Chpt 9 Male Genital W&L 37 Genitourinary system

The inguinal nodes should be included in RT fields for a. prostate b. testicular c. penile

c. penile

The total dose for irradiation of the prostate tumor bed is a. 20 to 30 Gy b. 30 to 45 Gy c. 50 to 60 Gy d. 66 to 75 Gy

d. 66 to 75 Gy

What does a full bladder do?

decreases bladder dose and displaces small bowel in lateral fields

How does bladder cancer spread?

direct spread through bladder walls and invade muscle

What should they be instructed to eat?

drink fluids and avoid high fiber foods

List 3 etiologic factors for bladder cancer?

dye working chronic bladder infections smoking exposure to cadmium previous pelvic irradiation

What is the etiology of bladder cancer?

dye, rubber, textile, leather, pain working chronic bladder infections smoking previous pelvic irradiation pesticide exposure contaminated water supply

How pre and postoperative fields be charged?

intermediate to complex due to beam shaping

What can be used for IGRT since the gland moves slightly?

internal fiducial markers or BAT

What is IVP?

intravenous pyelogram

What is IVP?

intravenous pyelogram also called an excretory urogram, is an X-ray exam of your urinary tract. An intravenous pyelogram lets your doctor view your kidneys, your bladder and the tubes that carry urine from your kidneys to your bladder (ureters).

What is phimosis

is a condition of the penis where the foreskin cannot be fully retracted over the glans penis

What is an ileal diversion?

is a surgical technique formerly referred to as the Bricker ileal conduit after its inventor, Eugene M. Bricker. It is a form of incontinent urostomy,[1] and was developed during the 1940s and is still one of the most used techniques for the diversion of urine after a patient has had their bladder removed To create an ileal conduit, the ureters are surgically resected from the bladder and a ureteroenteric anastomosis is made in order to drain the urine into a detached section of ileum at the distal small intestine, though the distal most 25 cm of terminal ileum are avoided as this is where bile salts are reabsorbed. The end of the ileum is then brought out through an opening (a stoma) in the abdominal wall. The residual small bowel is reanastamosed with the residual terminal ileum, usually seated inferior relative to the anastomosis.[2][3]

What is in the urinary system?

kidney and bladder

What is LDH?

lactate dehydregenase

What does IMRT technique do?

limits side effects but should not be parallel opposed to limit skin dose

What is usually the cause of death in bladder cancer patients?

liver failure and uremia

Distant mets can occur without lymphatics involvement; what are the most common met sites for prostate cancer?

liver, brain, lung, other soft tissue, bone

How does testicular cancer spread?

local and then spreads to lymph nodes in orderly fashion

What is the lymph spread of the kidney?

local invasion and paraaortic, paracaval, celiac axis,

Immobilization can be?

lower extremities with alpha cradle, vac lock, or simple block and Velcro feet

Where are the distant mets of penile cancer?

lung, liver, bone and brain

Where does testicular cancer spread to?

lungs

What are the signs and symptoms of penis cancer?

mass ulceration, bleeding, discharge pain

What might the patient experience after RT?

may experience nausea so give antiemetic before treatment

What is the most common pathology of penile cancer?

most are well-differentiated squamous cell carcinomas

How is RT usually used in renal cancer?

most often used palliatively

What needs to be done to protect the other testicle?

needs shielding from internal scatter radiation; use absorbed dose detector (i.e. diode, TLD) to ensure integrity of shield

What are kidney cancers in children?

nephroblastomas

How does prostate cancer met?

nerve chains, lymph and blood

What is etiology for penile cancer?

no circumcision at birth Phimosis poor hygiene, smegma HPV Ultraviolet radiation smoking

Is prostate cancer chemoreceptive?

no it's not; hormonal therapy for larger lesions and metastatic lesions

Are inguinal and femoral nodes commonly involved in testicular cancer?

no they are rarely affected

Do the lateral fields need beam shaping?

no they do not and will incur simple charges

Is Penile cancer common in the US?

no, rare in the US but higher incidence in Asia, Africa, South America

Is chemotherapy used in renal cancer?

not responsive, is investigational

Overall prostate cancer is a ____ growing malignancy

slow growing

There are no direct causes of kidney cancer, but what are the risk factors?

