RAD Onc

Question 1

define tumour

Answer 1

mass of tissue created by cells that divide more than they should or don’t die

Question 2

cancer

Answer 2

cells that divide without control AND are are ABLE to invade other tissues

Question 3

benign

Answer 3

Cells that do not spread to other parts of the body, and when removed dont usually come back

Question 4

malignant

Answer 4

can invade body tissues/ spread

Question 5

what are the 4 signs you know a lump of cells are cancerous?

Answer 5

1) angiogenesis - they have commendeered a blood supply 2) the mass exists - increased cell production, decreased cell death
3) invasion of basement membrane/ mets
4) genomic instability - there is damage to MMR or tumor suppressors that cannot be repaired

Question 6

how to cancers spread?

Answer 6

can be a) hematogenous b) local c) lymphatic d) transcoelomic ( ie in a cavity)

Question 7

what is the different between staging and grading

Answer 7

staging = combined clinical exam and imaging that gives you a TNM and helps you talk to other professioals/ helps determine prognosis. VS Grading = you get some cells and look at the histology - so this helps tell you the tumour type and potentially the malignancy potential

Question 8

what are the goals of radical cancer treatment?

Answer 8

complete ablation for cure. cut it out, chemo it, whatever needed to get rid of all of it.

Question 9

what are the aims of adjuvant therapy?

Answer 9

to target the MICROSCOPIC disease, and reduce recurrence

Question 10

what are the aims of palliative therapies?

Answer 10

to address pt symptoms only

Question 11

explain radiation therapy, what will happen to the pt

Answer 11

use of high energy photons/electrons damage DNA, which is aimed at a certain stpo on pt determined by CT. Pt will be positioned in a shell to ensure they are in the same spot each time.

Question 12

what are the ways we can deliver radiotherapy?

Answer 12

1) external beam radiotherapy,
2) brachytherapy ( beads that emit the electrons)
3) isotope therapy ( like radioactive idodine for the thyroid)
4) radio-immunotherapy

Question 13

what are the side effects of therapy?

Answer 13

locally, acute ( under 6 months), will get skin inflammation and moist skin desquamation. Later on, after 6 months, you get fibrosis of connective tissues/ changes in pigmentation

Question 14

what are some rad onc emergencies?

Answer 14

when the cancer starts threatening organ function eg: spinal cord compression, Superior vena cava obstruction, brain metastasis,

Question 15

what happens in spinal cord compression? what is the story?

Answer 15

cancer moves into epidural space, causes vascular damage and edemas that leads to cord ishemia/ infarction. pt complains of muscle weakness, or bladder/ bowel incontinence ( sphinctor dysfunction). px: corroberates. ix: Xray back or CT, myelography ( ocntrast to help visualize the spinal cord). tx steroids, surgery, radiotherapy if inoperable.

Question 16

what is the story with SVC compression?

Answer 16

blockage of the SVC by invasion/ external or internal blockage often from lung cancer. The person has SVC syndrome = edema of upper limbs and face/ venous distension. Doc my face is puffy, and my arms too. Px. Ix: fine blockage : CXR, CT. Tx: ABCs, Steroids. non small-cell cancer= needs radiotherapy because remember it is non surgical. Then small cell needs chemotherapy/ surgery.

Question 17

what is the story with brain mets?

Answer 17

person has new onset headache, cognitive impairment, hemiparesis, seizures. Tx: ABCs, steroids, anti epileptics, surgery, radiation therapy.

Question 18

what is the vascular issue that all cancers can lead to, what is the story?

Answer 18

malignant hemorrhage. the vasculature of the tumour is unstable = get bleeding. Commonly its a gynecological/ cervix tumour to lung. Tx: ABCs, stop bleeding ( packing, caudery, surgery), radiation to kill the cancer that went rogue