Week 8 Flashcards
What is the difference between aetiology and epidemiology?
Aetiology: is the study of the factors that have caused the disease
Epidemiology: looks at the disease on a population level studied over time, looks at relationships between illness and behavioural factors, genetics, economics etc.
What are some breast cancer signs and symptoms?
breast lump axilla lump changes in breast shape or size skin change nipple change
What are the skin changes that may indicate breast cancer?
dimpled or pucker. A thickening and dimpling of the skin is sometimes call orange peel skin
redness, swelling and increased warmth, may be a sign of inflammatory breast cancer
Itching of the breast or nipple may be a sign of inflammatory breast cancer
fungation or uleration from direct skin invasion
What signs may indicate inflammatory breast cancer?
skin change:
redness, swelling and increased warmth, may be a sign of inflammatory breast cancer
Itching of the breast or nipple may be a sign of inflammatory breast cancer
What nipple changes may indicate breast cancer?
inverted
discharge
crusting, ulcers or scaling
For a breast cancer patient set-up position the patient should be?
-comfortable, stable, reproducible
-most common - supine in immobilisation devices
-arms outside radiation beam
-lifts breast superior (reduces cardiac dose)
-sternum horizontal (reduce lung volume)
reduce folds in breast tissue
-if SCF (supraclavicular field) is required will need to check skin folds in this area
What observations can be made when comparing the dosimetry of supine and prone breast patients?
reduction in lung dose when using prone over supine
What is radiation dermatitis?
side effect of external beam ionizing radiation, that manifests within a few days to weeks after the start of treatment
What is acute radiation dermatitis/ skin reactions for breast treatment?
occurs within 90 days of exposure to radiation
erythema
desquamation - dry, moist
Fatigue
At what dose does erythema occur (for breast patients)?
3000cGy-4000cGy
At what dose does desquamation occur (for breast patients)?
4500cGy-6000cGy
What are the late change side effects for breast treatment?
occurs months to year after
fibrosis
telangiectasia
breast shrinkage
What is an example of scoring criteria for radiotherapy side effects?
NIH CTCAE:
- None
- Faint erythema or dry desquamation
- Moderate to brisk erythema
- Confluent moist desquamation
- Skin necrosis or ulceration
What do we need to tell cancer patients in regards to caring for side effects?
avoid abrasion to skin when washing
use simple soap or soap alternative
aqueous cream is applied twice daily at least 2h before or after treatment
Wear loose cotton garments
gentle arm exercises started after surgery are continued
How can you treat moist desquamation?
one percent hydrocortisone cream (for moist desquamation- RO to prescribe)
If a patient has a severe reaction to the external radiotherapy what should be done?
XRT (external radiotherapy) temporarily stopped and Atrauman gauze with a pad or hydrogel sheet or foam dressing applied until healing occurs
Mepitel or Mepilex film may be used to reduce skin reaction
Corticosteroid and non steroidal creams may assist
What are the critical structures to look at when treating a breast?
heart lung contralateral breast spinal cord depending on field arrangement for SCF
What are two other examples of scoring criteria for Acute Radiation Skin Reaction (ARSR)?
RTOG/EORTC (Radiation Toxicity Oncology Grading)
WHO (World health organisation)
What is the WHO grading system for acute and subacute toxicity?
- None
- Erythema
- Dry desquamation, vesiculation (blister), pruritus (severe itching)
- Moist Desquamation, ulceration
- Exfoliative dermatitis, necrosis requiring surgical intervention
What are the two main aims of Palliative care?
- quality rather than quantity of life (does the benefit of the treatment outweigh the adverse effects?, any net reduction in QOF can be considered a contra-indication for treatment)
- Pain and symptom relief (symptomatic pain, plus other discomforting or disabling symptoms: tissue size -reduce cell number, tissue function - restore normal tissue function)
What are 4 examples of palliative care?
- SVC obstruction
- Spinal cord compression
- Osteolytic bone metastases
- Brain metastases
What is SVC obstruction?
mass pushes against superior vena cava and impedes hear function
What is spinal cord compression?
metastases causes an erosion of the vertebral body and the lesion impacts on the neural pathways of the spinal cord causing paraesthesia (painful pins and needles)
followed by motor deficits, sensory deficits and autonomic dysfunction
What is osteolytic bone metastases?
eat into healthy bone by lysing (cause destruction) bone cells, causing skeletal dysfunctions
What is brain metastases?
can disrupt the healthy function of the rest of the brain, causing confusion and dizziness among other things. RT relieve this impediment effectively restoring normal function to the rest of the organ
How does radiation therapy treat spinal cord compression?
Radiation Therapy: most common treatment with fields encompassing at least one to two vertebral bodies above and below the metastatic lesions
How does surgery treat spinal cord compression?
Surgical intervention: often sought and a laminectomy (remove the back of one or more vertebrae) to reduce the spinal cord compression
How does Dexamethasone treat spinal cord compression?
Dexamethasone: most commonly administered glucocorticoid which inhibits prostaglandin E2 and VEGF production, leading to a decrease in vasogenic cerebral oedema (blood brain barrier oedema)
What are other considerations for palliative care?
pain is not the only major issue (loss of dignity)
our responsibility as a RT is to make the treatment as effective as possible and to minimise the impact on a patient’s dignity
know the cancer has mjor impact on a person’s psychological state and many aspect of their social life
What does fractionations are used for palliative spinal cord compression?
8Gy in 1#
12Gy in 2# consecutively or a week apart
20Gy in 5# given in 1 week
30Gy in 10# given in 2 weeks
What are the side effects of spinal cord compression?
nausea cramping diarrhoea erythema dry itchy skin flatulence (accumulation of gas) fatigue
What needs to be considered for patient set-up for a palliative patient?
stable and reproducible position
may require soft top, pillows and foam wedges to support the patient
If patient is anxious an anxiolytic drug like Diazepam may be required
What is the difference in field size for palliative vs radicle treatment?
field size needs to be adequate to allow for any likely movement. it should be a larger margin from PTV than a radical treatment
Whose responsibility is it to check that drugs have been administered prior to radiaition therapy treatment?
Radiation therapist
What are the two conclusive ways for determining prostate cancer?
biopsy
TRUS (Transrectal Ultrasound) biopsy
What are signs and symptoms for Prostate Cancer?
Digital Rectal Exam (DRE)
Elevated PSA (prostate-specific antigen) - doubling time
Increased frequency of urination and difficulty in micturition (sustaining urine flow)
Haematuria and urinary obstruction leading to back pressure on kidneys and possible renal impairment
sacral, sciatic and perineal pain may occur from infiltration of nerves in the pelvis
What is PSA?
prostate-specific antigen,
a protein produced by cells of the prostate gland
PSA Test measures levels of PSA in a man’s blood, raised levels (above 4.0ng/mL, doctors would recommend a prostate biopsy)
Doubling Time- watch to see if levels double
What are the clinical managements of prostate cancer?
watchful waiting surgery hormone therapy ultrasound cryotherapy (extreme hyper-cooling treatment) radiation therapy
What do you need to prepare before prostate treatment?
bladder filling
bowel preparation
What is radiation induced proctitis?
most commonly after treatment for cervial, prostate or colon cancer
involves the lower intestine, primarily the sigmoid colon and the rectum
it is inflammation of the lining of the rectum, can lead to bleeding or mucous discharge
looks like telangiectaisa of the rectum
What is RRP-Da Vinci Robot?
radical retro pubic prostatectomy has a high chance of impotence, however using robotic surgery there is more nerve sparing and a less risk of erectile disfunction
however both prostatectomy and robotic surgery have a chance of urinary incontinence