smoking cadmium, lead, asbestos exposure Thorotrast (alpha emitter) exposure low intake of vitamin A diabetes Polycystic kidney disease family history obesity hypertension

When irradiating seminoma stages I, IA IB the following nodes should be incldued: a. paraaortic b. Ipsilateral iliac c. mediastinal d. scalene

a and b

Cancers of the kidney usually arise in the a. cortex b. medulla c. renal pelvis d. adrenal gland

a cortex

Which of the following examinations are best used in the detection of bladder cancer? a. TURB b. Urine cytology c. cytoscopy d. DRE e. PSA

a,b,c

most bladder cancers arise in the a. posterior wall b. lateral wall c. trigone d. neck e. urethral opening

a,b,c

Which of the following are common immobilization devices for prostate cancer? a. polyurethane foam molds b. vacuum devices c. belly board d. rubber bands and other devices to position the feet

a,b,d

A blood serum marker used in determining extent of testicular cancer is a. AFP b. CA 19-9 c. CEA d. BRCA 1

a. AFP and BHCG

The upper border of the inverted Y field for the management of early-stage seminoma is at the level of a. T 10 b. T 12 c. T 8 d. L 1

a. T 10

nephroblastomas are also known as a. Wilm's tumor b. Ewings sarcoms c. Bowen disease d. Klinefelter syndrome

a. Wilm's tumor in children

The most common histologic type found in prostate cancer is a. adenocarcinoma b. Squamous cell c. transitional cell d. clear cell

a. adenocarcinoma

The bladder is ____ to the cervix and ____ to the symphysis pubis

anterial inferior posterior

What are signs and symptoms of prostate cancer?

asymptomatic with DRE (digital rectal exam) urinary tract obstruction pain in back, pelvis urinary incontinence weight loss, fever, fatigue, anemia bone pain associated with mets

What kind of diet should patient have?

avoid heavy, greasy foods

Testicular cancers are most frequently diagnosed in men aged a. 60 to 65 b. 15 to 35 c. 40 to 50 d. 70 to 80

b. 15 to 35

Brachytherapy in the management of prostate cancer would be a. HDR interstitial b. LDR interstitial c. HDR intracavitary d. HDR intraluminal

b. LDR interstitial

Cancers manifesting in the renal cortex are most commonly a. transitional cell b. adenocarcinoma c. clear cell d. squamous cell

b. adenocarcinoma

The most common pathology of malignant tumors of the prostate is a. SCC b. adenocarcinoma c. transitional cell d. burkitts cell

b. adenocarcinoma

The prostate gland is located ___ to the rectum a. posterior b. anterior c. superior d. both a and c

b. anterior

The most common presenting symptom of bladder cancer is a. back pain b. hematuria c. abdominal pain d. fever

b. hematuria

The seminal vesicles lie ____ to the prostate and ____ to the rectum

superior anterior

The bladder is ____ to the seminal vesicles and ____ to the ovaries

superior medial/inferior

How is patient positioned for bladder RT?

supine with hands folded on abdomen

How are early lesions with no positive lymph nodes treated?

surgical resection; total prostatectomy

What needs to be done with pediatric patients?

take care to cover the entire vertebral bodies to prevent uneven bone growth along the spine

What are the radiation fields for prostate cancer?

they can be a simple four field box for larger lesions and positive lymph nodes

What is beam shaping done for?

to protect bone marrow reserves in the iliac crest

What kind of beam shaping needs to be done?

to spare as much bowel as possible

When can RT be used?

to tumor bed, residual disease optional for T3 or larger to 50 to 50 Gy

What is the lower border for testicular RT?

top of symphysis pubis or margin on inguinal scar

most common histology of renal pelvis?

transitional cell

List 3 histologic types for bladder cancer

transitional cell squamous cell adenocarcinoma sarcoma lymphoma

What is the histology of bladder cancer?

transitional cell squamous cell adenocarcinoma sarcoma lymphoma

What is the most common histology of renal pelvis?

transitional cells (90%)

What are the histologic types of renal pelvis?

transitional cells (90%) squamous cell adenocarcinoma

What is TURB

transurethral bladder removal

Where does cancer of the bladder normally occur?

