Procedures: Treatment Sites and Tumors (11.5%)

ARRT-T · 34 questions

• A breast core biopsy returns an invasive carcinoma with no special type. Microscopy shows tubule formation across about 40% of the tumor, moderate nuclear variation, and a moderate mitotic count, scored 2, 2, and 2 in the three-part grading system. Which histopathologic grade and type should be recorded for this tumor?
• During a planning conference the team reviews a core biopsy from a patient's breast mass. The pathology report identifies invasive carcinoma with tumor cells forming glands in part of the specimen, marked variation in nuclear size and shape, and frequent mitoses; the Nottingham score is 8 of 9 across its three features. Which statement correctly classifies this tumor's histologic type and grade?
• A patient treated for squamous cell carcinoma of the head and neck three months ago returns with worsening hoarseness and noisy breathing that eases when he sits upright. His arm and leg strength is normal, he swallows without difficulty, and his facial appearance is unchanged. The oncology team orders urgent radiation to relieve the blockage. Which anatomical obstruction is this emergency treatment intended to relieve?
• In the usual drainage pattern, a tumor in the upper outer quadrant drains through a predictable chain of nodal groups, and that quadrant has the densest lymphatic connection of any area of the breast. Which lymphatic drainage pathway is usually the first stop for cells leaving such a tumor?
• A patient with metastatic lung cancer is admitted with worsening leg weakness, and MRI confirms cord compression at an untreated thoracic vertebra. Steroids have been started, and the radiation oncologist wants the first fraction delivered today while the spine team decides on stabilization. Which treatment course should the department plan for this cord compression emergency?
• A patient with a mid-rectal tumor finishes chemoradiation and is booked for a posterior pelvis course. The target covers the mesorectum plus the nodal drainage that runs beside the pelvic sidewall vessels. Which lymphatic chain should be outlined as the nodal target for this site?
• A patient with adenocarcinoma of the mid-rectum is simulated prone on a belly board, and the physician's note states that the primary lesion sits above the dentate line and is confined to the rectal wall. The therapist is asked to confirm the nodal basin covered by the elective target volume. Which lymph node group is the first-echelon drainage for this mid-rectal tumor?
• A patient with diffuse large B-cell lymphoma has cervical and mediastinal node involvement plus splenic involvement, with no distant organ disease. The treatment plan needs a stage recorded under the current PET-CT-based consensus classification that revised the original Ann Arbor system. Which staging system applies to this lymphoma case, and what does its classification describe?
• A patient with known lymphoma is admitted with new leg weakness, saddle numbness, and inability to void, and MRI confirms an epidural mass compressing the spinal cord. The team wants radiation planning started today. Which reason justifies treating this spinal presentation as an emergency?
• A lung biopsy report describes malignant cells arranged in sheets with intercellular bridges and keratin pearls, and the physician wants the classification entered before planning begins. The team is deciding how the tumor should be labeled. How should this tumor be classified by type and grade?
• A radiation oncology team reviews the staging workup for a newly diagnosed follicular lymphoma. PET-CT shows disease in two contiguous lymph node regions on the same side of the diaphragm, with no marrow or extranodal involvement and no B symptoms. Which staging description correctly classifies this patient's disease?
• A punch biopsy from a lung lesion comes back describing malignant cells arranged in nests with intercellular bridges and focal keratin pearls, noted as moderately differentiated, with mitoses visible in several high-power fields. The staging conference needs this entered correctly in the treatment record. Which statement matches the tumor's histologic type and grade?
• A patient being treated for lymphoma reports new mid-back pain that began over two days, weakness in both legs, and difficulty starting urination. The physician is called to the department, and the team must identify what this finding represents. Which clinical urgency and next step match this presentation?
• A patient with a right upper lobe lung tumor is being staged, and the physician reviews the usual regional nodal drainage from this tumor location before planning the target volumes. Which nodal group is the best answer for the first-echelon regional drainage?
• A patient with newly diagnosed Hodgkin lymphoma has biopsy-proven involvement of a right cervical node and of the mediastinal nodes. PET-CT shows disease confined to lymphatic tissue, entirely above the diaphragm. Which Ann Arbor stage applies to this pattern of nodal spread?
• A breast core biopsy reports invasive ductal carcinoma with tubule formation under 25 percent, marked nuclear variation, and a high mitotic count, giving a combined Nottingham score of 8 out of 9. Which histopathologic type and grade should be entered in the record that the treatment plan references?
