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Radiation Therapy > [4621] Gynecological powerpoint > Flashcards

[4621] Gynecological powerpoint Flashcards

1
Q

The uterus is located between the ______ and the ______.

A

bladder

rectum

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2
Q

What are the three sections of the uterus?

A

body

cervix

funds

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3
Q

What are the three layers of the uterine cavity?

A

mucous membrane lining (endometrium)

smooth muscle layer (myometrium)

outer serous coat (perimetrium)

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4
Q

Endometrial cancers originate from the __________ layer of the uterus.

A

endometrial (mucous membrane lining)

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5
Q

What is the most common malignancy of the female genital tract?

A

endometrial cancer

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6
Q

__________rate of endometrial cancers is higher in white women, but _________rates are higher in African American women.

A

incidence

mortality

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7
Q

What age is the highest risk for endometrial cancer?

A

postmenopausal 55 +

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8
Q

What hormone is associated with the risk factor of endometrial cancer?

A

estrogen

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9
Q

The major risk factor for endometrial cancers is a high cumulative exposure to ________.

A

estrogen

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10
Q

_______ women have a threefold to fivefold higher risk of development of endometrial cancer.

A

obese

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11
Q

Estrogen replacement without progesterone is a risk factor for ___________.

A

endometrial cancer

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12
Q

Never giving birth (nulliparity) is a risk to _________ cancer.

A

endometrial

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13
Q

Late menopaus, diabetes, history of infertility and TAMOFIXEN, and hereditary colon cancer are risk factors for _____________.

A

endometrial cancer

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14
Q

What is the most common histology of endometrial cancer?

A

adenocarcinoma (70%)

(evolve from endometrial hyperplasia or denovo)

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15
Q

What are the types of histology in endometrial cancer?

A

adenocarcinoma **

sarcomas
-endometrial stromal sarcoma
-mixed mesodermal
-leiomyosarcoma

benign leiomyoma (fibroids)

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16
Q

True or false: there is no standard screening for endometrial cancer.

A

True

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17
Q

What are the symptoms of endometrial cancer?

A

postmenopausal bleeding

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18
Q

Most endometrial cancers are diagnosed in stage_____.

A

1

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19
Q

What is the diagnostic procedure for endometrial cancer?

A

dilatation and curettage

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20
Q

What are the routes of spread for endometrial cancer?

A

direct extension and lymphatic

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21
Q

What structures are affected by direct extension in endometrial cancer?

A

myometrial wall

cervix

ovaries

vagina

parametric

bladder

rectum

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22
Q

What nodes are involved in lymphatic spread of endometrial cancer?

A

external iliac nodes

internal iliac nodes

common iliac nodes

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23
Q

What is the staging system used for endometrial cancer?

A

International federation of Gynecology and Obstetrics Staging System (FIGO)

American Joint Committee on Cancer (TNM staging system)

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24
Q

What are the treatment options for endometrial cancer?

A

surgery

endocrine/hormone therapy

chemotherapy

intracavitary radiation therapy (brachytherapy)

external beam radiation therapy

immunotherapy

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25
Q

In early stage endometrial cancer, ___________ alone or with an adjuvant therapy is preferred.

A

surgery

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26
Q

____________ are considered for high grade endometrial tumors.

A

adjuvant therapies such as postoperative radiation and chemotherapy

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27
Q

What is the treatment of choice for early stage endometrial cancer?

A

Surgery

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28
Q

What are the surgery options for endometrial cancer?

A

total hysterectomy

bilateral salpingo-oophorectomy with or without lymphadenectomy

(surgical removal of the Fallopian tubes and ovaries)

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29
Q

What hormone is used in hormone therapy for endometrial cancer?

A

progesterone (progestins)

*no one type of hormone treatment has been found to be the best for endometrial cancer

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30
Q

_________ is used to treat disseminated endometrial disease, is commonly used for high grade cancers, and for locally recurrent cancer as a radiation sensitizer.

A

chemotherapy

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31
Q

The majority of recurrences in endometrial cancer are distant metastasis to _____ or ______ with associated pelvic recurrence in 50%.

A

lung

bone

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32
Q

What are two types of brachytherapy used for endometrial cancer?

A

HDR (10-20 min)

LDR (1-4 days)

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33
Q

What isotopes are used for brachytherapy treatment of endometrial cancers?

A

Iridium-192

Cesium-137

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34
Q

A ________ introduces an isotope directly into the uterine canal, while ______ remain in the vaginal fornixes.

A

tandem

ovoid

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35
Q

HDR sources reach endometrial patients using ________.

A

cathaters

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36
Q

A ________ is used if the uterus is still present for brachytherapy implantation.

A

Heyman capsule technique or an intreauterine tandem

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37
Q

A __________ are used if brachytherapy is necessary but some surgical resection has already been done.