trigone, posterior/lateral walls or neck of the bladder

Daily billing can be simple to intermediate

true

Men are 2.5 times more likely than women to get bladder cancer?

true

Men are affected twice as much as women?

true

the boost fields may add modifiers such as wedges making it complex billing

true

What is the Gleason Scoring?

two most predominant histologic patterns are identified by the pathologist and then added to give the gleason score of 2-10

How is a uniform dose given to penis?

uniform dose to shaft using special penile box

Renal cell carcinomas have immediate access to the blood route via the? a. portal vein b. superior vena cava c. inferior vena cava and abdominal aorta d. mesenteric and femoral artery

c. IVC and abdominal aorta

What are preoperative doses?

20 to 45 Gy

What might the dose go up to for areas of gross nodal involvement?

35 to 40 Gy

Gleason developed a grading system based on the degree of differentiation seen in tissue samples. His system uses ____ different histologic patterns

5

What age is median age of onset of kidney (renal) cancer?

55 to 60 years old

Although it's AP/PA fields, beam shaping will incur ____ billing

complex

How can RT be used?

curatively to tumor bed or to the unresected prostate

What side effects may happen for definitive RT?

cystitis, proctitis, diarrhea

What are side effects of a box field technique?

cystitis, proctitis, diarrhea, dysuria

Inguinal node dose is to be delivered with 80% dose line at a depth of 5 cm. The electron energy most appropriate would be a. 5 MeV b. 10 MeV c. 12 MeV d. 15 MeV

d. 15 MeV 15/3 is the 80% line

What can a belly board do?

help decrease bowel volume in lateral treatment fields

What is the clinical presentation of renal cancer?

hematuria ( gross or microscopic) back pain palpable mass in abdomen weight loss fatigue fever

What are the signs and symptoms of bladder cancer?

hematuria (most often gross) urinary tract infection urinary frequency, urgency, dysuria

Where are bladder cancers more common?

high incidence in industrial cities

The prostate gland lies ____ to the bladder and ____ to the rectum

inferior anterior

What is cystitis?

inflammation of the bladder. urge to go, blood

What is proctitis?

inflammation of the lining of the rectum. Proctitis can cause rectal pain and the continuous sensation that you need to have a bowel movement

Where are metastatic deposits for penis?

inguinal nodes, which may also ulcerate

What can lower recurrence rates after surgery?

instillation/intravesical chemotherapy

What is the average age of onset?

60 years

If RT used definitively what are dose?

60to 70 gy

What doses of radiation to prostate?

66 to 75 Gy in 180 cGy fractions external beam

What is the median age of bladder cancer?

68 years

What is the dose for testicular RT?

125 to 180 cGy daily for total of 25 to 30 Gy

What are the doses for penile RT?

2 Gy daily up to 60 to 74Gy

how is prostate cancer staged?

AJCC TNM and Gleason grading

23. Kidney carcinoma can be attributed to the following. I. Cigarette use II. Obesity III. Betel nut chewing a. I and II b. I and III c. II and III d. I, II, and III

ANS: A Cigarette and tobacco use, obesity, and analgesic drug abuse are correlated with an increased risk and incidence of kidney cancer.

10. What is the most common form of penile cancer? a. squamous cell carcinoma b. germ cell tumors c. adenocarcinomas d. stromal tumors

ANS: A Most malignant penile tumors are well-differentiated squamous cell carcinomas.

18. Which of the following treatment techniques are most frequently used when irradiating the prostate? 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

ANS: A Patients are most often simulated in the supine position. Patients should be treated with a full bladder to minimize the amount of bladder in the treatment portals.

1. A total dose of 7200 cGy in fractions of 180 cGy is used to treat which male reproductive cancer? a. prostate b. testicle c. penis d. all of the above

ANS: A Prostate doses typically range from 72 to 80 Gy at 1.8 to 2.0 Gy per day. REF: Chapter 37, Male Reproductive and Genitourinary Tumors, p. 832

12. What is the primary treatment option for kidney cancer? a. surgery b. chemotherapy c. radiation therapy d. immunotherapy

ANS: A Radiation and chemotherapy have limited roles in the management of kidney cancers. REF: Chapter 37, Male Reproductive and Genitourinary Tumors, pp. 857-859

14. What is the 5-year survival of all stages of testicular cancer combined? a. 50% b. 70% c. 90% d. 100%

ANS: A Rates of disease-free survival for stage I testicular seminoma are in the 95% to 97% range at 5 years according to multiple studies. Corresponding cause-specific survival is 100%. For patients with stage IIA and IIB disease, rates of disease-free and cause-specific survival are 90% and 95%, respectively.

