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Endo Cervix CA
Endometrial, Cerbvix CA, Radiation Therapy, Treatment, Fields
| Question | Answer |
|---|---|
| Most frequent gyn cancer before age fifty is | cerix (16%), invasive in older group |
| Most grequent gyn ca in older women is | endometrial 48% |
| after reproductive years, incidence of endometrial and ovarian ca does what | increase |
| What does endometrial present with and what is good about it | irregular bleeding, early presentation (early diagnosis high cure rate) |
| What are risk factors of endometrial ca | high calorie and high fat diet, use of unopposed estrogen during 1960 and 1970s, link with diabetes and hypertension, women 50lbs overweight, prolonged hrt |
| What are some characteristics of vaginal and vulvar ca | rare, mostly older women, vulvar 3 times as common as vaginal risk |
| What provides early detection for endometrial ca | pap smear, done via curettage |
| Anatomically what is the cervix | The cervix is a part of the uterus that extends into the apex of the vagina, it is a firm and round structure from 1.5 to 3 cm in diameter. |
| In reference to location where is the cervix | The cervix is the lower third of the uterus that extends into the apex of the vagina |
| What standing does ovarian ca have in cause of death in women | 4th |
| Of the cancers pertaining to cervix what is the most common | Squamous cell |
| What cancer accounts for 10% of cervix cancers | Adenocarcinoma that arise from mucous-secreting endocervical glands |
| What cancer accounts for 2% of cervix cancers | Small cell and clear cell types, they also have a higher metastatic potential |
| What lymphatic drainage is included in cervical cancer | external iliac, obturator, and hypogastric (internal iliac) chains. |
| What staging system is used for cervix ca | FIGO staging system |
| What in regards to the stage of cervix ca is TX | Primary tumor cannot be assessed |
| What in regards to the stage of cervix ca is T0 | No evidence of primary tumor |
| What in regards to the stage of cervix ca is Tis | Carcinoma in situ, preinvasive carcinoma |
| What is special about stage 0 in regards to FIGO | FIGO no longer includes Stage 0 (Tis) |
| What in regards to the stage of cervix ca is T1 (FIGO I) | Cervial carcinoma confined to uterus (extension to corpus should be disregarded) |
| What in regards to the stage of cervix ca is T1a IA | INvasive carcinoma diagnosed by microscopy. Stromal invasion with a max depth of 5 mm and a horizontal measurment of 7 mm or less. If there is vascular space involvement venous or lymphatic does not affect the classification |
| What do you need to know in regards to the stage of cervix ca is T1a1 | Stromal invasion of 3 mm in depth and 7 mm or less in horizontal |
| What do you need to know in regards to the stage of cervix ca T1a2 | Stromal invasion of more than 3mm and no more than 5mm, horizontal spread of 7mm or less |
| What do you need to know in regards to the stage of cervix ca T1b | Visible lesion confined to cervix or microscopic lesion greater than T1a/Ia2 |
| What do you need to know in regards to the stage of cervix ca T1b1 | Clinically visible lesion 4 cm or less in greatest dimension |
| What do you need to know in regards to the stage of cervix ca T1b2 | Clinically visible lesion more than 4 cm in greatest dimension |
| What do you need to know in regards to the stage of cervix ca T2 | Cervical ca invades beyond uterus but not to pelvic wall or to lower third of vagina |
| What do you need to know in regards to the stage of cervix ca T2a | Tumor without parametrial invasion |
| What do you need to know in regards to the stage of cervix ca T2a1 | Clinically visible lesion 4 cm or less in greatest dimension |
| What do you need to know in regards to the stage of cervix ca T2a2 | Lesion more than 4 cm in greatest dimension |
| What do you need to know in regards to the stage of cervix ca T2b | Tumor with parametrial invasion |
| What do you need to know in regards to the stage of cervix ca T3 | Tumor extends pelvic wall/ causes hydronephrosis or nonfunctioning kidney |
| What do you need to know in regards to the stage of cervix ca T4 | Tumor invades mucosa of bladder or rectum/ extends beyond true pelvis (bullous edema is not sufficient to classify as T4) |
