Washington

1
Washington Leaver Principles and Practice of
Radiation Therapy,

• Chapter 35 Digestive System Tumors

2
At what age should a person of average risk have
his or her first screening colonoscopy?

• a. 30
• b. 40
• c. 50
• d. 60

3
ANS C

• According to the American Cancer Society
  screening guidelines for the early detection of
  colorectal cancer, beginning at age 50, it is
  recommended that an average-risk person undergoes
  an annual fecal occult blood test or fecal
  immunochemical test, a flexible sigmoidoscopy and
  double contrast barium enema every 5 years, and a
  colonoscopy every 10 years.

4
A three-field technique using hinge angles of 120
degrees can be used in the treatment of which
cancer?

• a. esophageal
• b. gastric
• c. rectal
• d. hepatic

5
ANS A

• A variety of off-cord field arrangements can be
  used, depending on the location of the tumor. The
  most common field arrangements are oblique and
  lateral radiation portals. Many institutions use
  a three-field approach an anterior field and two
  posterior-wedged obliques, especially for lesions
  of the thoracic esophagus.

6
Familial adenomatous polyposis (FAP) and
hereditary nonpolyposis colorectal syndrome
(HNPCC) are most closely associated with which
type of cancer?

• a. esophageal
• b. pancreatic
• c. colorectal
• d. anal

7
ANS C

• Other principal factors in the development of
  colon cancer include the following chronic
  ulcerative colitis, carcinomas arising in
  preexisting adenomatous polyps, and the
  hereditary cancer syndromes. These syndromes are
  FAP and HNPCC.

8
Gastroesophageal reflux disease (GERD) is
associated with cancer of which anatomic region?

• a. esophagus
• b. stomach
• c. liver
• d. colon

9
ANS A

• Long-standing gastroesophageal reflux disease
  called GERD is associated with the development of
  adenocarcinomas of the distal esophagus.

10
What is the treatment of choice for most anal
cancers?I. surgery II. ChemotherapyIII.
radiation therapy

• a. I only
• b. III only
• c. I and II
• d. II and III
• e. I, II, and III

11
ANS D

• Combination radiation therapy and chemotherapy
  (5-FU and mitomycin C) is advocated as the
  preferred method of treatment and considered the
  standard of care for most patients.

12
The Whipple is a surgical procedure associated
with cancer of which organ?

• a. pancreas
• b. esophagus
• c. stomach
• d. colon

13
ANS A

• The most common potentially curative surgical
  procedure for pancreatic cancer is a
  pancreaticoduodenectomy (Whipple procedure).

14
The vermiform appendix is most closely associated
with which portion of the digestive tract?

• a. ileum
• b. cecum
• c. duodenum
• d. rectum

15
ANS B

• The vermiform appendix is a diverticulum of the
  cecum

16
What is the dose-limiting structure of most
concern for radiation treatments of colorectal
cancers?

• a. spinal cord
• b. bladder
• c. normal colon
• d. small bowel

17
ANS D

• For irradiation of the pelvis, the dose-limiting
  structure or organ-at-risk (OAR) is the small
  bowel. The small bowel dose should be less than
  45 Gy.

18
What is the dose-limiting structure of most
concern for radiation treatments of the
esophagus?

• a. normal esophagus
• b. heart
• c. spinal cord
• d. trachea

19
ANS C

• Careful dosimetry planning is necessary to avoid
  overdosing the spinal cord when treating
  esophageal cancers. AP/PA fields are used
  initially as cord tolerance is approached, an
  off-cord technique is implemented.

20
What is the most common histologic type of
cancers that occur in the lower third of the
esophagus?

1. Adenocarcinoma
2. transitional cell carcinoma
3. squamous cell carcinoma
4. renal cell carcinoma

21
ANS A

• The most common pathologic types of esophageal
  cancer are squamous cell carcinoma and
  adenocarcinoma. Squamous cell carcinomas are
  found most frequently in the upper and middle
  thoracic esophagus. Adenocarcinoma typically
  occurs in the distal esophagus and
  gastroesophageal junction however, it can occur
  in other regions of the esophagus.

22
What substance is responsible for the brown color
of feces?

1. bilirubin
2. coli
3. Pepsin
4. undigested food

23
ANS A

• An obstruction of the biliary system results in
  excess bilirubin to be excreted in urine and less
  bilirubin to enter the bowel. This results in
  patients having dark urine and light-colored
  stools.

