Gynaecological Technique and Treatment

Question 1

How is cancer of the cervix typically treated?

Answer 1

• Usually stage IIB-IVA, anything above would be a surgical procedure
• Research shows limited success
• Both external beam RT and brachytherapy

Question 2

What is the pre-scan procedure for the cervix?

Answer 2

• Referral and consent is checked.
• Bladder protocol is decided upon and followed.
• If necessary, rectal and bowel control.
• Check contrast and any contradictions.

Question 3

What are the bladder protocols at the three cancer centres?

Answer 3

• Rosemere: Full Bladder - 450mL 30mins prior to scan

- CCC and CHX: empty bladder unless patient has had a hysterectomy.

Question 4

What are the bowel/rectal preparations at the three centres?

Answer 4

• RCC: Empty bowel, prep with enema - want less that 4cm diameter.
• CCC and CHX - No bowel prep

Question 5

What is the immobilisation for cervix treatment and endometrium?

Answer 5

• Supine, clothes parted in the middle
• Head support
• Kneefix
• Footfix *

Question 6

What are the scan limits for the cervix ?

Answer 6

• 3mm helical CT scan with a wide bore
• Levels are approximately L2 (or T10/11) to 5cm below Ischial tuberosity
• If vaginal involvement, scan further inferiorly and PA nodal involvement, further superiorly

Question 7

What is the typical XRT prescription for treating the cervix?

Answer 7

• 45-50.4Gy in 25-28# across 5-6 weeks
• Higher dose for nodal areas ( no extra dose from brachy)
• Weekly cisplatin usually given also

Question 8

How does cervix chemo-radiation work?

Answer 8

• Cis or Carboplatin

- Christie - Chemo is first then radiotherapy

Question 9

Endometrium cancer and management summary…

Answer 9

• Choice would be a hysterectomy
• RT only preferred if surgery is not possible
• Brachy may be used adjuvantly

Question 10

What is the typical prescription for XRT to the endometrium?

Answer 10

• 45-50Gy in 25-28# in approx 5 weeks

- If no brachy - 16-20Gy in 8-10# over approx 2 weeks

Question 11

What are Gynae organs at risk?

Answer 11

• Rectum
• Bladder
• Femoral heads
• Small Bowel
• Large Bowel - usually if no contrast uptake it is the large bowel
• Total Bowel
• Kidneys
• Spinal cord and cauda equina

Question 12

What are acute side effects for gynae RT?

Answer 12

• Diarrhoea - What are the baseline habits - advise to drink water and regain salts - advise against high fibre diet - Fybogel
• Cystitis/Dysuria - advise to take painkillers and drink lots of fluids - cranberry juice (if not on warfarin)
• Bloating/Pain - bowel habit disruption
• Nausea - usually PA - antiemetics (might have for chemo) - ginger also
• Fatigue
• Haematuria
• Thrush - hygiene, or broken down skin
• Haemmorrhoids flare up - usually if have a tendency

Question 13

How can vaginal health be promoted?

Answer 13

• RT can cause the vagina to shrink.

- Use dilators