Applied Radiation Oncology 1 – Exam 3 Study Guide – Flashcards
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Function of Lymphatic System
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absorb excess fluid and proteins and return them to the blood stream; absorb fat in the villi of the small intestine; immune system
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Composition of Lymphatic System
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lymph nodes, lymph vessels and organs
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Flow of Lymph
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lymph capillaries to lymph vessels to lymph nodes or glands to lymph ducts
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Two main lymph ducts
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thoracic duct and right lymphatic duct
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Thoracic Duct
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drains lymph from entire body except upper right quadrant; drains into left subclavian vien
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Right Lymphatic Duct
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drains lymph from upper right quadrant of the body; drains into right subclavian vein
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Where does the thoracic duct originate?
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as a dilated structure in the lumbar region of the abdominal cavity called the cisterna chyli
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Where are lymph nodes located?
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Along lymph vessels
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what are the function of lymph nodes?
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1. Promote lymphocytes (hemopoiesis) 2. filters out microorganisms and other debris (filtration and phagocytosis
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what is the sentinel lymph node?
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the first line of drainage from the tumor site
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what do t-cells do?
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directly attack infected or cancerous cells
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what do b-cells do?
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produce antibody against antigens
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when treating bone marrow, what must we keep an eye on as a therapist?
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blood counts because bone marrow produces RBCs, b-lymphocytes, monocytes and leukocytes
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Thymus Gland
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site of t-cell maturation; lymphocytes become specialized; very active as child and degenerates as you get older
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What is the function of tonsils?
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prevent bacteria from entering the upper respiratory and digestive tract
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three pairs of lymphoid structures that produce lymphocytes:
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Pharyngeal/Adenoid (located along pharynx wall); Palatine (we can see); Lingual (sit on back of tongue)
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Spleen
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largest lymph organ; does not filter lymph; if someone has a splenectomy, then the liver and red bone marrow take over its job; storage organ for an emergency blood supply
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Submandibular Node
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located under mandible, half way between chin and jaw joint
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Submental Node
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located under tip of chin
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occipital node
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located at the descendent part of the occipital bone
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jugulodigastric (subdigastric) node
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located at angle of the mandible; treated with ALL head and neck cancers
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posterior cervical chain (spinal accessory) nodes
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on lateral aspects of the posterior neck aligned with the cervical spine
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superior deep lateral cervical (internal jugular) node
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along neck muscle
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supraclavicular node
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superior to collar bone; breast cancer drains here
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what lymph node does the glottis drain to?
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it does not have any lymph nodes associated with it
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retropharyngeal nodes
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behind pharynx wall; the first one is called "Rouviere's node"; anterior and lateraly to C1 and C2 vertebral bodies
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parotid node
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drains to Stenson's duct; buccal mycosa also drains here
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intrapulmonary nodes
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located on bronchioles leading into lungs
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paratrachial nodes
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located along the trachea
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Scalene node
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located above lung and lateral to internal jugular vein;
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Bronchopulmonary (hilar) nodes
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located along the hilum (the opening to the lung where all of the bronchi and vessels feed into it); common node when talking about hodkins and lung cancer
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paraaortic nodes
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includes the cisterna chyli and celiac node; sentinel node for early testicular cancer
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common iliac node
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very close to hypogastric node and located at the biforcation of the common iliac blood vessel
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obturator node
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prostate Cancer sentinel node; involved with cervix and prostate
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external iliac nodes
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most lateral and anterior nodes; at the level of the pubic symphysis
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deep inguinal nodes
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treated with anal cancer and very low rectal and vulva cancer
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sacral nodes
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treated with rectal cancer
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Virchow's node
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located along thoracic duct
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lateral axillary nodes
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outer quadrant for breast drains to these nodes
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inframammary chain
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inner quadrant = 2-3 cm lateral to midline, 2-3 cm deep; drains to these nodes
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Nasal Cavity
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located above hard palate
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Oral Cavity
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located below hard palate and above the hyoid bone; includes the lip, floor of mouth, oral tongue, buccal mucosa and gingiva & hard palate