24
Which of the following cancers is most common in
the United States?

• esophagus
• Stomach
• Liver
• Colorectal

25
ANS D

• Cancer of the colon is ranked third in incidence
  when comparing men and women separately.

26
Which of the following cancers has the highest
incidence of cancer-related deaths in the United
States?

1. Esophagus
2. stomach
3. colorectal
4. anal

27
ANS C

• Colorectal cancer is the second leading cause of
  cancer death in the United States, accounting for
  approximately 53,000 deaths annually.

28
Which of the following is not a risk factor for
anal cancer?

• a. diet
• b. human papillomavirus
• c. anal intercourse
• d. immunosuppression

29
ANS A

• The etiologic factors for the development of anal
  cancer are associated with genital warts, genital
  infections, human papillomaviruses, anal
  intercourse in men or women before age 30, and
  immunosuppression

30
Which of the following cancer sites can be
treated with endocavitary radiation therapy?

1. esophagus
2. stomach
3. rectum
4. liver

31
ANS C

• Endocavitary radiation therapy is a
  sphincter-preserving procedure done for curative
  intent in a select group of patients with low- to
  middle-third rectal cancers that are confined to
  the bowel wall.

32
Which of the following methods may reduce the
dose to the small bowel during radiation
therapy? I. supine positioning II. prone
positioning III. full bladder IV. empty bladder

• a. I and III
• b. I and IV
• c. II and III
• d. II and IV

33
ANS C

• The reduction of the small-bowel dose is achieved
  through patient positioning and positioning
  devices, bladder distention, multiple-shaped
  fields, and dosimetric weighting.

34
What condition is an iron-deficient anemia
characterized by esophageal webs, atrophic
glossitis, and spoon-shaped, brittle fingernails?

• a. Barrett esophagus
• b. Gardner syndrome
• c. Plummer-Vinson syndrome
• d. tenesmus

35
ANS C

• Plummer-Vinson syndrome (also known as
  Paterson-Kelly syndrome) is an iron-deficient
  anemia characterized by esophageal webs, atrophic
  glossitis, and spoon-shaped, brittle fingernails.

36
What condition is most closely associated to
gastroesophageal reflux?

• a. Barrett esophagus
• b. Gardner syndrome
• c. Plummer-Vinson syndrome
• d. tenesmus

37
ANS A

• Barrett esophagus is a condition in which the
  distal esophagus is lined with a columnar
  epithelium rather than a stratified squamous
  epithelium. This mucosal change usually occurs
  with gastroesophageal reflux.

38
What condition is most closely associated to
adenomatous polyposis?

• a. Barrett esophagus
• b. Gardner syndrome
• c. Plummer-Vinson syndrome
• d. tenesmus

39
ANS B

• Patients with Gardner syndrome have adenomatous
  polyposis of the large bowel and other abnormal
  growths, such as upper gastrointestinal polyps,
  periampullary tumors, lipomas, and fibromas.

40
TRUE/FALSE
41

• Men are more at risk of developing anal cancer
  than women.

42
ANS F

• Cancers of the anus occur more often in women
  than in men

43

• Most esophageal cancers are discovered in early
  stages.

44
ANS F

• Esophageal cancer is usually diagnosed at an
  advance stage and is nearly a uniformly fatal
  disease.

45

• Pancreatic cancer is highly curable with combined
  therapies.

46
ANS F

• Pancreatic cancer has a high mortality rate and
  is considered one of the deadliest malignancies.

47

• Radiation treatment portals of the lower third of
  the esophagus typically include the
  supraclavicular lymph nodes.

48
ANS F

• Regional spread to draining lymphatics is a
  common early presentation and must be taken into
  consideration in the design of the radiation
  field. The cervical, supraclavicular,
  mediastinal, and subdiaphragmatic (celiac axis)
  lymph node regions are at risk. The degree to
  which these nodal groups are at risk depends on
  the location of the primary tumor.
  Supraclavicular nodes are involved more often
  with a proximal lesion than a distal lesion.

49

• The treatment volume for colon cancers typically
  includes pelvic lymph nodes.

50
ANS T

• The treatment fields for colon cancer patients
  are typically designed to encompass the primary
  tumor volume and pelvic lymph nodes, shrinking
  the field to treat the primary target volume to a
  higher dose.