ESOPHAGUS CH

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RadTherapy
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181127
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ESOPHAGUS CH
Updated:
2012-11-02 00:16:23
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ESOPHAGUS
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ESOPHAGUS CH
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  1. What is a straight collapsible 10 in tube that functions as a passageway thru the thorax
    esophagus
  2. The Esophagus begins at the base of the ____ at the level of ___ and descends behind the trachea thru the ____
    • pharynx
    • C6
    • mediastinum
  3. The esophagus penetrates the diaphragm thru an opening, the ___, and is continuous with the stomach on the abdominal side of the diaphragm
    Esophageal hiatus
  4. Where is the esophagus in close proximity to?
    Aorta and Trachea
  5. THe cervial esophagus is about ___ ling and extends from the level of ___ to the level of ___
    • 5cm
    • C6
    • T1
  6. Esophagus can be broken up into cervical and thoracic but also into
    • Upper 3rd
    • middle 3rd
    • lower 3rd
  7. Where are the esophageal cancers least and most common?
    • Least in the upper 3rd
    • Most in the middle or lower 3rd
  8. Drainage of the esophageal lymphatics is unpredictable and can skip met. A distance of as much as ____ of normal esophagus may be interposed between site of tumor and lymphatic met
    8 cm
  9. Which nodes are most important in esophageal cancers
    • Super Clav
    • Celiac
  10. What % of all cancers are esophageal?
    What % of all cancerl deaths are esophageal?
    • 1%
    • 2% death
  11. Men are how many more times likely to get esophageal CA than women?
    3-4 more times
  12. African American are ____ higher risk than whites for esophageal CA
    50%
  13. What is the age of diagnosis for esophageal CA
    55-85
  14. What are some incidences and etiology of esophageal CA
    • alcohol
    • tobacco
    • Barrett's Esophagus
    • Achalasia
    • Plummer-vinson
  15. The distal part of the esophagus is lined with ____ instead of ____ like the beginning.
    • columnar epithelium
    • stratified squamous
  16. What is a disease of the muscle of the esophagus in which the lower 2/3 loses normal peristaltic activity?
    Achalasia
  17. What is a disease that is in response to chronic GERD and changes the lining consistency of the esophagus
    Barrett's Esophagus
  18. What is an iron deficient anemai that causes a difficulty in swallowing
    Plummer vinson syndrome
  19. what are some clinical presentations of esophageal CA
    • #1 dysphagia and weight loss
    • chest pain
    • regurgitation
    • aspiration
    • odynophagia
    • hematoemesis (vomitting blood)
    • coughing
    • hemoptysis (spitting up blood)
    • hoarseness
  20. What are ways to detect esophageal CA
    • chest xray
    • PET/CT
    • esophagoscopy
  21. What % of esophageal CA is located in the middle 3rd?
    40-50% #1 spot
  22. What % of esophageal CA is located in the upper 3rd?
    10-25 % least common
  23. What % of esophageal CA is located in the lower 3rd
    25-50%
  24. What is the most common pathology for esophageal CA
    Squamous cell (upper and middle)
  25. What is the cancer called if found in this distal part or lower 3rd of the esophagus near the GE junction?
    Adenocarcinoma
  26. What is the staging for esophageal ca
    TNM and based on outward extension
  27. What is the 5 year survival rate for esophageal ca
    5%
  28. Once esophageal CA is in the ____ it can skip around via lymphatics
    submucosal layer
  29. Where are distant esophageal mets found
    • #1 LIVER
    • lung
    • bone
    • adrenals
    • brain
  30. How can esophageal ca spread?
    • lymphatics
    • local invasion (trachesophageal, bronchoesophageal)
    • blood
  31. Where can surgery be done for esophageal ca
    middle and lower 3rd and only for small non-mets
  32. What are the complications for esophageal CA
    • anastomic leaks
    • PE
    • myocardial infarction
    • strictures
    • GE reflux
  33. Which chemo durgs are used for esophageal ca
    • 5-FU, cisplatin
    • used in conjunction with radiation for better local control and distant met disease
  34. what margin do you use to treat esophageal CA with radiation
    • 5cm superior and inferior
    • 2-3 cm laterally
  35. If you have a lesion in your esophagus of the lower 3rd, how would you treat?
    Treat with fields to include the mediastinal nodes and celiac axis
  36. If you have a lesion in your esophagus of the upper 3rd, how would you treat?
    A field that begins at the level of the thyroid cartilage and ends at the level of the carina to include the SCV nodes, low anterior cervial, and mediastinal nodes.
  37. If you have a lesion in your esophagus of the middle 3rd, how would you treat?
    • treat to include
    • perisophageal modes
    • mediastinal nodes
  38. Which fields are used to treat the bulk of the esophageal tumor?
    AP/PA
  39. Which boost fields are done to treat esophageal ca
    • a 3-field technique- AP and 2 posterior obliques, or
    • olbiques, laterals or IMRT
  40. How should you position a patient for treatment of esophageal ca
    • Supine with arms overhead or by side
    • OR
    • prone with arms over head
  41. When treating esophageal CA using radiation with chemo, what dose do you use?
    5040 cGy with off cord at 3600-4500 cGy
  42. If using radiation alone to treat esophageal CA, what dose do you use?
    6500 cGy with off cord at 3600-4500 cGy
  43. What critical structures do you worry about when treating with radiation for esophageal ca
    • lungs
    • cord
    • heart
  44. What are the side effects for radiating esophageal ca
    • #1 ESOPHAGITIS
    • ulceration
    • decreased blood counts
    • radiation pneumonitis
    • pericarditis
    • strictures
    • transvers myelitis

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