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Skin Radiation therapy > vaginal cancer > Flashcards

vaginal cancer Flashcards

1
Q

is vaginal cancer common or rare

A

rare

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2
Q

age for vaginal cancer

A

most commonly >65 but can also be seen in young women mothers using diethylstilbestrol -estrogen therapy (however this is rarely used0

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3
Q

causes of vaginal cancer

A 
STI's
CIN (cervical intraepithelial neoplasia)
HPV (6and11)
use of dethyistillbeterol (estrogen therapy mothers used from the 1940's-1970's)
smoking 
previous pelvic XRT
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4
Q

Vagina connects what 2 structures

A

cervix to the vulva and the external structures

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5
Q

vagina is located ____ to the bladder and ____to rectum

A

post, ant

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6
Q

what are the functions of the vagina

A

Produces acidic pH secretions to prevent growth of bacteria and yeast
Produces mucus during sexual stimulation for lubrication
Acts as a canal to the exterior during child birth

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7
Q

spread in vaginal cancer

A

Direct extension to the parametrium, bladder or rectum

Distant spread to liver and lungs

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8
Q

where is vaginal cancer most common (what part of the vagina)

A

Most common in the post upper ⅓

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9
Q

most common presentation of vaginal cancer

A

most commonly asymptomatic at diagnosis

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10
Q

s&s of advanced vaginal cancer

A 
Abnormal bleeding
Vaginal discharge
Painless mass
Constipation
Painful urination
Hematochezia
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11
Q

diagnosis of vaginal cancer

A

FNA used for palpable inguinal l/n

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12
Q

most common histology of vaginal cancer, second most common?

A

most common is SCC then malignant melanoma

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13
Q

staging for vaginal cancer

A

Stage I:Limited to vaginal mucosa
Stage II: Extension to submucosa and parametrium but not to pelvic side walls
Stage III: Extension to pelvic side wall
Stage IV: Bladder, rectum or other distant mets
uses FIGO staging

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14
Q

use of surgery in the treatment of vaginal cancer

A

Less common now due to devastating functional results

Now used for recurrence

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15
Q

use of chemo in vaginal cancer

A

May be used adjuvantly in combo w/ XRT for stages IIB, III & IV

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16
Q

What chemo agents are used

A

cispltinum

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17
Q

when is XRT used in the treatment of vaginal cancer

A

Used as primary for stage IIB- IV and adjuvant for stage I-IIA following brachy

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18
Q

CT scanning limits for vaginal cancer

A

CT Scan Limits:
Sup= L3/L4
Inf= 5cm inf of ischial tuberosities

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19
Q

shielding for vaginal cancer treatment

A

5HVL midline shielding introduced at approx. 4000cGy to protect the rectum and bladder while still treating the parametrium
Shielding of the small bowel and femoral heads

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20
Q

target volume for XRT treating the upper 1/3 of the vagina

A

Upper ⅓= Same as for cervix

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21
Q

target volume for XRT treating the lower 2/3 of the vagina

A

GTV is entire length of vagina
All pelvic l/n
Inguinal and femoral l/n

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22
Q

Field borders XRT

A 
Sup= L4/L5 (to cover external iliac l/n) OR L2/L3 (to cover common iliac l/n)
Inf= Introitus (cover entire vagina)
Lat= 2cm lat to pelvic brim
23
Q

Drainage of the upper 2/3 of the vagina

A

FOLLW CERVICAL DRAINAGE paracervical- internal iliacs, external iliac, common iliac, paraaortic, cisternal chyli, thoracic duct

24
Q

drainage of the lower 1/3 of the vagina

A

Follow vulvar drainage and include femoral and inguinal Ln

25
Q

use of brachytherapy in vaginal cancer indications

A

Alone or in combo with EBRT of stage I tumours
As a boost post EBRT for stage II-III
As palliative tx for stage IV

26
Q

dose LDR/ PDR bratty

A

Sole Treatment: 60Gy at 0.5Gy/hr

Boost: After EBRT 45-50Gy should be to a dose of 20-25Gy at 0.5Gy/hr

27
Q

dose HDR bratty

A

Sole Treatment: 30-36Gy/5-6

Boost: After EBRT 45-50Gy delivered in 16.5Gy fractions in 3 fractions

28
Q

bratty types for vaginal

A

May use LDR iridium wire interstitial implants and afterloading implant techniques for either PDR or HDR

