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Skin Radiation therapy > Colorectal > Flashcards

Colorectal Flashcards

1
Q

CT sim scanning limits

A

L3/4-5 cm beyond anal verge

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2
Q

in what cancer location is kidney constraints most important

A

in the right colon 50% or mored of rt kidney could be in the field therefore its important to spare the left kidney

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3
Q

dose constraint of the kidney

A

2/3 of th kidney should get no more than 18-20Gy

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4
Q

tx options for colorectal

A

3 field: AP and lats with wedges
4 field (AP/PA and lats) used when there is risk of anterior lesions (pros vag)
IMRT

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5
Q

TYPICAL TX BORDERS

A

S: L5/S1
L: 2 CM LAT TO PELVIC BRIM
I: 3-5CM INF OF TUMOUR

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6
Q

Benefits of IMRT over conventional techniques

A
  • dose to small bowel
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7
Q

nodal target volume in IMRT

A

mesolectal, pre sacral and internal iliac

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8
Q

target volume in neo XRT

A

GTV= tumour + enlarged LN
CTV=perirectal, mesorectum, pre sacral space and int IL +2cm sup and inf
PTV=CTV +1cm

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9
Q

target volume in adj XRT

A

CTV same as neoadjuvant but the prep tumour bed

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10
Q

Dose

A

initial dose is 45Gy + boost: 5.4-9Gy to tumour bed in adjuvant tx
5.4 Gy boost in neoadjuvant setting

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11
Q

rectal cancer s&s

A

hematochezia, change in stool caliber and abdo pain

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12
Q

lt sided colon cancer s&s

A

similar to rectal cancer

  • blood in stool
  • change in stool caliber
  • abdo pain
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13
Q

rt sided colon cancer s&s

A
  • n&v
  • abdo pain
  • iron deficiency due to blood loss
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14
Q

1st diagnosis tsts for colorectal ca

A

TRUS, CT, MRI physical exam, proctoscopy, and imaging by

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15
Q

For patient >T2 what extra diagnostic tests should be done

A

chest XRAY, CT or abode and pelvis

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16
Q

DRE position of elderly patients

A

lt lateral debiculitis, when the knees are pulled up sims position is achieved

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17
Q

DRE position for non elderly pts

A

lateral recumbent

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18
Q

DRE position that may be used for women

A

dorsal lithotomy

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19
Q

lab studies done for DX

A

CBC, KRAS, CEA

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20
Q

what tumour marker may be elevated in colorectal cancer

A

CEA- carcinogenig embryonic antigen

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21
Q

what does KRAS determine

A

determines if pt is a candidate for monoclonal antibodies (ex cetuximab)

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22
Q

what is CEA levels what level indicates metastasis

A

these levels should be taken before and after treatment levels should fall after treatment
>20ng/ml can indicate metastasis

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23
Q

ages

A

60-80

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24
Q

_most common cancer in M, _ most common cancer in W

A

2nd, 3rd

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25
Q

what countries is it most common in

A

N america, western europe and australia

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26
Q

m vs women

A

mor common in men

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27
Q

dietary factors that cause colorectal cancer

A

high fat, high red and processed meats, low fruit and veg

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28
Q

lifestyle factors that cause colorectal cancer

A

high alcohol consumption, obesity, smoking and low physical activity

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29
Q

medical conditions that cause colorectal cancer

A 
adenomatous polyps 
familial adenomatous polyposis 
IBD, ulcerative colitis 
gardner syndrome
lynch syndrome
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30
Q

what can reduce risk of colorectal cancer

A

NSAIDS

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31
Q

ulcerative colitis occur in what part of colorectum

A

rectum and sigmoid colon

32
Q

lynch syndrome occurs in what part of the colorectumand occur in what age

A

they are right sided and are diagnosed at a young age

33
Q

subtypes of adenomatous polyps which is most commonly associated with colorectum

A

subtypes: villous or tubular

villous is most commonly associated with colorectal cancer

34
Q

what % of cancer occurs in proximal, distal colon or rectum

A

45% proximal
40% distal colon
15% rectum

35
Q

white vs blacks in location of tumour

A

white more commonly get distal colorectal cancer, blacks get proximal tumours

36
Q

8 divisions of the colon

A

cecum, ascending colon, descending colon, splenic flexure, hepatic flexure, transverse colon, sigmoid colon and rectum

37
Q

what parts of the colon have mesentery what does the indicate

A

cecum, transverse, and sigmoid colon

means it can be surgically removed

38
Q

what parts of the colon have mesentery where do these tumours spread

A

ascending descending splenic and hepatic flexures they spread to kidney and pancreas

39
Q

t levels for rectum

A

s3- puborectalis ring

40
Q

3 divisions of the rectum

A

up valve, mid vale and lower valve

41
Q

tumours that can be palpated on DE are considered to be

A

distal tumours of the rectum

42
Q

direct extension occurs in _____ fashion.

A

rADIAL

43
Q

When what layer is penetrated there is + risk of spread to abode and pelvic structures

A

serosa

44
Q

peritoneal seeding is more common in colon or rectum cancer?