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Larynx
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located below the hyoid bone; includes the supraglottis, glottis and subglottis
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Nasopharynx
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located behind the nasal cavity and is everything above the soft palate; pharyngeal tonsils (adenoids) located here; also houses the auditory openings
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Oropharynx
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located behind the oral cavity and is everything below the soft palate and above the hyoid bone; includes the base of the tongue, soft palate and tonsillar fossa
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Hypopharynx (laryngopharynx)
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located behind the larynx and is everything below the hyoid bone; includes the pharyngeal walls and pyriform sinus
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Base of tongue drains to:
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jugulodigastric, midjugular and low cervical
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Soft palate drains to:
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jugulodigastric
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tonsillar fossa drains to:
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jugulodigastric, submaxillary, rouviere's node(retopharyngeal) and midjugular
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Lip drains to:
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submandibular, subdigastric and submental
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floor of mouth drains to:
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submandibular and subdigastric
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oral tongue (anterior 2/3) drains to:
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submandibular and subdigastric
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Buccal Mucosa drains to:
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submandibular, subdigastric and upper jugular, parotid node
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Gingiva and Hard palate drain to:
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submandibular and subdigastric
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Nasopharynx drains to:
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jugulodigastric, jugular chain and posterior cervical or spinal accessory chain; may be hard to treat because it is difficult to excise
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Supraglottis drains to:
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subdigastric and midjugular
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Subglottis drains to:
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pretracheal, inferior jugular and mediastinal nodes
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Pharyngeal walls drain to:
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jugulodigastric and jugular chain
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Pyriform sinus drains to:
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jugulodigastric and jugular chain
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Nasal Cavity and paranasal sinus drains to:
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lateral pharyngeal nodes and subdigastric
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Major salivary glands drain to:
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parotid nodes located anterior and slightly inferior to the ear
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Lung drains to:
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hilar, mediastinal, supraclavicular and intrapulmonary nodes
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esophagus drains to:
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internal jugular, cervical, supraclavicular, paratracheal, hilar subcrinal, PARAESOPHAGEAL, paraaortic, to the lower part of the esophagus = paracardial, lesser curvature, left digastric and celiac nodes
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Stomach drains to:
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left digastric-drains a large surface on both sides of the stomach; splenic artery collecting trunks-drains fundus and body; hepatic artery collecting trunks-drains the right part of the curvature as far as the pylorus and gastroepiploic areas
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Small intestines drain to:
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mesenteric nodes and peyer's patches
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What is Peyer's Patches?
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conspicuous patches of lymphoid tissue located in the mucosa of the ileum. each patch consists of a cluster of lymph nodules; not all of them can be treated because there are too many and we would have to treat the whole abdomen
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Rectum drainst to:
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perirectal, sacral, hypogastric, inguinal (if the cancer is very low and close to the anus) and the external iliac nodes
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bladder drains to:
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external iliac, hypogastric and common iliac
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prostate drains to:
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OBTURATOR, periprostatic, hypogastric and external iliac nodes
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Testes drain to:
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Para-aortic(superior border located at T10-T11)-at the level of the renal pedicles (around L1 andL2) then may further extend to the thoracic duct; virchows node-next to left clavicle
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Cervix drains to:
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external iliac, hypogastric and common iliac nodes
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endometrium drains to:
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obturator, external iliac, common iliac, and para-aortic nodes at a higher stage
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Ovaries drain to:
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para-aortic and Virchows node
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Vagina drains to:
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upper portion-external iliac middle portion-hypogastric lower portion-common iliac
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Vulva drains to:
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inguinal nodes
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Breast drains to:
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axillary, internal mammary chain(inner quadrant of the breast) and supraclavicular nodes
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Upper extremities drain to:
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epitrocheal nodes drain the superficial areas; axillary nodes-drain the upper extremity, breast, and lower part of the neck(about 20-30 nodes in the axilla)
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Lower extremities drain to:
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Popliteal-drains into the deep inguinal nodes; Superficial nodes-lie above the termination of the great saphenous vein and drain the skin from all areas lying below the umbilicus; Subinguinal nodes-superficial and deep nodes, drains the superficial and deep structures of the lower extremity
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What are the two protective coverings of the brain?
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the skull and the meninges
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what is the outermost layer of the inner covering of the brain?
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Dura Mater-strong white fibrous tissue
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What is the middle layer of the inner covering of the brain?
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Arachnoid membrane-cobweb like
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What is the inner layer of the inner covering of the brain?
