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Endometrial, Cerbvix CA, Radiation Therapy, Treatment, Fields

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
show cerix (16%), invasive in older group  
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Most grequent gyn ca in older women is   show
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after reproductive years, incidence of endometrial and ovarian ca does what   show
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show irregular bleeding, early presentation (early diagnosis high cure rate)  
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show high calorie and high fat diet, use of unopposed estrogen during 1960 and 1970s, link with diabetes and hypertension, women 50lbs overweight, prolonged hrt  
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What are some characteristics of vaginal and vulvar ca   show
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show pap smear, done via curettage  
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Anatomically what is the cervix   show
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show The cervix is the lower third of the uterus that extends into the apex of the vagina  
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What standing does ovarian ca have in cause of death in women   show
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show Squamous cell  
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show Adenocarcinoma that arise from mucous-secreting endocervical glands  
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What cancer accounts for 2% of cervix cancers   show
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show external iliac, obturator, and hypogastric (internal iliac) chains.  
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What staging system is used for cervix ca   show
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What in regards to the stage of cervix ca is TX   show
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show No evidence of primary tumor  
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What in regards to the stage of cervix ca is Tis   show
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show FIGO no longer includes Stage 0 (Tis)  
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show Cervial carcinoma confined to uterus (extension to corpus should be disregarded)  
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What in regards to the stage of cervix ca is T1a IA   show
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show Stromal invasion of 3 mm in depth and 7 mm or less in horizontal  
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show Stromal invasion of more than 3mm and no more than 5mm, horizontal spread of 7mm or less  
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show Visible lesion confined to cervix or microscopic lesion greater than T1a/Ia2  
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show Clinically visible lesion 4 cm or less in greatest dimension  
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What do you need to know in regards to the stage of cervix ca T1b2   show
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show Cervical ca invades beyond uterus but not to pelvic wall or to lower third of vagina  
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What do you need to know in regards to the stage of cervix ca T2a   show
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What do you need to know in regards to the stage of cervix ca T2a1   show
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What do you need to know in regards to the stage of cervix ca T2a2   show
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show Tumor with parametrial invasion  
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What do you need to know in regards to the stage of cervix ca T3   show
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What do you need to know in regards to the stage of cervix ca T4   show
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show IIIB  
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show IVa  
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show M0 no distant mets, M1 Distant mets (including peritoneal spread, involvement of supraclav, mediastinal, or paraaortic lymph nodes, lung liver or bone)  
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show IVB  
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show Invasive, keratinizing, nonkeratinizing, verrucous  
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show initially a pelvic exam, pap smear, and biopsy of any lesions. To further stage, curettage and dilation under anesthesia to examine uterine involvement is needed, this would be paired with a cbc and urine  
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show Abodominal and pelvic ct  
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show total abdominal hysterectomy and removal of vaginal cuff.  
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If women with Tis/Ia1 wish to have children what can be done   show
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FOr stage Ia2 what might be used for tx   show
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For stage Ib2 cervical disease, what is used   show
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What treatment might a IIb, III, and IVa cervix carcinoma be treated with   show
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show Brachy is important aspect of tx and for control, when brachy is not used survival rates decrease.  
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What is the technique used on a whle pelvis (cervix ca)   show
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What is the lower border for RT with cervix cancer   show
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show at top or bottom of L5 or may be extended upward to l4 for a portion of treatment depending on potential involvement of nodes.  
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What are the lateral borders for cervix ca in regards to RT   show
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What blocking should be used for lateral fields on cervix ca   show
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if there is ant or post extension what must happen to the fields (cervix ca)   show
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show To decrease dose given to entire rectum and bladder, the four field technique allows you to block the bladder and rectum  
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in regards to positioning what may help with the tx of cervix ca   show
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show 2 cm sup to cervical os and 2 cm lat to endocervical canal  
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How is point B prescribed for cervix CA   show
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What are some of the clinical presentations of endometrial ca   show
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What workup can be done for endometrial ca   show
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What has been an increasing case for detection of endometrial ca   show
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show aspiration, chest xray, blood count, chemistries, urinalysis and nod surgery is the standard for initial defnitive management. An ultrasound and ct/mri is often being performed first if disease may be beyond uterus.  
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What is most common for endometrial ca   show
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What is seen about 20% of the time in endometrial cancer (type of ca)   show
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What is an extremely malignant form of endometrial ca   show
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show TAH and no other tx  
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show TAH and brachy alone, low doses of 60 to 70 gy used in one application, or high doses of 5 to 7 gy at a 5mm depth in three applications.  
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show Due to risk of pelvic node involvement, external beam and TAH  
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In addition to post surgery extrenal beam and TAH what are the nodal doses associated with IC or higher grade 3, as well as the dose given to the vaginal mucosa (via implant)   show
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show irradiation, 50gy external beam with an implant that will bring the tumor dose above 75 gy, for bulky disease the dose can be brought to 100gy (careful technique required paired with midline blocking)  
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For stage IB, grade 1 &2 and sometimes stage Ia, grade 2 what might be used (tx beyond TAH)   show
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For RT fields referring to endometrial ca, what are the field perameters   show
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show fatigue, diarrhea, dermatitis, dysuria  
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What usually occurs, acute side effects, in the second to third week of pelvic irradiation and why   show
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What can help against diarrhea that patients may experience   show
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show Dermatitis, due to ap/pa only fields, with use of bolus and using chemo as well.  
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What can be used to help with possible dermatitis   show
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show Dysuria, treatments done with a full or partial bladder exlusion on lateral fields and maintenance of a partially full bladder during brachytherapy (move bladder out of treatment)  
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What can be used to relieve urinary frequency when patient is having dysuria   show
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show Superficial en face radiation using orthovoltage, high-energy photons, or electrons can be applied directly to the vaginal and cervical tumors with large fraction size and not count against the total prescribed dose.  
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What can be helped with rectal irritation   show
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What are some late side effects of pelvic irradiation due to tx of gynecologic cancers   show
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show replacement hormonal therapy, dryness can be helped with Replens or hormonal creams, shrinkage can be prevented with vaginal dilators or regular sexual activity, and ulceration can e treated with local medications, pentoxifylline (antinflam)  
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As a therapist what are some things that can help reproducibility with pelvic irradiation   show
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In referrence to bowel movements in patients with pelvic irradiation what is the primary concern   show
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In reference to treatment being an SSD or SAD setup, what is going to be the setup for pelvic irradiation for gynecologic cancers   show
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