15. What is the treatment of choice for testicular cancers? a. surgery b. chemotherapy c. radiation therapy d. watchful waiting

ANS: A The initial management goal for a suspected malignant germ cell tumor of the testis is to obtain serum AFP and beta-HCG measurements and, after staging procedures, to perform a radical inguinal orchiectomy with high ligation of the spermatic cord. Further management depends on the pathologic diagnosis of the stage and extent of the disease.

9. What is the most common form of testicular cancer? a. squamous cell carcinoma b. germ cell tumors c. adenocarcinomas d. stromal tumors

ANS: B About 95% of testicular neoplasms originate in germinal elements.

19. Which of the following cancers is most likely to occur in a 27-year-old male? a. penis b. testicle c. prostate d. urethra

ANS: B Although testicular tumors are relatively rare, they are the most common malignancy in men between 20 and 34 years of age.

7. What is the most common form of bladder cancer? a. adenocarcinoma b. transitional cell carcinoma c. squamous cell carcinoma d. renal cell carcinoma

ANS: B Approximately 92% of bladder tumors are transitional cell carcinomas, 6% to 7% are squamous cell carcinomas, and 1% to 2% are adenocarcinomas.

8. What is the standard dose used when irradiating the entire bladder? a. 3000 to 3500 cGy b. 4500 to 5000 cGy c. 5000 to 6000 cGy d. 6500 to 7000 cGy

ANS: B The larger pelvic field to include the bladder and pelvic lymph nodes is generally treated to a dose of 45 to 50 Gy at 180 cGy per day, which requires 5 to 5 1/2 weeks of treatment.

11. What region might receive prophylactic radiation therapy for advanced right sided testicular cancer? a. right SCV nodes b. left SCV nodes c. para-aortic nodes d. left inguinal nodes

ANS: B The lymphatic pathways associated with the entire lower section of the body are associated with drainage into the thoracic duct, which is associated with the left side inlet in the supraclavicular region.

2. A total dose of 2500 cGy in fractions of 160 cGy is used to treat which male reproductive cancer? a. penis b. testicle c. prostate d. bladder

ANS: B The recommended dose to retroperitoneal and pelvic lymphatics for stages I and IIA disease is 2500 cGy in fractions of 160 to 180 cGy or 2000 cGy in 10 fractions with AP/PA fields given 5 days per week and both fields treated daily.

6. What is the most common form of kidney cancer? a. adenocarcinoma b. transitional cell carcinoma c. squamous cell carcinoma d. renal cell carcinoma

ANS: B Transitional cell carcinoma accounts for more than 90% of malignant tumors of the renal pelvis and ureter, and squamous cell carcinoma accounts for 7% to 8%.

4. Cancer of which urinary organ is most common? a. kidney b. ureter c. bladder d. urethra

ANS: C Approximately 67,160 new cases and 13,750 deaths from bladder cancer will be reported in the United States annually. The incidence peaks in the seventh decade, and in men this cancer is the fourth most prevalent malignant disease.

5. Cancer of which of the following male reproductive system component is most common? a. penis b. testicle c. prostate d. urethra

ANS: C Carcinoma of the prostate is the most common malignancy in males in the United States. REF: Chapter 37, Male Reproductive and Genitourinary Tumors, p. 823

17. Who has the most significant risk of developing prostate cancer? a. 45-year-old black male b. 50-year-old white male c. 70-year-old black male d. 81-year-old black female

ANS: C The incidence increases with each decade of life; more than 65% of prostate carcinomas occur in men 65 years and older. African-American men in the United States have one of the highest incidences, of prostate cancer in the world, significantly higher than that of white men of comparable age.

