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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [14] Radiotherapy > Flashcards

[14] Radiotherapy Flashcards

1
Q

What is radiotherapy?

A

The use of high-energy rays to treat disease

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2
Q

How does radiotherapy work?

A

By destroying cancer cells in the area that is being treated

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3
Q

Is radiotherapy given internally or externally?

A

Can be either

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4
Q

What is done in external radiotherapy?

A

High-energy x-rays are aimed at the affected area using a large machine

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5
Q

What is done in internal radiotherapy?

A

Radioactive material is placed inside the body

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6
Q

Can normal cells be damaged by radiotherapy?

A

Yes

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7
Q

What is the result of normal cells be damaged by radiotherapy?

A

Can cause side effects

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8
Q

How does the effect of radiotherapy differ in normal cells compared to cancer cells?

A

Cancer cells cannot repair themselves after radiotherapy, but normal cells can

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9
Q

What is it called when chemotherapy is given alongside radiotherapy?

A

Chemoradiation, or chemoradiotherapy

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10
Q

What effect might chemotherapy drugs have on radiotherapy?

A

May make cancer cells more sensitive to chemotherapy

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11
Q

What is the down side of giving chemotherapy and radiotherapy together?

A

Can make the side effects of treatment worse

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12
Q

What are the main types of radiotherapy?

A
  • External beam radiotherapy

- Internal radiotherapy

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13
Q

What are the types of external beam radiotherapy?

A
  • Conformal radiotherapy
  • Intensity modulated radiotherapy (IMRT)
  • Image-guided radiotherapy
  • 4C radiotherapy
  • Stereotactic radiotherapy
  • Total body irradiation
  • Intraoperative radiotherapy
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14
Q

What does conformal radiotherapy use?

A

A device inside the radiotherapy machine to shape the radiotherapy beams to fit the treatment area

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15
Q

What is conformal radiotherapy used to treat?

A

Many types of cancer

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16
Q

What does IMRT do?

A

Shapes the radiotherapy beams, and allows different doses of radiotherapy to be given to different parts of the treatment area

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17
Q

What is the advantage of IMRT?

A

It means lower doses of radiotherapy are given to healthy tissue surrounding the tumour

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18
Q

What is the importance of the reduction in radiotherapy to healthy tissue around in the tumour in IMRT?

A
  • It reduces the risk of immediate and long-term side effects
  • May allow higher doses of radiotherapy to be given to the tumour
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19
Q

What is the result of IMRT having a reduced risk of damage to healthy tissue and side effects on the tumours is used to treat?

A

It is often use to treat tumours that are close to important organs and structures

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20
Q

What kind of cancers is IMRT mainly used to treat?

A
  • Breast cancer
  • Head and neck cancer
  • Anal cancer
  • Prostate cancer
  • Bladder cancer
  • Gynaecological cancer
  • Lung cancer

dunno why i wrote cancer after every single one lol obvs its treating cancer its in the cancer care deck

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21
Q

What is volumetric modulated arc radiotherapy (VMAT)?

A

A newer way of giving IMRT, where the radiotherapy moves around the person while treatment is being given

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22
Q

What is the advantage of VMAT?

A
  • Shortens treatment time

- Uses lower dose of radiation

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23
Q

What is image-guided radiotherapy?

A

Where images are taken just before each treatment

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24
Q

What is the purpose of image-guided radiotherapy taking images just before each treatment?

A

It allows for comparison with images taken during the planning scan, and adjustment of to the treatment area

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25
Q

What is the advantage of adjusting the treatment area with image-guided radiotherapy?

A

It means it is very precide

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26
Q

Why is image guided radiotherapy helpful?

A

Because some tumours can shrink in size, or change in shape or position, during or between treatment

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27
Q

Give an example of a cancer that might change in shape or position during or between treatments

A

Prostate or cervical tumours can change depending on if the patient has a full bladder

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28
Q

What does 4D radiotherapy use?

A

A radiotherapy machine that takes images during the treatment

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29
Q

What is the purpose of 4D radiotherapy?

A

It shows any movement of the tumour, which is then used to adjust the radiotherapy treatment area during treatment

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30
Q

What is the purpose of 4D radiotherapy?

