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Radiation Therapy 2 > Lower GI part 1 > Flashcards

Lower GI part 1 Flashcards

1
Q

What does the Lower GI consist of?

A

small bowel
colon
rectum
anus

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2
Q

What are the 4 layers of the GI tract from inner to outer?

A

mucosa (epithelial)
Submucosa (connective tissue- contains blood and lymphatic vessels)
Muscularis (smooth muscle- involuntary contractions to break down food)
Serosa (serous membrane covering GI tract suspended in abdominal cavity

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3
Q

What is the epidemiology & aetiology of the small bowel?

A 
accounts for <5% of gastro-intestinal tumours
Malignant lesions occur frequently (duodenum &amp; jejunum)
Benign lesions (adenoma &amp; fibromas in ileum)
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4
Q

What are the genetic/ hereditary predispositions for small bowel tumours

A

polyposis
Crohn’s disease
Gardner’s syndrome

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5
Q

What are the signs & symptoms for Small Bowel cancer?

A 
often silent for long time
abdominal pain/cramps
chronic anaemia
abdominal haemorrhage
abdominal mass
weight loss
diarrhoea
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6
Q

How can cancers of the small bowel spread?

A

neighbouring organs

regional lymph nodes

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7
Q

What is the pathology of small bowel cancer?

A

Adenocarcinomas (45%)
Carcinoid (30%)
Lymphomas (10%)
Sarcomas (mostly leiomyosarcoma)

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8
Q

What is the clinical management of small bowel cancer?

A

primarily resection
post-op RT to tumour bed/ nodal areas
RT and Chemo
Whole abdo RT for lymphomas

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9
Q

If the cancer of the small bowel is unresectable what treatment is used?

A

Chemo/RT or Pre-op RT

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10
Q

How responsive to radiation are small bowel cancesr?

A

Generally poor radiosensitivity (except sarcomas)

20-25Gy +/- radiosensitings chemo (5FU or cisplatin based chemo)

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11
Q

What are the general features of the Colon?

A

1.5m long
ileum to the anus
absorb water
transmit the waste material

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12
Q

What is the epidemiology & aetiology for colorectal cancers?

A

2nd most commonly diagnosed cancer in Australia
Age
Diet
Alcohol, smoking, obesity, low physical activity

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13
Q

What are the Genetic/ Hereditary predispositions associated with colorectal cancer?

A

Polyposis
Crohn’s Disease (inflammation of lining of GI tract)
Diverticulitis (pouches along colon become inflamed)

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14
Q

What is the age bracket for colon/rectum cancers?

A

majority occur in the over 50s

Peak incidence 60 -80 years

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15
Q

What dietary factors affect colorectal cancer (Aetiology)?

A

high meat, fat, calorie, alcohol intake

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16
Q

What are the signs & symptoms of colorectal cancer?

A 
palpable mass
rectal bleeding &amp;/or blood in stool
diarrhoea
change in bowel habit
Tenesmus (cramping rectal pain)
Obstructive symptoms
Iron deficiency anaemia
Weight loss
vomiting
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17
Q

How can colorectal cancer be detected?

A

Faecal occult blood test
Digital Rectal Exam (DRE)
Sigmoidoscopy/ colonscopy

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18
Q

How does colorectal cancer spread?

A 
mucosal walls
lymph &amp; blood (submucosal layer)
Peritoneal Seeding
Pelvic lymph nodes 
Distant metastases
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19
Q

What are the common sites of distant metastasis for colorectal cancer?

A 
Liver via blood
Lung via IVC embolism
Bone
Ovaries 
Adrenal
20
Q

What are the different types of colorectal cancers?

A

adenocarcinoma
Signet-ring Carcinoma
Squamous Cell Carcinoma

21
Q

What staging is used for colorectal cancer?

A

Dukes
Aster-Coller
TNM

22
Q

What is Dukes Staging for colorectal cancer?

A 
A= no bowel penetration
B = bowel penetration
C= positive nodes
D= metastasis
23
Q

What is stage A of Dukes Staging for colorectal cancer?

