical dose for pancreatic XRT
50.4 with field eduction after 45Gy
141
a portion of the 4 field treatment of the pancreas has a limited dose? why ? what dose is it limited to?
the lats have a maximum dose contribution of 20Gy in order to avoid over dosing the kidneys which would be treated in the lat fields
142
functions of the pancreas
an exocrine function that helps in digestion and an endocrine function that regulates blood sugar.
143
function of the biliary ducts
To drain waste products from the liver into the duodenum. To help in digestion with the controlled release of bile.
144
function of the galbladder
Its primary function is to store and concentrate bile(which breaks down the fat in food)
145
XRT for locally advanced pancreatic tumours
LN are no included and it is limited to the tumour itself
146
typical treatment for pancreatic cancer
resection if possible followed by adjuvant chemorads 50.4/28 with concurrent 5FU+ gemacatabine
147
what chemo agents are used for pancreatic cancer
5FU + gemcetabine
148
IORT for radiation therapy
Used to target tumour bed and is accomplished by isodose of 10-20Gy intraoperative electrons as a boost following 50.4Gy delivered with external beam radiation therapy its advantage is to deliver more dose to the primary because of all the dose limiting structures which are shielded in IORT
