Benign Diseases Flashcards
Benign tutors are harmless except:
- Where they cause problems due to pressure (i.e., brain, mediastinum)
- Where they cause incidental complication (i.e., hemorrhage)
- Where they stimulate hormone production (i.e., pituitary)
- Where subsequent malignant change occurs (i.e. intestinal polyps)
Rules to use RT on benign disease?
- The potential risk must be recognized
- Safer acceptable methods should be used when available
- The RT technique should be optimal to reduce late skin and other organ damage as much as possible
- Irradiation of paediatrics rare
- Avoid organs at risk: thyroid, gonads, eyes, bone marrow, breast
Clinical presentation of Dupuytren’s Contracture
-Affects connective tissue of hands and feet
Early phase: firm nodule on palm of hand
-turns into a contracture in the Active phase
-Advanced stage: fibrous cords pull the fascia, which pulls the fingers towards the palms
Bilateral (50% of cases)
Risk factors of Dupuytren’s Contracture
Age: after the age of 50
Sex: men are more likely
Ancestry: Northern European
Family history: runs in family
Alcohol and smoking are associated with Duputren’s
People with diabetes are reported to have an increased risk of Dupuytren’s
Dupuytren’s Contracture-Treatment
Surgery: needle fasciotomy; surgery with skin graft
Radiation Treatment: (for early stage nodules)
-Orthovoltage: 120 KVP, split course 15 Gy/ 5 fr, 12 weeks then 15 Gy/5 Fr, lead shielding and direct apposition
-Electrons: 6-12 MEV, custom shielding and bolus, 21 Gy/ 3 fr
Grave’s disease
Hyperthyroidism- immune disease that results in the production of thyroid hormones
Risk factors of Grave’s disease
Family history-genetic component Gender-women Age-younger than 40 Other autoimmune disorders-such as type 1 diabetes or rheumatoid arthritis Pregnancy and smoking
Graves ophthalmopathy
Overproduction of cytokines that affect muscles and other tissues around the eyes.
Symptoms:
- exophthalmos/proptosis
- Gritty sensation in eyes
- Pressure/pain in eyes
- Puffy/retracted eyelids
- Reddened or inflamed eyes
- light sensitivity, double vision, vision loss
Grave’s ophthalmopathy treatment
- IMRT/3D-CRT/LOF
- IMRT gives better distribution
- Small unilateral fields (half beam block, 4cm x 4cm)
- 5 degree gantry angle to push field posteriorly and avoid the lens
- 6 MV photons
- 20 Gy/10 fr
Arteriovenous Malformations (AVMs)
- congenial defects of circulatory system
- masses of abnormal blood vessels
- can grow over time and exert pressure
- spine and brain are of most concern
AVM risks
- age: 20-40 years
- possible genetic component but not inherited
- greatest risk from an AVM is a hemorrhage
AVM symptoms
- depends on where the AVM is located
- bleeding
- progressive loss of neurological function
- headaches, nausea, and vomiting
- seizures
AVM treatment
Surgery: preferred tx because of risk of hemorrhage with RT. Non-surgical candidates get SRS
RT: Gamma knife or linac to thicken vascular wall. Small AVMs are more effectively treated due to larger doses possible
SRS:
- lesion <3cm 21-22 Gy to the margin
- lesion >3cm 16-18 Gy to the margin
takes 1-3 years to decrease bleeding risk
Keloids
Overgrown scar-collagenous tissue is overproduced and grows beyond the wound.
Keloids etiology
Derma injuries (burns, piercings, chicken pox, biopsy site, lacerations, acne)
Can become elevated, painful, itchy, fibrotic
