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Skin Radiation therapy > stomach > Flashcards

stomach Flashcards

1
Q

when is a second CT sim done

A

when pt loses >10% body weight or when the patient has anatomy changes d/t weight loss

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2
Q

prep for ct SIM/ tx

A

both CT sim and tx pt should fast for 3 hours prior

CT sim pt will have both oral and IV contrast and will have a 4DCT scan to track tumour motion during tx

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3
Q

patient position for treatment

A

pt typically will have wing board +/- vac loc and triangle under knees, arms should b above head

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4
Q

CT scanning limits

A

t4-5 to ischial tuberosities

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5
Q

OARS in general

A

kidney, heart, liver, spinal cord, small bowel

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6
Q

kidney OAR

A

2/3 of one kidney should be spared
For proximal lesions >50% lt kidney is in the field therefore rt kidney should be spared
for distal lesions the lRT kidney is in the field and should be spared as much as possible

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7
Q

what is included in CTV of tumours of the proximal GE/gastric lesions

A

the tumour + LN + 3-5 cm of the distal esophagus

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8
Q

CTV of esophagus

A

tumour +1.5-2cm margin and LN
(perigastric, celiac, portahepatis, supra pancreatic, splenic hilar, pancreatic duodenal, local PA and retroperitoneal LN

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9
Q

avg field size

A

15x 15

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10
Q

tx borders

A

s: t7-8
I: l3-4
lat: edge of body
M: 2-4 cm from vertebral bodies

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11
Q

energy

A

10-18MV

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12
Q

DOSES

A

45-50.4/25-28

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13
Q

MOST common s &s

A

appetite loss, early satiety, abode discomfort, wt loss, anemia, n &v and tarry stools

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14
Q

duration of symptoms

A

<3 mos in 40% pst

>1 year in 20 % ptr

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15
Q

what s&s is most common in the anTRUM AND cardia

A

vomiting and dysphagia

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16
Q

+ common age

A

50-70 yo

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17
Q

M vs f

A

+ common in men

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18
Q

most common nationalities

A

most common in back hispanics and native americans than whites

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19
Q

most common pathology

A

adenocarcinoma

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20
Q

adenocarcinoma subtypes

A

diffuse and intestinal

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21
Q

which adenocarcinoma has the worst prognosis

A

diffuse

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22
Q

which adenocarcinoma subtype is most common

A

intestinal

23
Q

where does intestinal and diffuse lesions most commonly occur

A

intestinal occur in distal areas and diffuse occur more commonly in the cardia

24
Q

proximal vs distal tumours regarding nationality

A

proximal moe common in whites and distal tumours more common in astern countries

25
Q

what etiological factors are associated with intestinal adenocarcinoma

A

chronic gastritis, h pylori, tobacco, salt intake ( + common in eastern counters)

26
Q

what etiological factors are associated with diffuse adenocarcinoma

A

mutation of e cahedrin

27
Q

what infections can cause gastric cancer

A

H pylori and chronic EBV infections

28
Q

what conditions can cause stomach cancer

A

gastric ulcers, barretts esophagus, lynch syndrome, pernicious anemia,

29
Q

what blood type has and + risk and - risk of gastric cancer

A

o blood has - risk and a has + risk

30
Q

what lifestyle factors + risk

A

no refrigeration diet high in salt, pickled, nitrites and low in fruits and vegetables, smoking, working in the rubber industry

31
Q

portions of the stomach

A

funds body pylorus and cardia

32
Q

GEJ T lvl

A

T11

33
Q

pylorus T level

A

L1

34
Q

LYMPHATIC DRAINAGE

A

Ln along the curvatures (gastric and gastropoelic) then splenic, hepatic and celiac

35
Q

4 layers of the stomach

A

serosa, mucosa, submucosa and muscular externa

36
Q

distant mets for various parts of he stomach

A

GE junction can spread to either lungs or liver

rest of the stomach spread to live via portal veins

37
Q

most common location of the primary

A

pylorus 40%
cardia 305
BODY 20 %

38
Q

typical tx for stage 1-2

A

surgery followed by chemo +/- XRT (45/25 given if the patient is LN + )

39
Q

How many ppl are dx at stage 1-2

A

<5% PTS DIAGNOSED AT this stage in north america

40
Q

surgical procedures & areas

A

for body and pylorus- radical subtotal mastectomy- 80% of the stomach, perigastric, gastrohepatic gastric omen and duodenum are resected
proximal area get total mastectomy

41
Q

what is required to cure gastric cancer

A

a resection is required to make the cancer curable

42
Q

adjuvant chemorads for stage 1b-2

A

after surgery

1) 5fu + cisplatinum is given (5FU days 1-21) and cisplatinum on days 1-5
2) concurrent chemoads ( 5fu + paclitaxel) given daily 5 days a week during XRT

43
Q

TREATMENT FOR STAGE 3

A

if initially unresectable: chemorads then surgery if resectable surgery then chemorads

44
Q

initially unresectable stage 3 treatment

A

induction chemo with 5fu, cisplatinum and paclitaxel then chemorads with 40-45/25 + paclitaxel +5fu
then the tumour can be restaged and resected

45
Q

completely unresectable treatment

A

35-40Gy EBRT + 5FU

46
Q

average time from curative tx to palliation

A

4-18 mos

47
Q

tx options for stage 4 tx

A

palliative chemo or XRT for pain relief

48
Q

chemo agents for metastatic disease

A

5FU-doxorubicin and methotrexate

49
Q

what staging systems are used

A

bormanns types and TNM

50
Q

Bormanns types

A

1) polypoid and fun gating
2) ulcerating w elevated borders
3) ulceration w invasion to gastric walls
4) diffusely infiltrating
5) unclassifiable

51
Q

what bormanns types are good prognosis and bad prognosis

A

1) polypoid and fun gating and 2) ulcerating ad elevated borders are good and type 4) diffusely infiltrating is poor prognosis

52
Q

what is the first XRT INDUCED SIDE EFFECT THAT WILL START

A

N & V can start right away

53
Q

side effects

A

anorexia, N&V, fatigue and diarrhea

54
Q

medications to be used for side effects

A

antiemetics: OTC- gravel
RX-kytril, zofran and stemetil
Antidiahhreals: OTC- ammonium and kapatocar
RX- lomotil

Skin Radiation therapy (40 decks)

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