• At the initial planning conference, the team describes a patient with lymphoma involving nodal chains in the neck and around the abdominal aorta, a liver biopsy free of disease, and extranodal sites uninvolved. Which staging designation correctly classifies this patient's disease?
• During a simulation conference for a patient with a 3 cm invasive tumor in the upper outer quadrant of the left breast and no palpable adenopathy, the team must decide which nodal regions to contour on the planning CT. Which lymphatic drainage pattern correctly guides that contouring decision?
• A 62-year-old patient newly diagnosed with Hodgkin lymphoma has biopsy-proven cervical and retroperitoneal lymph nodes; the staging workup shows no extranodal organ involvement, and the patient reports no fever, drenching night sweats, or weight loss. Using the Ann Arbor system, which statement correctly explains this patient's stage classification?
• A pathology report on a resected mass describes malignant cells of epithelial origin arranged in solid sheets with no gland formation, marked variation in nuclear size, and mitotic figures in most high-power fields. The oncology team is completing the diagnosis summary for the treatment plan. Which histopathologic type and grade should be recorded?
• A patient is simulated for breast-conserving treatment of a 3 cm mass in the upper outer quadrant of the right breast, and the surgeon has documented a positive level I axillary sentinel node. The oncologist wants the first-echelon drainage basin confirmed before contouring. Which lymphatic drainage pattern should the team expect from this tumor?
• During review of a prostate plan, the physician notes that the highest posterior dose lands on a hollow pelvic organ and asks the planner to pull up its dose-volume limits for late toxicity. Which organ should be evaluated for those limits?
• A patient who had a testicular tumor removed is simulated for irradiation of the nodal drainage area, and the therapist checks that the field boundaries match the first-echelon nodes for this site. Which nodal region receives the primary lymphatic drainage from the testis?
• Breast lymph drains from the tissue into nodal basins, although individual drainage pathways can vary. For a cancer in the upper outer quadrant, with the skin clear and the opposite breast unaffected, which nodal group is the usual first-echelon drainage site for that tumor?
• A woman completes breast-conserving therapy for a lesion in the medial quadrant of the breast. Because the nodal regions at risk depend on which quadrant drains into which basin, the oncology team reviews the lymphatic pathway before discussing regional nodal coverage. Which nodal chain receives lymph directly from the medial quadrants of the breast?
• A patient admitted with a swollen face, distended neck veins and breathing discomfort is found to have a large mediastinal mass compressing the superior vena cava. The oncology team calls the department to arrange treatment today. Which treatment approach reflects the emergency intent of this referral?
• A female patient is simulated for treatment of the cervix, and the therapist outlines organs at risk on the planning CT before the plan is scored. Which relationship between the cervical target and the nearby pelvic organs is correct on axial images?
• A biopsy confirms a 4 cm adenocarcinoma of the colon. The primary has grown through the muscularis propria into the surrounding pericolorectal fat, the serosa is intact, and no adjacent organ is involved. One regional lymph node contains metastatic tumor, and imaging shows no distant spread. Which TNM classification fits these findings?
• During image review for a prostate treatment, the therapist traces the target against its neighboring pelvic organs and must name the organ directly behind the prostate for the setup notes. Which structure lies immediately posterior to the prostate?
• A patient with metastatic lung cancer returns for planned palliative treatment of a painful vertebral metastasis and reports that back pain like last month's has returned, but this time with new leg weakness and difficulty passing urine over the past day. Which approach correctly matches treatment urgency to this presentation?
• A patient with known metastatic disease develops new leg weakness and urinary retention over two days, and MRI shows a mass pressing the spinal cord at T10 with vertebral height preserved. Pain is controlled with medication. Which radiation indication and timing best match this presentation?
• A patient is simulated for an upper abdominal treatment with daily portal imaging, and the physician wants a landmark that holds the same position between fractions so image matching stays reliable. Several organs appear in the same image. Which upper abdominal organ best serves as the stable retroperitoneal landmark?
• A biopsy of a lung mass is read as nests of malignant epithelial cells with intercellular bridges and abundant keratin pearls, and the pathologist notes that keratin production dominates the specimen. Which histopathologic type and grade does this description support?
• A patient with a 3 cm cancer in the upper outer quadrant of the right breast is simulated for whole-breast treatment with regional nodal irradiation. The physician asks the therapist to explain why the contoured nodes are on the right side of the chest. Which lymphatic drainage pathway most commonly accounts for the first-echelon nodal target?