A

domed cylinder or vaginal colpostats

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38
Q

Ring and Tandem for remote loading uses ________ with a half life of 74 days.

A

Iridium 192

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39
Q

What is the typical endometrial HDR dose?

A

60-70 Gy in two treatment sessions

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40
Q

What is the typical LDR for endometrial brachytherapy treatment?

A

7 Gy to a total of 21 Gy in three treatments

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41
Q

What beam energy is used to treat endometrial cancer?

A

10-18 MV

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42
Q

What beam arrangement is used to treat endometrial cancer?

A

four field box

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43
Q

What is the typical EBRT dose for endometrial cancer?

A

45-50 Gy in 1.8/fx

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44
Q

The endometrial cavity can be taken to ________ with combined EBRT and LDR therapies.

A

75-90 Gy

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45
Q

For endometrial cancer, the _____ and ______ must be kept to about 65-75 Gy or less.

A

bladder and rectum

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46
Q

for endometrial cancer, the _______ must be kept at or below 45-50 Gy if the treatment is radiation therapy alone.

A

small bowel

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47
Q

What are the acute side effects of endometrial radiation therapy treatment?

A

fatigue

diarrhea

cystitis

nausea

anorexia

vaginal dryness (more common in brachytherapy)

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48
Q

What is cystitis?

A

inflammation of the bladder

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49
Q

What are the chronic side effects of endometrial radiation therapy treatment?

A

chronic cystitis

proctosigmoiditis

small bowel enteritis

obstruction

vagnial stenosis (caused by scar tissue, makes vagina shorter and more narrow)

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50
Q

The _________is the lower 1/3 of the uterus.

A

cervix

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51
Q

There internal os is known as the _________.

A

endocervix

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52
Q

Ther external os is known as the ___________.

A

exocervix

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53
Q

The external os is lined with _____________.

A

squamous cell epithelium

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54
Q

What is the 3rd most common cancer in women?

A

cervical cancer

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55
Q

___________is most common in women under 50 years old, low socioeconomic groups, and those who suffer from human papilloma virus (HPV).

A

cervical cancer

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56
Q

__________ is the most important risk factor in cervical cancer.

A

presence of the Human Papilloma Virus (HPV)

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57
Q

What is the most common presenting symptom of cervical cancer?

A

abnormal vaginal bleeding

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58
Q

Bowel symptoms usually indicate advance disease with tumor invasion into the rectum in cervical cancer. (True or False).

A

True

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59
Q

At what age should screening for cervical cancer begin?

A

age 21

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60
Q

What is the cancer screening for cervical cancer?

A

pap smear

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61
Q

Women ages _______ should have a Pap test every three years.

A

21 to 29

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62
Q

Women ages _________ should have an HPV and Pap co testing every 5 years or a Pap test alone every 3 years/

A

30-65

63
Q

If a woman has abnormal Pap smear results or are at a high risk for the development of cervical cancer should also have a _________.

A

colposcopy

64
Q

What kind of cells are found on the endocervix?

A

glandular cells

65
Q

What kind of cells are found on the exocervix?

A

squamous cells

66
Q

What is the name of the place that the cells of the endocervix and the cells of the exocervix meet?

A

transformation zone

67
Q

What is the most common histology of cervical cancer? What location of the cervix are these found in?

A

squamous cell

exocervix (or ectocervix)

68
Q

What the possible histologies of cervical cancer?

A

squamous cell carcinoma **

adenocarcinoma

adenosquamous carcinoma

69
Q

What is the staging system used for cervical cancer?

A

FIGO *****

TNM

70
Q

What is the most significant prognostic factor in cervical cancer?

A

staging

71
Q

True or false: cervical cancers are fast growing.

A

false

72
Q

Where does cervical cancer spread through direct extension?

A

uterus

vagina

parametric

abdomen

pelvis

rectum

bladder

73
Q

True or false: lymphatic spread in cervical cancer is usually orderly.

A

True

74
Q

What lymph nodes are involved in cervical cancer?

A

parametrical nodes, common iliac, periarortic, and supraclavicular nodes

75
Q

What is the most common site of hematogenous spread for cervical cancer?

A

lungs, liver, and bone

76
Q

What is the treatment of choice for early stage cervical cancer?

A

surgery (total abdominal hysterectomy with or without a small amount of vaginal tissues (referred to as the vaginal cuff)

77
Q

Radiation therapy is ideal for cervical cancer when:

A

tumor is confined to the cervic but unresectable

advanced stage of disease

78
Q

What is the role of chemotherapy in cervical cancer?

A

radiosensitiszation

79
Q

Why are high energy photon beams necessary for pelvic treatments?

A

thickness of the pelvic area

80
Q

What is the beam arrangement for cervical cancer?