21. Which lymph node chains will be treated if a man is diagnosed with right-sided testicular cancer that has not spread outside the testicle? I. right SCV nodes II. para-aortic nodes III. right inguinal nodes a. I and II b. I and III c. II and III d. I, II, and III

ANS: C The most commonly applied treatment for patients with stage I seminoma is radical orchiectomy and postoperative irradiation of the para-aortic or para-aortic and ipsilateral pelvic nodes.

3. Which cancer can be treated using a water bath to provide dose homogeneity by compensating for the irregular surface with tissue equivalent material? a. penis b. testicle c. prostate d. bladder

ANS: C The water used, which is tissue equivalent, will compensate for the cylindrical presentation of the penis and ensure even dose distribution over the volume of interest. REF: Chapter 37, Male Reproductive and Genitourinary Tumors, p. 843, Figure 37-14

22. Which of the following treatment techniques can be used to treat the prostate? a. 4-field box b. IMRT c. brachytherapy d. all of the above

ANS: D All are viable treatment options for prostate cancer.

16. What is the 5-year survival of all stages of prostate cancer combined? a. 39% b. 59% c. 79% d. 99%

ANS: D Overall survival is a poor measure of treatment outcome for prostate cancer therapy because this is a slowly progressive disease that many men die with but not because of prostate cancer.

20. Which of the following is least likely to be used in the management of a patient with prostate cancer? a. watchful waiting b. hormone therapy c. radiation therapy d. chemotherapy

ANS: D Prostate cancer is noted as having several pathways associated with disease management, including surgery, hormone therapy, watchful waiting, and radiation therapy as mainline options. Chemotherapy is used often after hormone therapy has not yielded an acceptable response.

13. What is the most common symptom of testicular cancer? a. night sweats b. fever c. dysuria d. painless mass

ANS: D Usually, a testicular tumor appears as a painless swelling or nodular mass in the scrotum and is sometimes noted incidentally by the patient or a sexual partner.

4. Injury to the testicles is a known risk factor for developing a seminoma.

ANS: F

12. Variations in rectal fullness have very little effect on the daily position of the prostate.

ANS: F Exact prostate positions varies daily due to a number of factors including rectal fullness.

3. Hormone therapy can be used as a curative treatment for prostate cancer.

ANS: F Hormone therapy is used in addition to other therapies.

6. PSA is only useful in diagnosing prostate cancer.

ANS: F PSA is also helpful post treatment.

7. Radiation therapy treatments for seminoma include the primary tumor and regional lymph nodes.

ANS: F Patients with stage I testicular seminoma should receive megavoltage irradiation to the paraaortic or para-aortic and ipsilateral pelvic lymph nodes. The primary tumor has been removed and therefore is not in the treatment field.

10. The survival data for external beam radiotherapy and brachytherapy are better than surgery for prostate cancer when like groups are compared.

ANS: F Results with both external beam radiation and radiaoisotopic implant are much the same as for surgery if like groups are compared.

9. Scrotal irradiation is a commonly accepted practice for testicular cancer.

ANS: F The 1989 Consensus Conference in Leeds, England, recommended that inguinal or scrotal irradiation be omitted even if scrotal interference has occurred.

8. Radiation therapy is typically used as a primary treatment option for cancers of the bladder.

ANS: F Treatment of bladder cancer includes some form of surgical resection.

1. Bladder cancer is more common in men than in women.

ANS: T Bladder cancer occurs about four times more often in men than in women

11. Topical chemotherapy is often used when treating low staged penile cancers.

ANS: T Bowen disease and erythroplasia of Queyrat can be treated with topical 5-FU (5% cream), a local excision, or superficial x-rays (4500 to 5000 cGy in 4 to 5 weeks).

2. Early prostate cancer is asymptomatic.

ANS: T Carcinoma of the prostate can be asymptomatic until reaching a significant size.

5. Prostate cancer is the most common cancer affecting American men.

ANS: T Carcinoma of the prostate is the most common malignancy in males in the United States.

How is RT delivered to kidney?

AP/PA fields sufficient until cord tolerance

What are the borders?

AP/PA fields upper border at L5 down to obturator foramen laterally 2cm beyond the pelvic brim for coverage of external iliac nodes opposing laterals should have an anterior border to symphysis pubis and posterior border to S2 taking care to exclude as much rectum as possible

What are the RT borders for kidney?

