Ch. 29 Endo cancer

What are the four categories of thyroid cancer?

1. papillary 2. follicular 3. medullary 4. anaplastic

Are pituitary tumors normally benign or malignant?

almost always benign

Clinical presentation of Thyroid cancer?

most have a palpable neck mass

What is dopamine used for?

prolacinomas, GH secreting tumors

What hormones does the anterior part of the pituitary gland secrete?

prolactin (PRL) adrenocorticotropic hormone (ACTH) follicle-stimulating hormone (FSH) lutenizing hormone (LH) growth hormone (GH) and thyroid stimulating hormone (TSH)

how is the patient positioned for 3 field or parallel opposed fields?

supine with neutral head position protect the lens of eye

Can arcs be administered in noncoplanar arrangements?

yes and will require couch kicks

Are neoplasms of the adrenal cortex rare?

yes only account for .04% of all cancers

Are permanent interstital implants used?

yes, Y^90 dose range 500 to 1000 cGy, but rarely used in the US

Is proton therapy a good option for pituitary tumors?

yes, because of short range and Bragg's pean in the thin area of the body

8. In which gland is prolactin (PRL) produced? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: B PRL is secreted by the pituitary; PRL-secreting tumors represent 65% of all functioning pituitary adenomas.

25. What is the most common form of thyroid cancer? a. follicular b. papillary c. medullary d. lymphoma

ANS: B Papillary and mixed papillary-follicular cancers are the most common types of thyroid cancer, representing 33% to 73% of all malignant thyroid lesions. REF: Chapter 31, Endocrine System Tumors, p. 647

26. What is the most common form of thyroid cancer seen in irradiated individuals? a. follicular b. papillary c. medullary d. lymphoma

ANS: B Papillary carcinoma is the type most frequently seen in irradiated individuals. These tumors are slow growing, are nonaggressive, and have an excellent prognosis. REF: Chapter 31, Endocrine System Tumors, p. 647

Who normally gets thyroid cancer, M or F?

Females have higher risk of thyroid cancers

Which of the following does not belong in this group a. medulla b. cortex c. follicular d. mineralocorticoids, glucocorticoids

c. follicular

The pituitary tumors that remain within the pituitary are a. intrasellar b. diffuse c. intrahypophyseal d. invasive

c. intrahypophyseal

The anatomic structure located just superiorly to the pituitary gland is? a. sphenoid sinus b. maillary sinus c. optic chiasm d. occipital lobe of the brain

c. optic chiasm

How are pituitary cancers staged?

classified by location: suprasellar, parasellar and infrasellar

which of the following is an indication for the use of radioactive iodine? a. inoperable primary tumor b. thyroid capsular invasion c. distant mets d. all the above

d. all the above

Proton beams are sometimes used in the treatment of ___ tumors a. breast b. thyroid c. adrenal gland d. pituitary

d. pituitary

What are side effects of pituitary RT?

edema, skin reddening and hair loss

Are low or high energy x-rays used?

external beam, standard fraction with low energy x-rays

Etiology of Thyroid cancer

external radiation to the gland is the only well documented etiologic factor

What is the treatment for pituitary tumors?

have to treat hormonal imbalance and reduce size of growth

What other symptoms might occur from pressure on nerves and orbit compartment?

headache visual disturbances cranial nerve III, IV, V, VI palsy hydrocephalus seizures

What are pituitary cancers now classified by?

hormone function or non-functioning such as: GH producing ACTH producing TSH producing

What is the Hardy's classification?

indicates location and tumor size and grade

What is the latent (time) period between exposure and incidence of abnormalities?

it varies with age. the average latent period in infants is 11 years in adolescents its 15 to 30 years

How is patient positioned for 3 field or rotational arc

may be prone with chin hyperextended

Epidemiology of thyroid cancer

most common of endocrine cancers but represent only 2% of all cancers

Is staging used in radiation oncology for pituitary cancers?

no

Does the pituitary gland have lymph node spread?

no lymph drainage regional spread only

What are the most common types of thyroid cancer?

papillary and mixed papillary-follicular

What are the principal organs of the endocrine system?

pituitary, thyroid and adrenal also the parathyroid gland and the specialized cells in the pancreas called the islets of Langerhans

What can RT be used for?

postoperative treatment after subtotal removal, recurrent disease, or when surgery not possible

The production of hormones by the thyroid rely on the ability of the thyroid to?

remove iodine from the blood

What are the doses for SRS? sterotactic radiosurgery

single fraction dose need to limit dose to optic chiasm to 8 to 10 Gy 12 to 35 Gy using SRS; lower doses for nonfunctioning tumors and higher doses for functioning tumors

What are the RT borders?

small because no lymph drainage usually 6x6 cm field size surface landmarks are just inferior to the glabella at midline; 2.0 cm anterior and 2cm superior to the external auditory meatus

What other RT can be used?

stereotactic radiosurgery with single dose x-rays or gamma knife

How is the patient positioned for rotational arcs

supine with max chin flexion for rotational arcs through the coronal plane or 3 field vertex and laterals

What can be done for small tumors as either resection or biopsy?

surgery using a transsphenoidal approach

What are signs and symptoms of pituitary/hypophysis tumors?

symptoms are influenced by the part of gland affected

The posterior of the pituitary gland releases?

vasopressin/anti-diuretic hormone (ADH) and oxytocin

What are some of the signs and symptoms of pituitary gland cancer?

weight changes excess hormone levels uncontrolled diabetes hyperparathyroidism multigland hyperplasia amenorrhea short stature syndromes

What are treatment techniques for thyroid cancer?