A

four field box

IMRT

VMAT

81
Q

What is the EBRT dose for a whole pelvis in the case of cervical cancer?

A

40-50 Gy

82
Q

Total tumor dose for cervical cancer is _______ Gy for low volume disease and up to _______ for advanced or bulky disease.

A

70

85

83
Q

What are the organs at risk in the EBRT treatment of cervical cancer?

A

rectum

bladder

84
Q

For intracavitary radiation standard pelvic points in treatment of cervical cancer, The goal is to deliver 50 to 60 Gray to microscopic disease,
60 to 70 Gray to small macroscopic disease, and 70 to 90 Gray to large macroscopic disease (or its high-dose-rate
equivalent) while limiting the volume and dose to the
bladder, colorectal tissues, and small intestine.

A

50-60

60-70

70-90

85
Q

What are vaginal colpostats?

A

two golf club shaped hollow tubes placed laterally to the tandem in vaginal fornices for brachytherapy.

86
Q

What is the isotope used for LDR?

A

Cesium-137

87
Q

What is the isotope used for HDR?

A

Iridium-192

88
Q

Brachytherapy treatment of the cervix results in a ______ shaped distribution.

A

pear shaped

89
Q

What are the acute side effects of treatment of cervical cancer?

A

fatigue

diarrhea

cystitis

nausea

anorexia

skin changes

90
Q

What are the chronic side effects of treatment of cervical cancer?

A

chronic cystitis

proctosigmviditis

small bowel enteritis

obstruction

91
Q

_________ cancer is associated with ages 70+, hispanic women, African American women, HPV, smoking, multiple sexual partners, sex at early age, STDs, diethylstilbestrol exposure, carcinoma in situ in the cervix, immunosuppression, and vaginal irritation.

A

Vaginal cacner

92
Q

What is diethylstilbestrol?

A

a hormone given to mothers and associated with vaginal cancer

93
Q

What are the presenting symptoms of vaginal cancer if the patient is not asymptomatic at the time of diagnosis?

A

visible lesion

abnormal vaginal bleeding

watery vaginal discharge

painless mass

painful urination

frequent urination

constipation

94
Q

What is the screening available for vaginal cancer?

A

PAP, colposcopy, biopsy

95
Q

What is the most common histology of vaginal cancer?

A

squamous cell carcinoma (90%)

96
Q

What kind of vaginal cancer is associated with DES exposure?

A

adenocarcinoma

97
Q

What are the 4 kinds of histologies of vaginal cancer?

A

squamous cell

clear cell adenocarcinoma

malignant melanomas

sarcomas

98
Q

What is the most common site within the vagina of vaginal cancer?

A

upper third of the posterior wall

99
Q

What are the staging systems used for vaginal cancer?

A

FIGO

TNM

100
Q

Early stage vaginal cancers that are limited to the vagina can be effectively treated with ________.

A

radiation alone or with surgery

101
Q

SCvCB stands for:

A

single channel vaginal cylinder brachytherapy

102
Q

MCVCB stands for:

A

multi channel vaginal cylinder brachytherapy

103
Q

True or false: external beam radiation therapy and brachytherapy are not effective treatments of vaginal cancer.

A

False, they are very effective

104
Q

What is the total dose for treatment of vaginal cancer?

(______ Gy in 25 fractions EBRT followed by five 5 fractions of _______ GY of HDR).

A

60-70 Gy

(45; 5)

105
Q

The vagina can tolerate up to _________ Gy before extensive fibrosis occurs.

A

100 Gy

106
Q

Of the vagina, uterus, cervix, and ovaries, which organ is the most radiosensitive?

A

ovary

107
Q

What are the acute side effects of vaginal cancer treatment?

A

fatigue

diarrhea

cystitis

nausea

anorexia

108
Q

During vaginal EBRT treatment, the _______ and the ________ show the most acute side effects because of the radio sensitivity of these structures and the quality of the treatment beams used for treatment.

A

vulva

perineum

109
Q

What are the chronic side effects of vaginal EBRT treatment?

A

chronic cystitis

proctosigmoiditis

small bowel enteritis

obstruction

110
Q

What structures are part of the vulva?

A

opening of the vagina

labia minors

labia majors

clitoris

111
Q

What cancers are associated with the following risk factors: postmenopausal age 70+, chronic disease in this area, smoking, genital warts, leukoplakia, immune system deficiency, multiple sexual partners, sexual intercourse at a young age.

A

Cancer of the vulva

112
Q

What is leukoplakia?

A

presences of white patches on a mucous membrane

113
Q

What is the screening for cancer of the vulva?

A

there is no screening

114
Q

What is the preferred modality of diagnosis and staging of vulvar cancer?

A

MRI

115
Q

What is the staging system for vulvar cancer?

A

FIGO

116
Q

What are the presenting symptoms of vulvar cancer?