A

more common in the colon as the retum is located below the peritoneal reflection

45
Q

how common is LN mets at dx?

A

50%

46
Q

tumours above anorectal ring metastasize via what LN

A

mets along int iliac Ln

47
Q

rumours that extent into the anal canal spread via what LN

A

inf rectal and ext IL LN

48
Q

Distant mets in rectum

A

sup 1/2 of rectum spreads to liver via portal drainage

inf 1/2 of recum spreads to lung via IVC

49
Q

Rectal cancer recurrence location? and occurs via ? what does this indicate tx wise?

A

ca recurrence occurs In post portion of the pelvis and occurs via mets to int IL & pre sacral LN there 2 need to be irradiated as they can not be surgically removed

50
Q

most important prognostic indicator

A

tumour stage

51
Q

do males or females have better prognosis

A

females

52
Q

what tumour types have worse prognosis

A

mutinous, singet cell and small cell have worse prognosis

53
Q

are mobile or tethered tumours better prognosis and why?

A

mobile is better as they are nice easily resectable

54
Q

what is the typical screening for colorectal cancer

A

Screening starts at age 50 and is as follows:
-FOBT (fecal occult blood test) annually
-sigmoidoscopy / 5 years
-colonoscopy /10 year s
double contrast barium enema/ 5 years

55
Q

what people are considered high risk in terms of screening

A

personal or family history of colorectal ca or adenomatous polyps
personal history of IBD or UC
family history of FAP or lynch syndrome

56
Q

treatment to T1-2 tumours

A

Surgery alone is treatment of choice

57
Q

lt hemicolectomy

A

used for left side of large bowel

58
Q

rt helicolectomy

A

removes the cecum, ascending colon, hepatic flexure, 1st 1/3 of the transverse colon & part of terminal ileum w fat and LN

59
Q

what locations of the colon can be resected with wide local excision

A

ascending and descending colon, mid sigmoid and transverse colon

60
Q

what portions of the colon have low and high rates of recurrence after wide local excision and why

A

ascending and descending colon has high recurrence
mid sigmoid and transverse colon are mobile and wide margins are achievable therefore low recurrence rates in these areas

61
Q

what surgical procedure can be used for T1 rectal cancer

A

local excision

62
Q

what surgery type is SOC of rectal cancer

A

total mesolectal excision

63
Q

LAR vs APR location location of excision

A

LAR removes more proximal tumours 6-8 cm from anal verge

apr- USED FOR lesions 5-6 cm from anal verge therefore distal 1/3 ectum

64
Q

which requires colostomy (LAR or APR)

A

lLAR gets a non permanent ileostomy whole the anamatose heals
APR gets a permanent colostomy

65
Q

STAGE 3 COLON CANCER TX

A

SURGERY
THEN ADJUVANT CHEMORADS
(FOLFOX) + 50.4-54GY (45gy to pelvis + 4.5-9Gy boost to tumour bed)

66
Q

stage 3 rectak cancer treatment

A 
neoadjuvant chemorads (50.4 GY) + continuous infusions of 5FU or capacetabine 
surgery 
adjuvant chemotherapy (FOLFOX or capacetabine + oxoplatin)
67
Q

what agents are in FOLFOX

A

5FU
oxoplatin
leucovrin

68
Q

why is neoadjuvant tx one for rectal cancer (stage 3)

A

its done to ry to downgrade the need for APR (with permanent colostomy) to LAR with no colostomy needed
Also tumour down staging, + respectability and + sphincter preservation

69
Q

treamtmen of stage 4 cancer

A

FOLFIRI +/- monoclonoal antibodies ex: bvacuziman and cetuximab
+/- palliative XRT

70
Q

WHAT agents are in FOLFIRI what is i used for

A

used for recurrent or metastatic disease

Agents are 5FU, LEUCOVIRIN AND irinitonecan

71
Q

most common pathology

A

adenocarcinoma in 90-95% of cases

72
Q

what are the 2 staging systems

A

dukes and TNM

73
Q

side effects relaxing to blood levels in XRT

A

thrombocytopenia (- platelets) normal levels (165,000-415,000) severely low amount is <20,000`
leukopenia (- leukocytes) normal level around 30% (20-40% )

74
Q

what medications can be given to that side effect

A

antidiahreals (ammonium and kapacotate (OTC)
RX- lomotil
anorectal creams -proctofoam, proctodesyl

75
Q

what is done tx wise for a patient with churns disease

A

would only get SX+ CX as pt is too sensitive for XRT

76
Q

WHAT does i indicate if pt has flu like ymptoms

A

they may have leakage in the bowel wall which causes a fever, the RO will put them on antibiotics bt we can continue tx the patient

77
Q

What would you tell a patient if they told you they were having a mucous discharge?

A

Explain that this is normal and it is due to the radiation working and breaking down the tumor. Once it gets broken down, it exits through the anus.

Skin Radiation therapy (40 decks)

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