Surgery Radioactive Iodine Thyroid hormonal therapy External beam radiation

Of all functioning pituitary adenomas, prolactic-secreting tumors affect the _____ as a target organ a. thyroid b. pancreas c. breast d. uterus

c. breast

7. In which gland is follicle-stimulating hormone (FSH) produced? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: B FSH is secreted by the pituitary; this hormone stimulates egg and sperm production.

9. In which gland is luteinizing hormone (LH) produced? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: B LH is secreted by the pituitary; this hormone stimulates sexual and reproductive activity.

23. Which of the following critical structures is of most concern when treating thyroid cancers with external beam radiation? a. optic nerves b. spinal cord c. parotid glands d. ears

ANS: B OAR for external beam radiation therapy include the lung and spinal cord for thyroid cancers and the optic chiasma, optic nerve, lens of the eye, and parotid glands for pituitary adenomas.

What is traditional method for external beam fractionation

40 to 50 Gy using 3 field technique (vertex + laterals or anterior + laterals) to spare normal brain tissue or parallel opposed laterals or rotational arcs

What is the staging for thyroid cancer?

AJCC TNM staging staged based on histologic type and age of the patient

2. Cancer of which of the following endocrine glands has the highest incidence rate? a. thyroid b. adrenal c. pituitary d. Parathyroid

ANS: A Although thyroid cancers are the most common of the endocrine malignancies (accounting for approximately 94% of all new cases and 63% of deaths), they represent only 2% of all cancers

3. Cancer of which of the following endocrine glands is the most deadly? a. thyroid b. adrenal c. pituitary d. parathyroid

ANS: A Although thyroid cancers are the most common of the endocrine malignancies (accounting for approximately 94% of all new cases and 63% of deaths), they represent only 2% of all cancers

22. Which of the following critical structures is of most concern when treating pituitary tumors with radiation? a. optic nerves b. spinal cord c. parotid glands d. ears

ANS: A Organs-at-risk (OAR) for external beam radiation therapy include the lung and spinal cord for thyroid cancers and the optic chiasma, optic nerve, lens of the eye, and parotid glands for pituitary adenomas.

6. In which gland is ACTH produced? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: B ACTH is secreted by the pituitary; this hormone influences the action of the adrenal cortex.

Adrenocorticotropic hormone (ACTH)-secreting tumors of the pituitary typically present with symptoms similar to cancer of which other endocrine gland? a. parathyroid b. adrenal c. thyroid d. pancreas

ANS: B As the target tissue of ACTH is the adrenal cortex, ACTH-secreting tumors of the pituitary typically present with symptoms similar to adrenal cancer

14. In children, somatophen-secreting pituitary tumors can present as which of the following conditions? a. Cushing's syndrome b. gigantism c. acromegaly d. diabetes insipidus

ANS: B The hypersecretion of growth hormone produces clinical symptoms such as weight gain; thickening of the bones and soft tissues of the hands, feet, and cheeks; and overgrowth of the jaw and tongue. Patients are hypertensive and commonly complain of headaches and lassitude. This clinical syndrome is referred to as acromegaly, if hypersecretion occurs after puberty, and giantism, if it happens before puberty. REF: Chapter 31, Endocrine System Tumors, p. 653

20. Which of the following conditions most generally occurs in children but not in adults? a. Cushing's syndrome b. gigantism c. acromegaly d. diabetes insipidus

ANS: B The hypersecretion of growth hormone produces clinical symptoms such as weight gain; thickening of the bones and soft tissues of the hands, feet, and cheeks; and overgrowth of the jaw and tongue. Patients are hypertensive and commonly complain of headaches and lassitude. This clinical syndrome is referred to as acromegaly, if hypersecretion occurs after puberty, and giantism, if it happens before puberty. REF: Chapter 31, Endocrine System Tumors, p. 653

4. In which gland is antidiuretic hormone (ADH) produced? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: B The posterior lobe or neurohypophysis secretes oxytocin (which causes smooth muscle contractions) and ADH or vasopressin, which regulates free water resorption in the kidneys.

5. In which gland is oxytocin produced? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: B The posterior lobe or neurohypophysis secretes oxytocin (which causes smooth muscle contractions) and ADH or vasopressin, which regulates free water resorption in the kidneys.