AP/PA to include bilateral paraaortic lymph nodes

Is testicular cancer more common in Caucasian or african americans?

Caucasian

What are the histologic types for the Renal parenchyma?

Adenocarcinoma clear cell granular cell spindle cell

What is the workup for prostate cancer

CT MRI Transurethral ultrasound (TRUS) biopsy via transurethral resection of the prostate (TURP) cytoscopy PSA, PAP, SAP markers bone scan for suspected mets

What is the workup of bladder cancer?

CT abdomen and pelvis Transurethral biopsy of the bladder (TURB) urine cytology urinalysis IVP ultrasound chest x-ray for metastasis cystoscopy with brushing

What is the workup for kidney cancer?

CT chest and abdomen MRI Cystoscopy Blood chemisty urine cytology IVP ultrasound biopsy (US or CT guided)

What is done to workup testicular cancer?

CT of abdomen, pelvis Ultrasound of scrotum Lymphangiogram-traditional HCG, AFP, LDH serum markers Chest x-ray for metastasis

What is CTV?

Clinical Target Volume GTV plus margin for subclinical disease extension

What is the etiology for testicular cancer?

Cryptochordism Klinefelter syndrome mumps orchitis

What is cystectomy?

Cystectomy is the surgical removal of all or part of the bladder. It is used to treat bladder cancer that has spread into the bladder wall or to treat cancer that has come back (recurred) following initial treatment

What is Queyrat and Bowen disease?

Erythroplasia of Queyrat (EQ) is an uncommon carcinoma in situ that usually arises on the mucosa of the glans penis or prepuce as red, shiny, sharply demarcated velvety plaques. It is usually painless, and not itch. Erythroplasia of Queyrat usually occurs in uncircumcised men

What is GTV?

Gross Tumor Volume palpable or visible extent of tumor

What is HCG?

Human chorianic gonadotropin

What nodes need to be involved in RT treatment for penile?

Inguinal nodes

What are the RT borders?

Inverted Y or hockey stick technique

What is the staging for Penile cancer?

Jackson's staging or TNM The depth of invasion is important (nodes) Mohs technique is helpful

What is a gleason score of 5-7

Moderately differentiated and fair prognosis

What is PTV?

Planning Target Volume CTV plus margin for treatment reproducability (patient/organ movement, daily setup error)

What is the histology of penile cancer?

Queyrat and Bowen disease (shiny, red, velvety plaque on the prepuce or glans) squamous cell basal cell melanoma

How are seminomas stage I, IIA, IIB treated?

RT follows orchiectomy

What is the upper border and lower border?

S1 and lower border at obturator foramen

What are the histologies of testicular cancer?

Seminoma (classic, anaplastic, spermatocytic) Embryonal carcinoma Teratocarcinoma Choriocarcinoma Yolk sac tumors Teratomas

How is testicular cancer staged?

Serum markers are strongly considered in staging using TNM

What are the RT borders for penile treatment?

Should include the entire shaft and lower pelvic lymph nodes; inguinal nodes especially

How is patient positioned for testicular RT

Supine with arms at sides, elevated or high on chest

What is the upper border for testicular RT?

T10, wide enough to include the renal-hilar nodes

how is bladder cancer staged?

TNM and grading specified as high or low

How are kidney cancers staged?

TNM staging, grading specified as high or low Robson staging I-IV expressing confinement to kidney or vein and node involvement and distant mets

What male cancer has a low occurrence but is the most common male cancer for 15 to 35 year old males?

Testicular

how are superficial tumors (T is) treated?

Transurethral resection

What is TURP?

Transurethral resection of prostate

Resectable, early-stage is curable with surgery only

True

What is Treatment Volume?

