Common Cancers and Staging Flashcards
Top 3 cancers in Australia?
- Breast Cancer
- Lung Cancer
- Prostate Cancer
(they are also the most common sites to cause spinal cord compression)
What are common treatments of breast cancer?
Surgery (primary), Chemotherapy, EBRT with tangential fields, IMRT/VMAT
these treatments increase survivability
How is the breast usually planned?
Tangential fields. Field usually encompasses the whole breast with a 2cm air gap (margin). This allows for breathing (when the chest rises and falls anteriorly). Also accounts for swelling of the breast.
What is the equipment used for immobilization of a breast patient?
Prone breast board Supine breast board Wingboard Kevlar/Fibre glass board for MRI machines Knee bolster
What are the benefits of using a prone breast board?
Large breasts tend to fall laterally, making it difficult to treat. Having a prone breast allows breasts to fall inferiority making it easier to treat. (fits square shape of treatment field)
The breast moves from the chest wall and heart
It is reproducible, minimises the skin reactions found in the fold of the breast
DISADVANTAGES: difficult for patients to get on and off the bed, time consuming.
What is the primary intervention for most cancers?
Surgery
What are the risk factors of breast cancer?
Genetic risk: (BRAC1, BRAC2), p53 genes don’t work
Familiar risk: breast cancer in a male relative, a family member getting breast or ovarian cancer
Staging of Breast: Stage 1
Early disease tumor or confined to the breast (node-negative)
Staging of Breast: Stage 2
Early disease; tumor spread to moveable ipsilateral axilliary nodes (node positive)
Staging of Breast: Stage 3
Disease has spread to superficial structures of the chest wall and has moved to ipsilateral mammary lymph nodes
Staging of Breast: Stage 4
Advanced (metastatic) disease commonly spreads to bone, liver, lungs and brain (also spreads to supraclavicular lymph nodes)
Describe the TNM staging system?
T: described the original primary tumour
N: describes whether or not the cancer has reached nearby lymph nodes
M: tells whether there are distant metastases
What is the T category for staging?
TX - Primary tumor cannot be evaluated (unknown)
T0-No evidence of primary tumour
Tis - carcinoma is situ (early cancer that has not spread to neighboring sites)
T1-T4: Size/extent of primary tumour
How large is a tumor at T1 stage (breast)?
less than or equal to 20mm in greatest dimension
How large is a tumor at T2 stage (breast)?
Tumor is greater than 20mm but is less than 50mm
20-50mm
How large is the tumor at T3 stage (breast)?
The tumor is greater than 50mm
How large is the tumor at T4 stage (breast)?
Tumor is of any size but it extends into the chest wall and/or skin.
What is the N category for staging?
NX - Regional lymph nodes cannot be evaluated
N0- No regional lymph node involvement
N1-N3 involvement of regional lymph nodes (number and/or extent)
What is the M category for staging?
M0 - no distant metastasis (cancer has not spread to other parts of the body)
M1- distant metastasis (larger than 0.2mm)
What is the leading cause of cancer death among men and women in the world?
Lung cancer
How do we treat lung cancer (radiation)?
Usually 3 or 4 beams - anterior oblique, lateral and posterior oblique.
3D CRT, IMRT, DCAT, VMAT, SABR, Cyberknife
What are organs at risk for lung cancer?
The heart, spinal cord, vena cava, aorta and other lung are organs at risk
How large is the tumor at T1 (lung)?
3cm or less in greatest dimension (surronded by lung and visceral pleurae)
How large is the tumor at T2 (lung)?
more than 3cm but less than 7cm
3-7cm
How large is the tumor at T3 (lung)?
more than 7cm OR one that directly invades any of the following: parietal pleurae (PL3), chest wall, diaphragm, phrenic nerve, mediastinal pleurae,
How large is the tumor at T4 (lung)?
Tumour of any size that invades and of the following:
mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, vertebral body, carina, oesophagus,
What are the detection methods for prostate cancer ?
Digital rectal exam (DRE)
Blood test - PSA
TRUS biopsy
What happens in a digital rectal exam?
The doctor inserts their finger into the rectum and palpates the prostate and feels for bumps and hard spots (and other abnormalities).
What is a PSA test?
Prostate specific antigen (also detectable in women with breast cancer).
measures the amount of PSA in the blood and measures the increase of it (if it increases rapidly in 12 months then this indicates that person may have prostate cancer)
What is a TRUS biopsy?
Trans-rectal ultrasound guided biopsy. The doctor can see the opacity in the prostate (using a probe) and they can sample cells to see if they have cancer.
(THE ONLY CONCLUSIVE WAY TO CHECK IF YOU HAVE PROSTATE CANCER).
How large is the tumor at T1 (prostate)?
Clinically inapparent tumour that is not palpable or visible by imaging
How large is the tumor at T2 (prostate)?
Tumour confined within within prostate
How large is the tumor at T3 (prostate)?
Tumor extends through the prostate capsule
How large is the tumor at T4 (prostate)?
Tumour extends from the prostate capsule and invades seminal vesicles, rectum, bladder, levator muscles, pelvic wall
What does pT mean?
pathologically proven with a TRUS biopsy