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Pia Mater-adheres to the outer surface of the spinal cord and is transparent;very vascular and is the provides the nutrition to the brain
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What are the three layers in the Dura Mater?
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Falx Cerebri, Falx Cerebelli and tentorium cerebelli
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What is the falx cerebri?
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projects longitudinally down between the two cerebral hemipsheres
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What is the falx cerebelli?
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separates the two cerebellum hemispheres
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What is the tentorium cerebelli?
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separates the cerebellum from the cerebrum
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Where is it most common for peds to get brain tumors?
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infratentorium
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Where is it most common for geriatrics to get brain tumors?
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supratentorium
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Which tentorial tumor will be detected earlier?
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infratentorium
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What are the three spaces in the meninges?
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Epidural-between duramater and skull(cushion); subdural-between duramater and arachnoid membrane(lubricating); subarachnoid-between arachnoid and pia mater(CSF)
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What is cerebrospinal fluid (CSF)?
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located in subarachnoid space and around teh brain, spinal cord and cavities and canals(ventricles) of the brain and spinal cord; 4 large ventricles of brain are the fluid filled spaces
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Where are the 1st and 2nd ventricles located?
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laterally; located in each hemisphere of the cerebrum
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Where is the 3rd ventricle located?
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midline thin pocket located just below lateral ventricles
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Where is the 4th ventricle located?
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diamond shaped; anterior to cerebellum and posterior to brainstem
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How is CSF created?
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by separation of blood in the choroid plexuses.
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What is a choroid plexus?
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networks of capillaries that project from the pia mater into the lateral ventricles and in to the roof of the third and fourth ventricles
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Why would we be worried about CSF?
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because it could move down the spinal cord and then the patient would need to be craniospinally treated
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How does the CSF flow?
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lateral ventricle-->third ventricle-->cerebral aqueduct or aqueduct of Sylvius-->fourth ventricle-->through lateral foramen-->cisterna magna located behind the medulla which is continuous with the subarachnoid space
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How far down does the spinal cord go down the spine?
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from the foramen magnum to L1-L2; then because the cauda equina; contains meninges, CSF, adipose tissue and blood vessels
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When is the brain to its full size?
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about age 18; it grows rapidly for the first 9 years of life
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What are the four divisions of the brain?
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Cerebrum, cerebellum, diencephalon and brain stem
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What does the brain stem contain?
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medulla oblangata, pons and midbrain
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What are the functions of the brain stem?
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sensory motor and reflex, pons regulates breathing, midbrain controls pupillary reflexes and eye movements, sleep and wake cycles and BP, arousal and consciousness, and heartrate
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What is contained in the diencephalon?
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between cerebrum and midbrain; thalamus, hypothalamus, optic chiasma, and pineal body
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What are the functions of the diencephalon?
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Thalamus-pain, temp,touch, feelings of pleasantness and unpleasantness; hypothalamus- floor of third ventricle, controls and regulates body responses, maintains homeostasis
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What are the functions of the cerebellum?
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coordination of muscles, controls posture and smooth movement, and controls skeletal muscles to maintain equilibrium; *COORDINATION AND BALANCE*
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What are the four parts of the cerebrum?
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Frontal, Temporal, Parietal, and Occipital
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what are the functions of the frontal lobe?
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behavior, personality, emotion, intelligence, problem solving
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What are the functions of the parietal lobe?
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intelligence, spatial and visual perception, reading, sensation of touch
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What are the functions of Occipital lobe?
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controls vision
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What are the functions of the temporal lobe?
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hearing, memory, understanding language
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what symptoms could a brain tumor or injury cause?
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reduced thinking speed, confusion, reduced attention and concentration, fatigue and impaired cognitive(thinking) abilities
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Oh Oh Oh To Touch And Feel Very Good Vagina And Hymen
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Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory and Hypoglossal
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Some Say Marry Money But My Brother Says Big Butts Matter More
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sensory, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor
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What is Nerve 1 function?
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Olfactory, sensory; senses smell; sits behind frontal sinus and above ethmoid bone
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What is the function of Nerve 2?
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Optic, sensory; vision; from retina to occipital lobe
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What is the function of Nerve 3?
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Occulomotor, motor; muscles of eye, constriction of pupil, controls amt of light coming into eye
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What is the function of Nerve 4?