A

it means that if the tumour moves, it’s possible to make sure that it’s fully treated

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31
Q

When is 4D radiotherapy useful?

A

In tumours that move during treatment

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32
Q

Give an example of a tumour that moves during treatment

A

Lung cancer, which moves as you breathe

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33
Q

What does stereotactic radiotherapy use?

A

Many small beams of radiation to target the tumour

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34
Q

What is the advantage of stereotactic radiotherapy using many small beams of radiation?

A

It makes it very precise, and able to deliver high doses of radiotherapy to very small areas of the body, reducing the risk of side effects

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35
Q

What does total body irradiation involve?

A

Giving large single doses, or 6-8 smaller doses, of radiation to the whole body

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36
Q

What is the purpose of total body irradiation?

A

To destroy the cells of the bone marrow

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37
Q

When is total body irradiation used?

A

May be given to people who are having stem cell transplants as part of their treatment

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38
Q

What is intra-operative radiotherapy?

A

Giving a single dose of radiation in the operating theatre at the time a cancer is being removed

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39
Q

What are the types of internal radiotherapy?

A
  • Bradytherapy

- Radioisotope therapy

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40
Q

What is brachytherapy?

A

The insertion of radioactive material directly into the affected area

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41
Q

What is the advantage of brachytherapy?

A

A high dose of radiation is given to the tumour, but healthy tissue only gets a small amount of radiation

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42
Q

What are the ways of giving brachytherapy for prostate cancer?

A
  • Permanent seed brachytherapy

- High-dose rate brachytherapy

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43
Q

What is permanent seed brachytherapy also known as?

A

Low-dose rate (LDR) brachytherapy

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44
Q

What does permanent seed brachytherapy use?

A

Small radioactive ‘seeds’ that are inserted into the tumour

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45
Q

What is the purpose of the seeds in permanent seed brachytherapy?

A

They mean the radiation is released slowly

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46
Q

Are the seeds removed in permanent seed brachytherapy?

A

No obviously not otherwise why would it be called permanent seed

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47
Q

What happens to the radiation in permanent seed brachytherapy over time?

A

It fades away over about 6 months

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48
Q

What precaution should be taken when patients are receiving permanent seed brachytherapy?

A

Patient should avoid long periods of contact with children and pregnant women

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49
Q

What does high-dose rate brachytherapy involve?

A

Placing thin plastic or metal tubes into the prostate gland, and then inserting radioactive material into the tubes by a machine

50
Q

What happens after insertion of the radioactive maternal in high-dose rate brachytherapy?

A

The radioactive material is left in the tubes for a set period of time (few minutes), then withdrawn

51
Q

What happens after the treatment in high-dose rate brachytherapy?

A

The tubes are removed and no radioactive material is left in the prostate

52
Q

How is brachytherapy for cervical and womb cancer given?

A

Through special hollow tubes called applicators that are inserted into the womb or vagina

53
Q

What are the different types of brachytherapy used in cervical and womb cancer?

A
  • High-dose rate

- Low-dose rate

54
Q

How does the dose differ in high-dose rate and low-dose rate brachytherapy in cervical and womb cancer?

A

The same dose of radiotherapy is given, but over different times

55
Q

Over what period of time is high-dose rate brachytherapy given in cervical and womb cancer?

A

10-15 minutes, given as one short burst, or several short bursts over a few days

56
Q

Over what period of time is low-dose rate brachytherapy given in cervical and womb cancer?

A

Longer period of time, usually 12-24 hours

57
Q

What happens in brachytherapy using caesium or iridium wires?

A

Very thin radioactive needles, wires, or tubes are inserted while under general anaesthesia

58
Q

What can brachytherapy using caesium or iridium wires be used to treat?

A

A number of different cancers, including cancers of;

  • Mouth
  • Lip
  • Cervix
  • Breast
59
Q

What does radioisotope therapy do?

A

Delivers radiation directly into cancer cells

60
Q

How is radioisotope therapy given?

A
  • Capsule
  • Drink
  • Injection into vein
61
Q

How does radioisotope therapy work?

A

Cancer cells absorb the radioactive substance more than normal cells, so they receive a higher dose of radiation, causing the cells to die

62
Q

What are the different types of radioisotope therapy?