| What does N1 represent in the FIGO staging system | IIIB |
| What does T4 represent in figo staging | IVa |
| In regards to metastasis what guidelines are there for classifying cervix ca metastasis | M0 no distant mets, M1 Distant mets (including peritoneal spread, involvement of supraclav, mediastinal, or paraaortic lymph nodes, lung liver or bone) |
| What does M1 signify in the FIGO staging system for cervix ca | IVB |
| List the diff histologic groupings or types of squamous cell ca of the cervix | Invasive, keratinizing, nonkeratinizing, verrucous |
| What is the workup for cervix ca | initially a pelvic exam, pap smear, and biopsy of any lesions. To further stage, curettage and dilation under anesthesia to examine uterine involvement is needed, this would be paired with a cbc and urine |
| What has replaced IVP's for staging now | Abodominal and pelvic ct |
| What is traditional tx for Tis & Ia1 | total abdominal hysterectomy and removal of vaginal cuff. |
| If women with Tis/Ia1 wish to have children what can be done | Tandem and ovoid giving 45 to 55 gy to point a. |
| FOr stage Ia2 what might be used for tx | more aggressive modified radical hysterectomy, if inoperable 70-80gy to cervix and parametrial tissue delivered with TNO impolant in 2/3 tx. If tx is in 4-6 tx it would be 25-30gy with HDR insertion |
| For stage Ib2 cervical disease, what is used | rad therapy doses 80 to 85 gy using combined treatments. |
| What treatment might a IIb, III, and IVa cervix carcinoma be treated with | irradiation and chemo, unless chemo is contraindicated. |
| What is important in regards to treatment of cervix and brachytherapy | Brachy is important aspect of tx and for control, when brachy is not used survival rates decrease. |
| What is the technique used on a whle pelvis (cervix ca) | 4 field box or high energy (min of 16 mv) AP/PA technique |
| What is the lower border for RT with cervix cancer | LOwer border falling at inf aspect of obturator foramen unless vaginal involement is present in which case lower extent of border is at least 4 cm below most infereior extent of disease. |
| What is the upper border usually for cervix ca | at top or bottom of L5 or may be extended upward to l4 for a portion of treatment depending on potential involvement of nodes. |
| What are the lateral borders for cervix ca in regards to RT | 1.5 to 2 cm lateral to pelvic sidewall in ap/pa plane, ant border of lats may fall beyond pubic symphysis if not at it. |
| What blocking should be used for lateral fields on cervix ca | block that includes external iliac nodes and post border including s3 |
| if there is ant or post extension what must happen to the fields (cervix ca) | widening of lats or ap/pa field widening as well to include s4/s5. |
| What purpose would brachytherapy have when combined with 4 field box rt (cervix) | To decrease dose given to entire rectum and bladder, the four field technique allows you to block the bladder and rectum |
| in regards to positioning what may help with the tx of cervix ca | prone positioning on belly board or full bladder may allow exclusion of small bowel without risking full dose to tumor |
| How is point A prescribed for cervix ca | 2 cm sup to cervical os and 2 cm lat to endocervical canal |
| How is point B prescribed for cervix CA | 3cm lat to point a |
| What are some of the clinical presentations of endometrial ca | 75% present with vaginal bleeding, 30% have putrid vaginal discharge |
| What workup can be done for endometrial ca | aspiration curettage is the standard currently, due to the increase of accuracy over pap smears. |
| What has been an increasing case for detection of endometrial ca | women with uterine bleeding have been getting endometrial sampling or aspiration while in the office setting. |
| To get a complete workup of endometrial ca what can be done | aspiration, chest xray, blood count, chemistries, urinalysis and nod surgery is the standard for initial defnitive management. An ultrasound and ct/mri is often being performed first if disease may be beyond uterus. |
| What is most common for endometrial ca | adenomcarcinoma of the endometrial lining. |
| What is seen about 20% of the time in endometrial cancer (type of ca) | adenocarcinoma with squamous differentiation, also means more advanced in stage (usually). |