A

A- Confined to bowel wall ie. musoca and submucosa or early muscular invasion

24
Q

What is stage C of Dukes Staging for colorectal cancer?

A

C1- lymph node involvement but not up to highest point of vascular ligation
C2- Nodes involved up to highest nodes at the point of vascular ligation

25
Q

What is the TNM staging for colorectal cancer?

A 
T1,2,3,4,
T1 = submucosa
T2= muscularis propria
T3 = beyond 2
T4= other organs invaded
N1,2
N1= 1-3 nodes
N2= >3 nodes
M1= metastatic
26
Q

What are the clinical management options for colorectal cancer?

A

surgery
radiotherapy
chemotherapy

27
Q

What are the factors to consider with RT for colon cancer?

A

Difficult to determine the volume to be irradiated

proximity to OAR

28
Q

Surgery - colorectal cancer

A

primary definitive treatment

Total mesorectal excision (TME) (reduced local recurrence rate to <10% compared to 30% previously

29
Q

What do the inferior mesenteric nodes drain?

A

Descending Colon
Left side of mesentery
Sigmoid Colon
Rectum

30
Q

What is the 5yr survival for the Grading for colorectal cancer?

A 
G1-2 = 55% 5 yr survival
G3-4 = 30% 5 yr survival
31
Q

What is a Total Meso-rectal Excision (TME)

A

Remove the mesenteric fat and muscle around the rectum

32
Q

How does distance from the ano-rectal junction affect TME?

A

If the rectal cancer is >5-6cm above the ano-rectal junction then can perform a low anterior resection and join the bowel together (anastomosis)
If less than this then abdomino-perineal resection and permanent colostomy with closure of anus

33
Q

What is the difference between short and long course of pre-op RT?

A

short course: doesn’t allow for tumour downstaging) but doesn’t delay surgery for as long, less side effects because tumour cut out 1 week after RT therefore before they experience these side effects
Long course: 28 fractions, more side effects, RT affects healing of cells after surgery

34
Q

What is the standard dose fractionation for short course (Swedish protocol) pre-op RT? (for rectum)

A

25Gy in 5 fractions over 1 week, surgery follows in next 7-10 days
improvement 5 year survival

35
Q

What is the standard fractionation for long course Pre-op RT for rectum

A

45-50.4Gy in 25-28 fractions over 5-6 weeks
surgery follows approx 8-10 weeks later
(downsizes tumour)

36
Q

What is the lymphatic drainage of the Anus?

A

lymph from anal canal drains into superficial inguinal lymph nodes -> external iliac

37
Q

What is the epidemiology & aetiology of anus cancer?

A 
rare- 2% large bowel cancer
slightly more common in women
AIDS related
HPV
SCC (squamous cells)
38
Q

What is the epidemiology & aetiology of anus cancer?

A 
rare- 2% large bowel cancer
slightly more common in women
AIDS related
HPV
SCC (squamous cells)
39
Q

What are the signs and symptoms of anal cancer?

A

visible or palpable mass
bleeding
pain &/or discharge
Pruritus (itchiness) (more perianal)

40
Q

How does anal cancer spread?

A

local invasion of anal sphincter and rectal wall

Prostate, bladder or cervix spread

41
Q

What is the staging used for anal cancer?

A

AJCC (American joint cancer committee) (TNM)
T size
N nodes
M metastatic

42
Q

What is the Clinical Management of Anal cancer?

A

RT (only if chemo not tolerated) or Chemo/RT is primary option
high survival rate
looking to preserve anal sphincter (instead of removal -> colostomy bag)
surgery for very early disease or post RT for recurrence
Chemo Radiosensiting (5FU &/or mitomycin C)

43
Q

What are the standard doses for anal cancer?

A

Ph 1: pelvis & nodes (30.6 - 45Gy with chemo) (2-4 fields)
Ph 2: Primary site (add 24.4-
14.4Gy) (include superficial inguinal nodes)

44
Q

What is the typical set-up for anal cancer?

A

mainly prone + belly board

can be supine

45
Q

What is the typical set-up for anal cancer?

A

mainly prone + belly board

Radiation Therapy 2 (5 decks)

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