Lecture 6 - Cancer management and patient care

Question 1

What are some signs and symptoms of breast cancer?

Answer 1

Breast or axilla lump, change in breast shape, nipple change, dimpled/puckened, redness or swelling - inflammatory breast cancer, peau d’orange - thickening and dimpling of skin

Question 2

Breast cancer set up and positioning and what are the aims?

Answer 2

• comfy stable and reproducible
• supine in immobilization - breast board and vac fix

Aims - reduce folds in breast, arms outside of beam ,lift breast superiorly therefore reducing cardiac dose

-prone breast - bigger breasted ladies

Dis - can include higher cardiac dose because of gravity, compensation sternum horizontal

Question 3

What are the critical structures with BC?

Answer 3

Heart, lungs, collateral breast and spinal cord

Question 4

What are some side effects to BC treatment?

Answer 4

• fatigue
• breast - acute radiation dermatitis, desquamation and erythema

Late change - fbrosis, telangiectasia, breast shrinkage

Question 5

What are the scores for acute radiation?

Answer 5

0 - no change over baseline
1 - folicular, faint or dull erythema, dry desquamation
2- tender or bright erythema
2.5 - patchy moist desquamation, moderate odema
3 - confluent most dequamation, pitting oedema
4 - ulceration, hemorrhage and necrosis

Question 6

What are some management options to help skin reactions?

Answer 6

-avoid abrasion to skin when washing
-simple soap or soap alternative
-1% hydro cortisone cream
-aqueous cream 2hr before or after
-mepitel or mepilex film
-loose cotton garmetns
Serve reactions - RT temporarily stopped and Atrauman gauze with hydrogel or foam applied until healed

Question 7

What is palliative treatment?

Answer 7

• quality of life not quantity

- symptomatic pain relief

Question 8

What is SVC obstruction?

Answer 8

Mass pushes against SVC and impedes heart function

Question 9

What is spinal cord compression?

Answer 9

metastases causes an erosion in vertebral body by osteoclasts ans oteoblasts –> lesion impacts neural pathway of spinal cord –> parathesia, sensory and motor defects, autonomic dysfunction and localized area

Question 10

What is osteolytuc bone metastases?

Answer 10

Eat into healthy bone by lysing bone cells –> skeletal dysfunciton

Question 11

What is brain metastases?

Answer 11

Healthy brain function decreases –> dizziness and confusion –> RT relieve impairment by restoring normal function to rest of organ

Question 12

Example of palliative spine dose?

Answer 12

8 Gy in 1
12 Gy in 2
20 Gy in 5
30 Gy in 10

Question 13

What is the different treatment lines of a palliative spine?

Answer 13

Radiation therapy - 1-2 vertebrae above and below
Surgical intervention - decompress compression
Dexamethasone

Question 14

What are some side effects of palliative spine?

Answer 14

• nausea
• cramping
• fatigue
• diarrhoea
• erythema
• flatulence

Question 15

What are the aspects of palliative treatments?

Answer 15

• adequate pain relief –> accurate treatment
• stable and reproducible treatment –> soft and supportive
• field size adequate for movement
• drugs for anxiety –> diazepam (RT responsibility to ensure drugs have been administered prior to treatment)

Question 16

Signs and symptoms of prostate cancer?

Answer 16

• digital rectal exam
• elevated PSA
• increased frequency of urination
• sacral, sciatic or perineal pain

Question 17

What are the preparations prior to prostate treatment?

Answer 17

• full bladder

- empty rectum

Question 18

What are the treatment paths of prostate cancer?

Answer 18

• surgery
• hormone therapy
• RT