A
  • Iodine-131
  • Strontium-89 and Samarium-153
  • Radium-223
63
Q

What is the most common type of radioisotope treatment?

A

Iodine-131

64
Q

What is iodine-131 used to treat?

A
  • Specific types of thyroid cancer

- Can also be used to treat some rarer types of cancer, such as neuroblastoma

65
Q

What does a patient on iodine-131 treatment need to be made aware of?

A

They will be slightly radioactive for a short time after their treatment

66
Q

How does the radioactivity leave the body after iodine-131 treatment?

A

Slowly leaves body in urine, stools, period blood, saliva, and sweat

67
Q

What is the result of the patient being slightly radioactive after treatment with iodine-131?

A

They will need to follow safety measures after treatment, and for a short time after going home

68
Q

What can strontium-89 and samarium-153 be used to treat?

A

Certain types of secondary bone cancer

69
Q

What is the purpose of strontium-89 and samarium-153 in the treatment of secondary bone cancer?

A
  • Reduce bone pain

- Improve quality of life

70
Q

What is radium-223 used to treat?

A

Secondary cancer in the bone from prostate cancer that is no longer responding to hormonal therapy

71
Q

How often is curative (radical) radiotherapy given?

A

Usually involves having a course of treatment given once a day, often with a rest at weekends

72
Q

How long does curative radiotherapy treatment last?

A

1-7 weeks

73
Q

What is each treatment called in radical radiotherapy?

A

A fraction

74
Q

What is the purpose of giving radiotherapy treatment in fractions?

A

Ensures that less damage is done to normal cells than cancer cells

75
Q

When might radiotherapy be given, with respect to other treatments?

A
  • Given on its own
  • Before or after surgery or chemotherapy
  • Same time as chemotherapy
76
Q

What is the purpose of palliative radiotherapy?

A

Symptom control

77
Q

Give 3 examples of situations where palliative radiotherapy may be used

A
  • To one or more of the bones, to help control pain caused by bone metastases
  • To the lungs, to reduce coughing caused by cancer in the lungs
  • To help control bleeding caused by lung, bladder, or skin tumours
78
Q

How many sessions is palliative radiotherapy given over?

A

May involve only one or two sessions of treatment, but sometimes can involve 10 sessions or more

79
Q

What is the disadvantage of palliative radiotherapy that is only given in 1 or 2 sessions?

A

It is more likely to cause short-term side effects, e.g. flu-like symptoms

80
Q

What needs to be done before starting radiotherapy?

A

Treatment needs to be planned

81
Q

What is the purpose of treatment planning in radiotherapy?

A

To make sure that the radiotherapy is aimed precisely at the cancer, and causes the least possible damage to surrounding tissue

82
Q

What might done people need before treatment planning?

A

A mask or mould to be made

83
Q

How long does a radiotherapy planning visit take?

A

30-60 minutes, although can take longer

84
Q

What imaging is required in radiotherapy treatment planning?

A

Usually need a CT scan of the area to be treated, and sometimes an MRI or PET is also required

85
Q

What is the purpose of moulds and masks in radiotherapy?

A

They are made to help the patient stay still and in the correct position during radiotherapy

86
Q

What are moulds and masks for radiotherapy made out of?

A

Plastic mesh

87
Q

How are moulds and masks for radiotherapy made?

A

They are warmed and put on the patient’s body part, so it moulds to fit the area being treated

88
Q

What is done once the treatment area for radiotherapy has been decided?

A

Markings are made on the skin to help accurate positioning for treatment

89
Q

How are skin markings made for radiotherapy treatment markings?

A

Via tattoos

90
Q

What is true of side effects for most people having radiotherapy?

A

They will have few side effects, and they will often be mild

91
Q

What do the side effects of radiotherapy depend on?

A
  • Type of treatment

- Area of the body being treated

92
Q

What are the most common side effects of radiotherapy?

A
  • Fatigue
  • Nausea
  • Problems with eating and drinking
  • Skin reaction
  • Flu-like symptoms
  • Hair loss
  • Changes in blood count
93
Q

How long do most side effects of radiotherapy last?

A

10-15 days after treatment finishes, and then gradually get better

94
Q

Which side effect of radiotherapy may last for longer?

