Radiotherapy Flashcards
What is the etiology of HPV?
HPV 16 AND 18 (70% of cervical cancers in UK)
What viral proteins are involved in the pathophysiology of HPV?
E6 and E7
When is surgery suitable for in cervical cancer?
STAGE 1
What does HPV cause other than cervical cancer?
oropharyngeal ca
Risk factor of cervical cancer?
smoking/age of onset of intercourse/ HIGH risk male (his partners ALSO got cancer) /OCP/ multiple partners
How may cervical cancer be presented?
- screening
- PCB/IMB/PMB (abnormal bleeding)
- Acute renal failure
Staging of cervical cancer?
- the higher the stage the more aggressive the cancer
- surgical intervention is POSSIBLE with: Stage 1A/B
- stage 2a (Vaginal involvement)
What does the surgery involve?
- excision of the transition zone
WHat does surgical rx for advanced cervical cancer involve?
- cervical-paramterial disection
- complete abdominal hysterectomy
What does radiotherapy involve?
- 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 _____
Name the diff. types of chemotherapy
- neoadjuvant (SHRINKS tumor)
- concomittant (given same TIME as radiotherapy) —-improves EFFICACY of chemo
- palliative (for those with malignant cancer)
Name chemo drugs.
- CISPLATIN (40MG/2 weekly)
- carboplatin and paclitaxol
What is brachytherapy?
INTERNAL radiation therapy
—intrauterine tube/ ring applicator/ ovoids)
IS chemo-radiation used to treat endomterial cancer>
NO
Chemo-radiation is rarely used to treat endometrial cacner
—treated if disease is BEYOND uterus or d.t COMORBIDITIES
RX for endometrial cancer?
TAH BSO
washings
- role of lymphadenopathy
- Adjuvant radiotherapy (Vault bachytherapy/ external beam)
RX of high grade endometrial cancer ?
adjuvant chemotherapy —prevents RELAPSE
RX of high grade endometrial cancer ?
adjuvant chemotherapy —prevents RELAPSE
IS it rare for ovarian cancer to spread to the brain?
- YES
- unless BRCA mutation exists
Risk factors of ovarian cancer?
>50yrs nulliparity (or low parity) delayed pregnancy family history of breast or ovarian cancer BRCA1 (40%) and BRCA2 (18%)
What is the presentation of Ovarian cancer?
- usually presents later stage (60%)
- non specific presnL ASCITES/ PELVIC MASS, bladder dysfxn/ PLEURAL EFFUSION/ SOB/incidental finding
How is ovarian cancer dx?
- Ca125 - bloods
- USG (transvaginal/abdominal)
- Cytology (pleural fluid/ascite)
- pathology
When is the pt referred to gynaecology?
- those with RMI >200
IIary cause of ovarian tumors?
krukenburg tumors *(pancreatic cancer spread to ovaries)
How may ovarian cancer spread to the rest of the body?
transcoelomic (CAULIFLOWER like metastases) spread/ peritoneal seeding within pelvis → abdominal cavity
haematogenous spread → liver, lungs, brain- late and rare
<2% incidence of BRAIN metastases
What % of ovarian tumors are epithelial cell tumors?
> 90%
<10%- germ cell, granulosa cell
Spread of cancer to omentum results in ______
omental cake
What is involved in the rx of ovarian cancer?
- SURGERY (TAH, BSO, omentectomy, optimal debulking)
- surgery and chemo
- chemo and surgery
- timing and sequence
Ovarian cancer pt may come into check up on pleural effusion?
- cytology of pleural fluid
Newer therapy for cancer rx?
-IMMUNOTHERAPY
What chemo drugs are given for ovarian cancer?
CARBOPLATIN/ PACLITAXEL
What chemo drugs are given for ovarian cancer?
CARBOPLATIN/ PACLITAXEL
some receive many classes of chemotherapeutic agents before their disease becomes truly drug resistant. Name some 2nd/3rd line drugs.
etoposide, caelyx, topotecan, gemcitabine, chlorambucil
