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Organisation of the Body

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Question
Answer
Scale of cancer   show
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show Differentiation is incomplete to some extent Described in terms of tumour grade Grade I - well differentiated Grade III - poorly differentiated Has prognostic value  
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Stage of tumours   show
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show Different cancers have different clinical outcomes Judged by survival or progression free survival Early stage cancers have the best prognosis whilst late stage cancers have the worst Linked to treatment options  
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show Surgery 49% - can cure local cancers by removing the tumour Radiotherapy 40% - large contribution Chemotherapy 11% - relatively little use except in certain tumour types  
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show Detected by damage sensors e.g. ATM Can lead to cell cycle arrest, DNA repair or apoptosis  
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Ionising radiation   show
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Iodine - 131   show
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Brachytherapy   show
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show 60% of patients receive this (alone or alongside chemo/surgery) High energy X rays delivered with a linear accelerator Localised against the tumour to avoid normal tissue Patient is immobilised Planning CT performed Can be palliative or curative  
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Linear accelerator   show
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show Ionisation of water forces out electrons The scattered photons then have an increased wavelength Electron has a lower wavelength - depth of the effect is pronounced -  
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show The peak delivery is around 2 1/2 cm depth At greater depths the ionising potential is lost Changing voltage has very little effect Due to Compton effect Limits therapeutic potential  
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show Many structures in the body are radiosensitive E.g. heart, lungs, spinal cord Dosage to these areas must be limited to prevent damage  
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show Lead plates that can be adjusted to shape the x-ray beam The radiotherapy fields can be conformed to the shape of the tumour Enables shielding of some surrounding normal tissue  
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Wedges   show
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Gross tumour volume   show
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show Contains the GTV and surrounding areas considered likely to contain subclinical disease e.g. adjacent tissues, lymph nodes  
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Planning Target volume   show
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show Treatment must be delivered to the intended area otherwise the tumour is missed and normal tissue inadvertently irradiated Need to be able to place patient in a position where they will remain still Precisely matched to patient anatomy  
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show How much the organ moves e.g. lung tumours Level of importance of immobility e.g. radiosurgery of brain tumours  
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show Patient undergoes a CT wearing any immobilising structures They are in the same position as they will be for the radiation - markers are placed on the patient to ensure the same position is used each time  
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3D conformal radiotherapy - Planning   show
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show Involves a high dose of radiotherapy to patients with curable disease 3 or more intersecting beams Enables precise decisions to be made regarding treatment volumes Homogenous dose across tumour Beams can be aligned, shaped and wedged  
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show Oncologist plans treatment Each Ct slice outlines tumour and organs Grow to PTV Decide on dose and tell physicists what tolerances will be accepted by tissues Physicists optimise beam arrangements  
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show Beams delivered from many directions Lots of beams provide low dose from each direction to give a highly specific higher dose Limits dosage to surrounding tissue SABR (A-ablative) at non-cranial sites  
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show Using varying intensities of hundreds of small radiation beams produce dose distributions that are more precise compared to 3DCRT Difference in physics Allows irradiation of local lymph nodes Lowers exposure to surrounding tissue  
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