19. Tumors of which of the following endocrine glands are treated using arc radiation therapy? a. adrenal b. pancreas c. pituitary d. thyroid

ANS: C Due to its midline location, pituitary lesions are in an optimal location for rotational or arc therapy

17. Survivors of the atomic bombs developed which type of endocrine gland cancer most frequently? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: C Many studies have been conducted on the inhabitants of Nagasaki and Hiroshima after the explosion of the atomic bomb in 1945. Of 20,000 heavily and lightly exposed individuals examined every year since 1959, approximately 0.2% have developed thyroid cancer.

15. Radioactive iodine is used to treat cancers of which of the following endocrine glands? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: C Radioactive iodine is used to treat papillary, mixed papillary-follicular, and follicular cancers. REF: Chapter 31, Endocrine System Tumors, p. 648

13. In adults, somatrophin-secreting pituitary tumors can present as which of the following conditions? a. Cushing's syndrome b. gigantism c. acromegaly d. diabetes insipidus

ANS: C The hypersecretion of growth hormone produces clinical symptoms such as weight gain; thickening of the bones and soft tissues of the hands, feet, and cheeks; and overgrowth of the jaw and tongue. Patients are hypertensive and commonly complain of headaches and lassitude. This clinical syndrome is referred to as acromegaly, if hypersecretion occurs after puberty, and giantism, if it happens before puberty. REF: Chapter 31, Endocrine System Tumors, p. 653

12. In which gland is T4 produced? a. parathyroid b. pituitary c. thyroid d. adrenal

ANS: C The thyroid gland produces several hormones, including thyroxine (T4) and triiodothyronine (T3), which are responsible for metabolic regulation.

16. Radiation is a known risk factor for cancers of which of the following endocrine glands? a. adrenal b. pancreas c. pituitary d. thyroid

ANS: D External radiation to the thyroid gland, particularly before puberty, is the only well-documented etiologic factor. REF: Chapter 31, Endocrine System Tumors, p. 644

24. Which of the following hormones is not secreted by the pituitary? a. ADH b. TSH c. FSH d. PTH

ANS: D PTH is secreted by the parathyroid.

11. In which gland is epinephrine produced? a. parathyroid b. pituitary c. thyroid d. adrenal

ANS: D The adrenal cortex manufactures steroid hormones that are critical in metabolic regulation, and the medulla produces epinephrine (Adrenalin) under the regulation of the autonomic nervous system.

10. In which gland is cortisol produced? a. parathyroid b. pituitary c. thyroid d. adrenal

ANS: D The adrenal cortex produces steroid hormones, including glucocorticoids, mineralocorticoids, and sex hormones, which are responsible for metabolic regulation. These hormones include cortisol, aldosterone, estrogen, and androgen.

21. Which endocrine gland contains a medulla and a cortex? a. pancreas b. pituitary c. thyroid d. adrenal

ANS: D The adrenal gland is composed of the cortex and the medulla.

18. The pituitary gland is located within what portion of the sphenoid bone? a. hypothalamus b. cribiform plate c. sphenoid sinus d. sella turcica

ANS: D The pituitary gland is 1.3 cm in diameter and located at the base of the brain. Attached to the hypothalamus by a stalklike structure (the infundibulum), the pituitary gland lies in the sella turcica of the sphenoid bone

2. Parafollicular cells is another term used to describe the parathyroid glands.

ANS: F Parafollicular cells (also called C cells) are cells in the thyroid that produce and secrete calcitonin.

1. Most pituitary tumors are malignant adenocarcinomas.

ANS: F Pituitary tumors are most always benign, with malignancies accounting for fewer than 1% of all pituitary tumors.

4. The most common form of pituitary tumors is adenocarcinomas.

ANS: F Pituitary tumors are most always benign, with malignancies accounting for fewer than 1% of all pituitary tumors.

3. The parathyroid glands are imbedded in the thyroid gland.

ANS: T The thyroid gland, consisting of a right lobe and a left lobe, lies over the deep structures of the neck; is close to the larynx, trachea, parathyroid glands, and esophagus; and is anterior and medial to the carotid artery, jugular vein, and vagus nerve.

Which of the following are symptoms of pituitary adenomas? a. uncontrolled diabetes b. visual disturbances c. sinus pressure

All of them can occur

Which of the following is not a hormone secreted by the pituitary gland? a. ZH b. TSH c. FSH d. ACTH

a ZH

Which of the following would not be considered an endocrine type tumor? a. breast b. thyroid c. adrenal gland d. pituitary

a breast

The cancers that are most common of the endocrine malignancies are? a. thyroid b. pituitary c. adrenal gland d. parathyroid

a thyroid

Radioactive Iodine-131 is used in the treatment of ____ tumors a, thyroid b. pituitary c. adrenal gland d. parathyroid

a. thyroid

What is the worst overall prognosis type of thyroid cancer?

anaplastic. rare, but patients normally die within year of diagnosis

How are adrenal tumors classified?

as either cortex or medullary

What was pituitary cancer traditionally classified as

basophil adenoma eosinophil adenoma chromophobe adenoma

How is thyroid cancer detected and diagnosed?

biopsy (most important) imaging studies and lab testing