A

General tiredness

95
Q

What is it called when side effects of radiotherapy persist after the patient has finished treatment?

A

Long-term or late effects

96
Q

How do internal and external radiotherapy compare in terms of side effects?

A

External radiotherapy usually causes more general side effects than internal radiotherapy

97
Q

Who might develop a skin reaction from radiotherapy?

A

People having external radiotherapy

98
Q

How long after radiotherapy does a skin reaction begin if its going to happen?

A

Usually after about 10 days

99
Q

What will how the skin reacts to radiotherapy depend on?

A

The amount of radiotherapy a patient has

100
Q

What are the possible skin reactions that may result from radiotherapy?

A
  • Red, sore, itchy skin
  • Darker skin with black/blue tinge
  • Breakages and leakage from skin
101
Q

What might be required if the skin reaction to radiotherapy is severe?

A

The treatment may have to be delayed for a short time to allow the area to recover

102
Q

How long do skin reactions from radiotherapy take to settle down?

A

Usually settle down 2-4 weeks after treatment has finished, however the area may stay slightly darker than the surrounding skin

103
Q

What symptoms might patients experience if they are given palliative radiotherapy in one or two treatment sessions?

A

Flu-like symptoms, including;

  • Headaches
  • Aching joints or muscles
  • Lethargy
104
Q

What are the more serious long-term side effects of radiotherapy?

A
  • Changes in blood count

- Second cancers

105
Q

What kind of radiotherapy can cause a change in blood count?

A

Radioisotope therapy, such as strontium or samarium, and sometimes external radiotherapy

106
Q

What effect might radiotherapy have on the blood count?

A

Can temporarily reduce the number of normal red and white blood cells produced by the bone marrow

107
Q

What is the result of the change in blood count that can occur with radiotherapy?

A

It can cause an increased susceptibility to infection and anaemia

108
Q

What do patients need to be made aware of as a result of the potential for radiotherapy to cause a change in blood count?

A

They need to be advised to seek medical advice if they feel unwell, have a fever, or start feeling cold and shaky

109
Q

Why is radiotherapy given despite it’s potential to cause cancer?

A

Only a small number of people will develop a second cancer because of the radiotherapy, and the chance is so small that the risks of radiotherapy are far outweighed by the benefits

110
Q

What do patients need to be advised of when having radiotherapy if they are of childbearing age?

A

That it is important that they don’t become pregnant during their treatment

111
Q

Why is it important not to become pregnant during radiotherapy treatment?

A

As radiotherapy given during pregnancy could harm a developing fetus

112
Q

What do you need to do when gaining consent for radiotherapy, regarding pregnancy?

A

Ensure the patient is not pregnant, and that they understand that they should not become pregnant during treatment, and therefore need to use a reliable form of birth control

113
Q

What should male patients having radiotherapy be advised of, regarding fathering children?

A

They should be advised not to father a child during treatment, and for a few months father it’s finished

114
Q

What will follow up after radiotherapy depend on?

A
  • Type of cancer
  • Type of radiotherapy
  • Response of patient to treatment
115
Q

Will everyone having radiotherapy need follow up appointments?

A

No

116
Q

What should be done if a patient does not need follow up after radiotherapy?

A

They should be given advice on potential problems to look out for, and the details of someone to contact if necessary

117
Q

When do follow up appointments for radiotherapy usually happen?

A

About 4-6 weeks after treatment has finished

118
Q

Where can radiotherapy follow up appointments take place?

A
  • Radiotherapy department
  • Hospital
  • On phone
119
Q

What does a radiotherapy follow up appointment include?

A
  • Assessment of how patient is doing

- Opportunity for patients to discuss any problems or worries they have

120
Q

What should patients be advised of in radiotherapy follow up?

A

If they have any problems or notice any new symptoms at any time, or between appointments, they should contact their oncologist, rather than waiting for their next scheduled appointment

121
Q

What is prophylactic cranial radiotherapy?

A

A treatment used to prevent or delay the spread of cancer to the brain

122
Q

Who is prophylactic cranial radiotherapy given to?

A

Usually people with SCLC, but may occasionally be given to people with acute lymphoblastic leukaemia

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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