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Trochlear, motor; moves eye towards nose and downward, trauma results in double vision
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What is the function of Nerve 5?
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Trigeminal, mixed; Opthalamic-scalp, upper eyelid, cornea, lacrimal gland; maxillary-nasal cavity, cheek, upper teeth, lip; mandibular-muscles of mastication, chin, anterior tongue
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What is the function of Nerve 6?
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Abducens, motor; abducts eye
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What is the function of Nerve 7?
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Facial, mixed; extends superficial muscle of face to make expressions and receives sensory impulses from taste buds
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What is the function of Nerve 8?
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Vestibulocochlear, sensory; equilibrium and hearing
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What is the function of Nerve 9?
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Glossopharyngeal, mixed; sensation of tongue, movement of swallowing and secretion of saliva; REFLEX CONTROL OF BP AND RESPIRATION
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What is the function of Nerve 10?
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Vagus, mixed; slows heart, increased peristalsis, muscles of voice production
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What is the function of Nerve 11?
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Accessory, motor; shoulder, neck, thoracic, abdomen, pharynx and larynx; assists body movement as an accessory
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What is the function of Nerve 12?
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Hypoglossal, motor; controls tongue and throat, swallowing
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Oligodendrocyte
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gray matter; nondividing neuroins
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Oligodendroglia
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white matter; nerve fibers with axon and supporting structures
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Most common side effect with brain tumors?
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70% headaches; 55% seizures
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What does it mean if there is a sudden onset of symptoms?
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the grade is high, with undifferentiated cells that grow faster than normal nerve cells
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What will be done if a person shows symptoms of a brain injury or tumor?
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There will be a complete neurological workup with eye, tongue, speech, walking, memory test
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What helps define prognosis?
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grading of the tumor
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Tolerance dose (TD) for lens of eye
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1000cGy
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TD for lacrimal gland
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2600cGy
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TD for optic chiasm
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5000cGy
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TD for optic nerve
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5000cGy
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TD for 1/3 of the brain
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5800cGy
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TD for 3/3 of the brain
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4700cGy
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TD for 1/3 of brain stem
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6000cGy
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TD for 3/3 of brain stem
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5000cGy
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TD for 3/3 of spinal cord
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4700cGy
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TD for ear
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3000cGy; 5500cGy
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What are the 5 classifications of primary brain tumors?
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Glioma, neuronal/glioneural neoplasms, embryonal neoplasms, meningeal neoplasms, and miscellaneous nonglial neoplasms
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What are some acute side effects of radiation therapy?
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temporary hair loss (200-4000cGy), permanent hair loss (over 4000cGy), fatigue, brain swelling (treated with corticosteroids)
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What are some late side effects of radiation therapy?
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focal necrosis, long term damage that may cause stroke, decreased hormone production, decreased intellect/dementia
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Gliomas in adults vs. pediatrics
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50% of primary brain tumors, most common in cerebrum in adults and 45% of primary brain tumors, most common in cerebellum and brain stem in children
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Types of gliomas
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astrocytoma, oligodendroglioma, ependymoma, mixed cell
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What is the difference between a focal tumor and a diffuse tumor?
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a focal tumor is more confined and encapsulated where is a diffuse tumor has less borders and is more infiltrative
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Grade 1 tumor
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low proliferative potential, possibility of cure after surgery
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Grade 2 tumor
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generally infiltrative, low mitotic activity and may progress to higher grades
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Grade 3 tumor
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clear mitotic activity, infiltrative
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Grade 4 tumor
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prone to necrosis, rapid pre/post-op evolution of disease and very active mitotic lesions
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Oligodendroglioma
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less than 5% of all primary brain tumors, usually found in supratentorium, 65-90% survival rate at 5 years
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Ependymoma
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less than 5% of all primary brain tumors, cells align by ventricles, spinal tap will be done
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Meningioma
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only 8% will be malignant, very slow growing with recurrence happening about 4 years after surgery; 90% survival rate with full resection and 81% for partial resection
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Metastatic Brain tumor
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most common brain lesion, 20-40% of all cancer patients will develop metastasis in brain with an avg of 6 month survival; over 5 lesions will be treated whole brain
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German helmet
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used when there is CSF involvement, includes cribiform plate, temporal fossa and level of C2 in order to get brain stem