29
Q

PDR/HDR indications

A

Therefore limited to tumours where the PTV will not be more than 1cm from the surface
Typically used for lesions that have been completely excised or for flat superficial tumours
For those w/ a high risk of nodal disease, EBRT should also be considered adjuvantly

30
Q

treatment stage 1 vaginal cancer

A

Primary brachy w/ possible adjuvant brachy mucosal boost and/or EBRT pelvic boost)
Superficial tumours may be treated with only intracavitary cylinder covering the entire vagina with 60Gy and an additional mucosal boost of 20-30Gy
EBRT should be reserved for very aggressive lesions to supplement intracavitary- whole pelvis treated with 10-20Gy w/ additional parametrial dose should be delivered w/ a midline 5 HVL block shielding the brachy volume to give a total dose of 45-50Gy to the parametric

31
Q

treatment stage 2 a vaginal cancer

A

Stage IIA: (Primary brachy w/ adjuvant pelvic EBRT and possible brachy boost)
Requires a greater EBRT dose- whole pelvis to 20-30Gy w/ additional parametrial dose w/ midline block for a total dose of 45-50Gy

32
Q

stage 2b-4 vaginal cancer treatment

A

Stage IIB-IV: (Primary EBRT with adjuvant brachy and possible brachy boost)
For advanced tumours 40Gy whole pelvis and 55-60Gy total parametrial dose w/ midline shielding w/ intracavitary brachy for a total tumour dose of 75-80Gy and parametrial dose of 65Gy
An interstitial implant boost of 20-25Gy is sometimes used w/ pts w/ extensive parametrial infiltration

33
Q

most important prognostic indicator

A

stage

34
Q

prognostic indicators

A 
stage
Age
Extent of mucosal involvement
Degree of differentiation
Histology
35
Q

how long is the vagina

A

7.5cm

36
Q

anterior vaginal wall drainage

A

deep pelvic nodes (including inter iliac and parametrical LN)

37
Q

what LN is most often involved in lower 1/3 vagina

A

inguinal LN

38
Q

what type of test can detect early SCC but not CCA (clear cell carcinomas)

A

exfoliative cytology

39
Q

which is more likely to recur SCC or adenocarcinoma

A

adenocarcinoma

40
Q

which vaginal cancer histology is worst

A

non epithelial cancers (ex: sarcoma, melanoma)

41
Q

preferred treatment for vaginal cancers

A

XRT

42
Q

CCA (clear cell carcinoma) is mostly associated with what risk factor

A

mothers having used diethylbestorol

43
Q

treatment for when LN are palpable

A

additional 15Gy should be given with 10-18Mv and 2 cm bolus should be used

44
Q

interstitial bratty sources

A

cs137 ra226 Ir192

45
Q

ages for vagonal cancer

A

can be >65 (SCC)

OR LESS commonly in younger Pt (15-29) for clear cell carcinoma

46
Q

where do most vaginal cancers arise

A

upper 1/3 of the vagina

47
Q

tumours in the apex of the vagina are associated with what in majority of cases?

A

60% are associated with hysterectomy- most likely because the apex of the vagina is close to cervix

48
Q

lYMPHATIC DRAINAGE OF VAGINAL APEX

A

follows cervical lymphatics drainage

Parametric- pelvic- common iliacs- paraortics-s’clav

49
Q

lymphatic drainage of the posterior pelvic wall

A

drain to Sup and inf gluteal Ln

50
Q

lymphatic drainage of lower 1/3 of vagina

A

can follow vulvar drainage- inguino and femoral Ln

51
Q

most common presentation

A

is most commonly diagnosed asymptomatic

52
Q

MOST COMMON PATHOLOGY

A

SCC 80-90%

53
Q

what treatment modality is not typically used? and why?

A

surgery- as the loss of function is devastating to the patent, its only used for recurrence of tumour

Skin Radiation therapy (40 decks)

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