Volume enclosed by appropriate isodose in achieving the treatment purpose

What is a gleason score of 2-4

Well differentiated and good prognosis

For patients with bladder cancer, the bladder should be ___ during whole bladder radiation a. empty b. partially full c. full d. localized with contrast material

a. empty

Hormonal therapy for prostate cancer may include the administration of a. lupron b. tamoxifen c. megace d. taxol

a. lupron lutenizing hormone inhibitor

The four box field technique would likely be used in the management of ____ cancer a. prostate b. testicular c. penile

a. prostate

The tumor of the male reproductive and genitourinary system for which a brachytherapy implant would be most likely used to control the disease is a. prostate b. kidney c. testis d. bladder

a. prostate

The cancer with the highest incidence for males is a. prostate cancer b. penile cancer c. kidney and ureteral cancer d. lung cancer

a. prostate cancer

The ureters enter the kidney at the a. renal pelvis b. renal cortex c. adrenal cortex d. medullary zone

a. renal pelvis

The most common testicular tumor pathology is a. seminoma b. chorocarcinoma c. teratoma d. embryonal carcinoma

a. seminoma

The appropriate treatment position for the patient treated with opposing hockey stick fields is a. supine with arms above head b. supine with hands folded on abdomen c. prone with arms up around pillow d. lateral decubitus with elbows bent

a. supine with arms above head

Cancers manifesting in the renal pelvis are most commonly? a. transitional cell b. adenocarcinoma c. clear cell d. squamous cell

a. transitional cell

What is the histology of prostate cancer?

adenocarcinoma (95 to 98%) transitional cell squamous cell sarcoma

most common histology of renal cortex?

adneocarcinoma

Who presents later stage and have worse prognosis than caucasians?

african americans

When treating a patient with bladder carcinoma peroperatively, the treatment portals should be large enough to include a. obturator nodes b. obturator, external, hypogastric and presacral nodes c. hypogastric and presacral nodes d. obturator, parraortic, and paracaval ndoes

b. obturator, external, hypogastric and presacral nodes

The ureters attach the ____ surface of the bladder a. anterior b. posterolateral c. superior d. inferior

b. posterolateral

The lower border of the inverted Y field for the management of early-stage seminoma is at the level of a. the ischial tuberosity b. symphysis pubis c. the lower edge of the SI joints d. The lesser trochanter

b. symphysis pubis

Of the following tumors, which would require the lowest dose to control disease? a. prostate b. testis c. penis d. breast

b. testis

Urine passes from the bladder to the outside of the body via a. ureter b. urethra c. trigone d. calyx

b. urethra

What can RT and chemotherapy be used together for?

bladder sparing

What is the most common met site for prostate cancer?

bone

The most common type of kidney tumor is a. transitional cell lymphoma b. chorocarcinoma c. adenocarcinoma d. seminoma

c. adenocarcinoma

Severe wet desquamation should be managed with a. applications using cold packs b. hot baths with Epsom salt c. Applications for severe radiation dermatitis; open wounds d. applications of petroleum jelly

c. applications for severe radiation dermatitis

The patient complaining of diarrhea should be advised to a. east fresh fruit and veggies b. eat more starch and dairy products c. avoid high fiber foods d. consume liquids only

c. avoid high fiber foods

A carcinogen linked to renal cell and bladder carcinomas found in RT departments is a. benzene b. asbestos c. cadmium d. leather

c. cadmium

A side effect associated with the treatment of prostate cancer, in which the adult male is unable to obtain an erection, is a. benign prostatic hypertrophy b. transurethral resection of the prostate c. impotence d. none of the above

c. impotence

The right kidney is slightly lower than the left due to the presence of the a. diaphragm b. adrenal gland c. liver d. spleen

c. liver

The most common cancer of germinal origin of the testis is? a. teratocarcinoma b. choriocarcinoma c. seminoma d. embryonal

c. seminoma

The tumor of the male reproductive and genitourinary system that requires the lowest dose to control the disease is a. prostate b. kidney c. seminoma d. bladder

c. seminoma

What is the etiology of prostate cancer?

cause is unknown maybe genetic altered hormone levels possible

What is intravesical therapy?

chemo into the bladder given weekly (6-8x) holding time 2 hours

What is the chemotherapy used?

cisplatin- and methotrexate based chemo

What is the lymph drainage of bladder?

common, external, internal iliac nodes, obturator nodes

Common metastatic sites for renal cell carcinoma is/are a. bone b. brain c. lung d. all the above

d. all the above

A common location for distant mets from seminoma is a. brain b. skin c. liver d. lung

d. lung

What are the distant mets of kidney cancer?