| What is an extremely malignant form of endometrial ca | Papillary serous adenocarcinoma, tends to spread rapidly through abdomen. |
| What is the treatment guideline for endometrial ca stage Ia grade 1 | TAH and no other tx |
| What is the treatment guideline for endometrial ca stage Ib, grade 1 & 2 | TAH and brachy alone, low doses of 60 to 70 gy used in one application, or high doses of 5 to 7 gy at a 5mm depth in three applications. |
| What is the treatment guideline for endometrial ca stage Ic or higher, grade 3 | Due to risk of pelvic node involvement, external beam and TAH |
| In addition to post surgery extrenal beam and TAH what are the nodal doses associated with IC or higher grade 3, as well as the dose given to the vaginal mucosa (via implant) | Nodal dose of 45-50 gy, and 80 gy to the mucosa |
| For medically inoperable and stage III/Iv endometrial patients what tx alone can be used | irradiation, 50gy external beam with an implant that will bring the tumor dose above 75 gy, for bulky disease the dose can be brought to 100gy (careful technique required paired with midline blocking) |
| For stage IB, grade 1 &2 and sometimes stage Ia, grade 2 what might be used (tx beyond TAH) | vaginal cylinder or colpostats, which are used to treat the vaginal cuff. |
| For RT fields referring to endometrial ca, what are the field perameters | similar to cervical fields, midline blocking used if brachytherapy is included. |
| What are some acute side effects of pelvic radiation therapy | fatigue, diarrhea, dermatitis, dysuria |
| What usually occurs, acute side effects, in the second to third week of pelvic irradiation and why | Diarrhea, and is related to large/small bowel treatment. Chemo may significantly worsen problem |
| What can help against diarrhea that patients may experience | Low fiber diets, sucralfate (carafate which coats bowels), lomotil, and loperamide. |
| What is a side effect more common using low energy beams in treating gynecologic cancers | Dermatitis, due to ap/pa only fields, with use of bolus and using chemo as well. |
| What can be used to help with possible dermatitis | Domboro soaks, aquaphor and natural gels/lotions. |
| What side effect may occur in the third or fourth week of pelvic irradiation for gynecologic cancers and how can it be lessened | Dysuria, treatments done with a full or partial bladder exlusion on lateral fields and maintenance of a partially full bladder during brachytherapy (move bladder out of treatment) |
| What can be used to relieve urinary frequency when patient is having dysuria | Levsin (hyoscyamine) and Hytrin (terazosin) |
| What can be helped correct tumor bleeding | Superficial en face radiation using orthovoltage, high-energy photons, or electrons can be applied directly to the vaginal and cervical tumors with large fraction size and not count against the total prescribed dose. |
| What can be helped with rectal irritation | hemorrhoidal preparations, steroids, topical anesthetic agents, and sitz baths |
| What are some late side effects of pelvic irradiation due to tx of gynecologic cancers | menopause, vaginal dryness/narrowing/shortening, chronic cystitis, proctosigmoiditis, enteritis, and bowel obstruction. |
| What can be done to help late side effects of pelvic irradiation due to gynecologic cancers (vaginal dryness, shrinkage, ulceration) | replacement hormonal therapy, dryness can be helped with Replens or hormonal creams, shrinkage can be prevented with vaginal dilators or regular sexual activity, and ulceration can e treated with local medications, pentoxifylline (antinflam) |
| As a therapist what are some things that can help reproducibility with pelvic irradiation | Reminding patient to maintain a full bladder to exclude small bowel, keep patient on low residue diet and to remain open and responsive to patient concerns. |
| In referrence to bowel movements in patients with pelvic irradiation what is the primary concern | Watery diarrhea, which needs to be brought to the staff's attention. |
| In reference to treatment being an SSD or SAD setup, what is going to be the setup for pelvic irradiation for gynecologic cancers | SAD |
Created by:
emeriken1277
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