A

palpable mass on labia major

history of pruritus

itching, burning, bleeding on the vulva that does not go away

changes in color of the skin (redder or whiter)

skin changes in the vulva (appears like rash or warts)

117
Q

What is pruritus?

A

sever itching

118
Q

what is the most common histology of vulvar cancer?

A

squamous cell carcinoma (90%)

119
Q

What is the most common site of vulvar cancer?

A

labia major

120
Q

True or false: vulvar cancers appear raised, ulcerated, and warlike or leukoplakic

A

True

121
Q

What is the most common route of spread for vulvar cancers?

A

direct extension

122
Q

What are the sites affected by direct extension in vulvar cancer?

A

vagina

uterus

anus

123
Q

True or false: hematogenous spread is common in vulvar cancer.

A

false. It is rare

124
Q

What lymph nodes are involved in vulvar cancer?

A

superficial inguinal nodes

deep inguinal nodes

125
Q

Vulvar cancer spread in a very orderly pattern from ______ lymph nodes to ______ lymph nodes.

A

Inguinal

pelvic

126
Q

What is the treatment of choice for vulvar cancer?

A

surger

(local excision

vulvectomy

bilateral inguinal lymphadectomy)

127
Q

What is the positioning used for vulvar treatment?

A

supine

frog legged (decrease dose to soft tissue of the thighs)

128
Q

In vulvar treatment, a bolus is placed on the vulva in order to __________.

A

eliminate cold spots within the treatment area.

129
Q

What beam arrangement and dose is used to treat vulvar cancer and to what dose?

A

AP/PA at 50 Gy

130
Q

For vulvar treatment, an electron boost is used directly at the vulva for a dose of ________ Gy, and the patient may be positioned on all fours.

A

10-20 Gy

131
Q

True or false: vulvar cancer is a difficult cancer to treat effectively.

A

true`

132
Q

vulvar cancers spread from superficial to deep and ________ to ________.

A

inguinal femoral nodes to

iliac nodes

133
Q

The _________ is the main source responsible for the estrogen and progesterone hormones.

A

ovaries

134
Q

What is the 5th most common cancer in the US and leading cause of death from genealogical cancers?

A

ovarian cancer

135
Q

What age and race has the highest incidence in ovarian cancer?

A

age 63+

white women

136
Q

True or false: most ovarian cancer patients present with advanced disease due to nonspecific symptoms.

A

true

137
Q

The exact etiology is unknown, but common symptoms of ___________ cancer are:

nulliparity

early monarche

smoking

immunosuppression

family history of breast/ ovarian cancer

pelvic inflammatory disease

first childbirth after 35

late menopause

Jewish descent

A

ovarian

138
Q

What is nulliparity?

A

never having given birth

139
Q

What are the three main types of ovarian cancer?

A

epithelial tumors (covering)

germ cell tumors (produce eggs)

stromal tumors (connective tissue//produce estrogen and progesterone)

140
Q

What is the most common type of germ cell tumor in ovarian cancer?

A

dysgerminoma

141
Q

After reaching advanced disease, what are the symptoms of ovarian cancer?

A

anorexia

fatigue

pelvic/abdominal pain

consitpation/diarrhea

nausea

ascites

142
Q

What is ascites?

A

accumulation of fluid in the peritoneal cavity, causing swelling.

143
Q

What is the recommended ovarian cancer screening for the general population?

A

there is none

144
Q

Elevated CA125 is associated with what cancer?

A

ovarian cancer

145
Q

what diagnostics are used for ovarian cancer?

A

laparoscopy

CT

Ultrasound

146
Q

Transperitoneal seeding is a route of spread in ______ ovarian cancer. It commonly spreads to the ______ from metastatic seeding.

A

diaphragm

147
Q

Advanced stages of ovarian cancer typically spreads through ________, ________, or _________.

A

direct extension of adjacent organs

peritoneal fluid

lymph nodes

148
Q

What lymph nodes are frequently involved in ovarian cancer?

A

pelvic

paraaortic

149
Q

For ovarian cancer, hematogenous spread is rare, but can cause spread to the:

A

liver

lungs

diaphragm

bladder

colon

150
Q

What is the treatment of choice for ovarian cancer?

A

surgery + chemotherapy

(partial hysterectomy

total hysterectomy

bilateral sapling-oophorectomy)

151
Q

For ovarian cancer, what procedure is serves as surgical evaluation for staging?

A

bilateral sapling oophorectomy (BS0)

152
Q

When is chemotherapy administered in ovarian cancer?

A

after surgery

153
Q

True or false: radiation therapy is frequently used in treatment of ovarian cancer.

A

False; not common and has not been proved to improve survival outcomes

154
Q

What EBRT techniques are used for ovarian treatment?

A

open field technique

moving strip technique

Radiation Therapy (26 decks)

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