Radiotherapy

Question 1

What is the etiology of HPV?

Answer 1

HPV 16 AND 18 (70% of cervical cancers in UK)

Question 2

What viral proteins are involved in the pathophysiology of HPV?

Answer 2

E6 and E7

Question 3

When is surgery suitable for in cervical cancer?

Answer 3

STAGE 1

Question 4

What does HPV cause other than cervical cancer?

Answer 4

oropharyngeal ca

Question 5

Risk factor of cervical cancer?

Answer 5

smoking/age of onset of intercourse/ HIGH risk male (his partners ALSO got cancer) /OCP/ multiple partners

Question 6

How may cervical cancer be presented?

Answer 6

• screening
• PCB/IMB/PMB (abnormal bleeding)
• Acute renal failure

Question 7

Staging of cervical cancer?

Answer 7

• the higher the stage the more aggressive the cancer
• surgical intervention is POSSIBLE with: Stage 1A/B
• stage 2a (Vaginal involvement)

Question 8

What does the surgery involve?

Answer 8

• excision of the transition zone

Question 9

WHat does surgical rx for advanced cervical cancer involve?

Answer 9

• cervical-paramterial disection

- complete abdominal hysterectomy

Question 10

What does radiotherapy involve?

Answer 10

• normal cells improve better than cancer cells
• targeted at tumor and +/- Nodes
• –external bean therapy targeted at cancer tissue; followed by Brachytherapy (allows very high dose to cervix _____

Question 11

Name the diff. types of chemotherapy

Answer 11

• neoadjuvant (SHRINKS tumor)
• concomittant (given same TIME as radiotherapy) —-improves EFFICACY of chemo
• palliative (for those with malignant cancer)

Question 12

Name chemo drugs.

Answer 12

• CISPLATIN (40MG/2 weekly)

- carboplatin and paclitaxol

Question 13

What is brachytherapy?

Answer 13

INTERNAL radiation therapy

—intrauterine tube/ ring applicator/ ovoids)

Question 14

IS chemo-radiation used to treat endomterial cancer>

Answer 14

NO
Chemo-radiation is rarely used to treat endometrial cacner
—treated if disease is BEYOND uterus or d.t COMORBIDITIES

Question 15

RX for endometrial cancer?

Answer 15

TAH BSO
washings
- role of lymphadenopathy
- Adjuvant radiotherapy (Vault bachytherapy/ external beam)

Question 16

RX of high grade endometrial cancer ?

Answer 16

adjuvant chemotherapy —prevents RELAPSE

Question 17

RX of high grade endometrial cancer ?

Answer 17

adjuvant chemotherapy —prevents RELAPSE

Question 18

IS it rare for ovarian cancer to spread to the brain?

Answer 18

• YES

- unless BRCA mutation exists

Question 19

Risk factors of ovarian cancer?

Answer 19

>50yrs
nulliparity (or low parity)
delayed pregnancy
family history of breast or ovarian cancer
BRCA1 (40%) and BRCA2 (18%)

Question 20

What is the presentation of Ovarian cancer?

Answer 20

• usually presents later stage (60%)

- non specific presnL ASCITES/ PELVIC MASS, bladder dysfxn/ PLEURAL EFFUSION/ SOB/incidental finding

Question 21

How is ovarian cancer dx?

Answer 21

• Ca125 - bloods
• USG (transvaginal/abdominal)
• Cytology (pleural fluid/ascite)
• pathology

Question 22

When is the pt referred to gynaecology?

Answer 22

• those with RMI >200

Question 23

IIary cause of ovarian tumors?

Answer 23

krukenburg tumors *(pancreatic cancer spread to ovaries)

Question 24

How may ovarian cancer spread to the rest of the body?

Answer 24

transcoelomic (CAULIFLOWER like metastases) spread/ peritoneal seeding within pelvis → abdominal cavity

haematogenous spread → liver, lungs, brain- late and rare

<2% incidence of BRAIN metastases

Question 25

What % of ovarian tumors are epithelial cell tumors?

Answer 25

> 90%

<10%- germ cell, granulosa cell

Question 26

Spread of cancer to omentum results in ______

Answer 26

omental cake

Question 27

What is involved in the rx of ovarian cancer?

Answer 27

• SURGERY (TAH, BSO, omentectomy, optimal debulking)
• surgery and chemo
• chemo and surgery
• timing and sequence

Question 28

Ovarian cancer pt may come into check up on pleural effusion?

Answer 28

• cytology of pleural fluid

Question 29

Newer therapy for cancer rx?

Answer 29

-IMMUNOTHERAPY

Question 30

What chemo drugs are given for ovarian cancer?

Answer 30

CARBOPLATIN/ PACLITAXEL

Question 31

What chemo drugs are given for ovarian cancer?

Answer 31

CARBOPLATIN/ PACLITAXEL

Question 32

some receive many classes of chemotherapeutic agents before their disease becomes truly drug resistant. Name some 2nd/3rd line drugs.

Answer 32

etoposide, caelyx, topotecan, gemcitabine, chlorambucil