easily accessible to the renal artery and vein to the lung, liver, bone and brain

How can inguinal nodes be treated?

electron therapy; unknown status of pelvic nodes should be treated

What is the order of lymph nodes that testicular cancer spreads?

external and internal iliac, common iliac, paraaortic, paracaval, renal-hilar commonly involved

What are the lymph nodes?

external and internal iliacs, common iliac, obturator, pereprostatic

What are the AP/PA fields for testicular RT?

field length may extend outside of collimator limits for tall males; SSD technique may be required in this instance

Where can adenocarcinomas of the kidney spread to?

fingers, eyelids and nose

What is the distant spread of bladder cancer?

first to bone then liver, lung and rarely to the skin

How can IMRT be used?

for small local disease

Modulation of dose is done for?

giving adequate dose to gland and seminal vesicles; low dose to bladder and rectum

How do renal cancers respond to Interferon or interleukin-2?

has low response but results outweigh cytotoxic chemotherapy

What fields are used for penile RT?

opposing lateral fields

How are nonseminomas and beyond stage IIB treated?

orchiectomy and nodal dissection then chemotherapy

What are the signs and symptoms for testicular cancer?

painless, testicular mass Testicular swelling Gynecomastia infertility back pain

What else can RT be used for?

palliation/urinary bleeding

How should patient be positioned?

patient supine with arms above head or akimbo for easy triangulation

The TD 5/5 of the kidney ranges from 18-23 Gy. when treating the pediatric patient, the opposite kidney should be shielded so that dose is limited to less than 15 Gy. Why is the tolerance lower in this case?

pediatric patient has greater sensitivity due to dividing immature cells. the pediatric patient is hoped to have a longer life expectancy and therefore the focus has to remain on keeping the possibility of long-term effects at the bare minimum

What is the lateral border?

pelvic rim

What are the lymph nodes involved with penile cancer?

penile and regional pelvic

What can be used for local lesions and low grade?

permanent LDR brachytherapy using permanent, interstitial implant

What is the workup for penile cancer?

physical exam of penis and inguinal nodes tumor biopsy Chest x-ray CT of abdomen and pelvic Needle aspiration sentinel node biopsy

What is a gleason score of 8-10?

poorly differentiated and poor prognosis

Positioning the patient how can decrease small bowel in lateral fields in box fields?

prone

How is the patient set up for Penile RT?

prone on board or supine with penile box containing wax or water bath

What is the number one cancer incidence for males in the US?

prostate cancer

What field shaping will need to be done for testicular RT?

protect kidneys, bowel, bladder, and bone marrow reserves in iliac crests

How is late stage testicular cancer treated?

radical inguinal orchiectomy and lymph node dissection

What is the mainstay for penile treatment?

radical surgery but consider function; partial or total penectomy topical chemotherapy laser ablation Mohs surgery Radiation with external beam or interstitial brachytherapy for those who refuse surgery or are low stage

How are early stage renal cancers treated?

radical, simple or partial nephrectomy and involved veins if positive lymph nodes

What is the age range for penile cancer?

range from 22 to 90 generally a disease of older men in the US 29% were younger than 30 years old

What is cystectomy?

removal of bladder

What can radical cystectomy also include?

removal of the prostate in men and removal of reproductive organs in women; urethra may be partially removed if high risk for local recurrence; will require an ileal diversion

How can solitary metastatic lesions be treated?

resected

Prostate cancer is ___ in mortality in the US

second in mortality lung first

How are low grade tumors treated?

segmental or radical cystectomy

If no penile box is used what side effects should be expected?

severe desquamation, stricture, fistula

Should patient bladder be empty or full for RT?

should be consistent so tell patient to empty bladder

What are the pre and post operative fields?

simple AP/PA fields or four field box

When can RT be used for bladder cancer?

used if no surgery or preoperatively for tumors invading the superficial muscle

How can the boost be delivered?

using rotational arcs

What is the lateral borders for testicular RT?

wide enough to include bilateral paraaortic nodes and ipsilateral external iliac or bilateral external iliac if inverted Y preferred

Can alopecia occur?

yes in the abdominal area