Oncology 2 Section 6

lithotomy or “frog-leg” position is most commonly used for

vulva

doses for temporary and permanent sterility

temporary = 50 cGy

permanent = 200 cGy

major risk factor for endometrial cancer

estrogen

double fold of peritoneum attached to the stomach

omentum

high risk/etiologic factors for cervical cancer

• HPV - main cause

• multiple sex partners

• smoking

• intercourse at an early age

• low socioeconomic status

• Herpes simplex type 2

high risk/etiologic factors for endometrial cancer

• estrogen - major risk factor

• obesity

• nulliparity

• diabetes

• hypertension

• Tamoxifen

• age

• late menopause

treatment choices for cervical cancer

• pre-invasive and early stage (0-Ia) - surgery is treatment of choice (Total Abdominal Hysterectomy or TAH)

• stage Ib-IIa - surgery + radiation (80-85 Gy)

• stage IIb-IVa - definitive RTT with or without chemo

• stage IVb - combination of surgery, RTT, and chemo

male urologic cancer for which monthly exam beginning shortly after puberty

testicular

overall 5 year survival for cervical cancer

70%

treatment principles for endometrial cancer

early stages - definitive surgery (hysterectomy)

medically inoperable and later stages (III or IV) - definitive RTT post-op hysterectomy

ovarian carcinomas tend to spread to what structure

omentum

most common cell type for endometrial cancer

endometrium: mostly adenocarcinoma, some adenosquamous

corpus: some type of sarcoma

most common cell type for ovarian cancers

epithelial (90%)

etiologic factors for bladder cancer

• analine dye

• smoking

• chronic bladder infections (long term catheter use)

• calculus disease (kidney stones)

• pesticide exposure

• contaminated water supply

primary definitive treatment for ovarian carcinoma

chemotherapy

gynecomastia is a most common symptom for what treatment

hormonal manipulation for prostate cancer

ER/PR + status vs prognosis

better prognosis

overall survival rate of endometrial cancer

83-85%

inner portion of the ovary (or any organ)

medulla

first node group for cervical cancer spread

parametrial nodes

treatment principles for testicular cancer

• seminoma stage 1a-2b: orchiectomy followed by RTT

• seminoma stage 2b and non-seminomas: orchiectomy + nodal dissection + chemo

prognosis for seminomas

90% 5-year survival

cell type seen in women exposed to DES and tend to occur in younger women (median age = 19)

clear cell carcinoma

advantage of moving strip technique

less morbidity, much better tolerated by patient

disadvantage of moving strip technique

lower reproducibility and more complicated

staging for cervical cancer

• stage 0: carcinoma in situ

• stage 1: cancer confined to cervix

• stage 2: extension beyond cervix but not to pelvic sidewalls or lower third of vagina

• stage 3: extension to pelvic sidewalls or lower third of vagina and/or hydronephrosis

• stage 4: extension outside the pelvis and invasion of bladder and/or rectum

region of vagina where cancer usually occurs

upper third

treatment techniques for ovarian cancer

• AP/PA abdominal bath

• moving strip technique

term that describes all cancers arising from the placenta

gonadotrophoblastic disease

nodes treated with “smokestack” field

para-aortic nodes

staging system used for cervical and all GYN carcinomas

FIGO (International Federation of Gynecology and Obstetrics)

small bowel coating agent used to decrease the effects of RTT to the small bowel (diarrhea)

carafate

pre-malignant cervical disorder that describes “disordered cellular development”

dysplasia

most common cell type for cervical cancer

squamous cell carcinoma

medications used to treat cystitis

• urispas/urised

• pyridium

most common histology for renal cell carcinoma

adenocarcinoma

doses to non-bulk cervical cancer from external beam therapy

65-70 Gy

most endometrial cancer patients present at diagnosis with what stage

stage 1

male genital cancer that would most likely involved gapped fields

seminoma

gynecological cancers that oral contraceptives have been shown to reduce the risk of

uterus and ovarian

most common cell type for testicular cancer

seminoma (germinal)

demographic of men who have the highest risk of prostate cancer

African-Americans

inverted “U” field is commonly used for

• cervix with implant

• endometrium with implant

spinal levels where kidneys are generally located

T11 to L3

cancers that have associated hematuria

• kidney

• ureter

• bladder

male cancer treated with “low dose”

seminoma

percent of bladder cancers occurring in the trigone

40%

staging for bladder cancer

• T1 AKA stage A: tumor that infiltrates connective tissue

• T2 AKA stage B: infiltrating superficial muscle

• T3 AKA stage C: infiltrating deep muscle

• T4 AKA stage D: invading adjacent organ

typical external beam dose for bladder cancer

65-70 Gy

nodes most likely to be involved first by prostate carcinoma

• periprostatic

• obturator

• external iliac

number of lobes in prostate

3: medial and 2 lateral/peripheral

common age group for prostate cancer

elderly

most common cell type for prostate cancer

adenomacarcinoma

most common screening/diagnostic procedure for prostate cancer

digital rectal exam (DRE)

prostate cancer most commonly mets to

bone

typical dose for testicular cancer

25-30 Gy in 3 weeks for seminomas

45 Gy for non-seminomas

male cancers considered “high dose” RTT

prostate and bladder

Gleason system range and formula

2-10

#-4×15=% chance of lymph spread

overall 5 year rate for prostate cancer

70-85%

common age group for testicular cancer

young adults

20-35, average: 32

treatment principles for seminomas

stage 1A-2B: orchiectomy followed by RTT

stage 3 and 4 and non-seminomas: orchiectomy + nodal dissection + chemotherapy

testicular cancer cell type with best prognosis and radiosensitive

seminoma (germinal)

testicular cancer cell type with worst prognosis

choriocarcinoma

chemotherapy drug commonly used in treating testicular/cervical/ovarian cancer

Cisplatin

most common cell type for bladder cancer

transitional cell

most common symptom for bladder cancer

gross painless hematuria

age that men should have a yearly prostate exam and PSA test

50

most common site of hematologous mets from testicular cancer

lungs

borders of a typical prostate field

• inferior: bottom of ischial tuberosities

• lateral: 2 cm lateral to pelvic sidewall

• anterior: symphysis pubis

• posterior: must include presacral nodes down to S3

most important factor for staging bladder cancer

depth of penetration into bladder wall

gravida

number of pregnancies

ascites

accumulation of serous fluid in peritoneal cavity

borders of a typical cervix field

• superior: L4/L5 interspace

• inferior: bottom of obturator foreman or 4 cm inferior to lowest extent of disease

• lateral: 1.5-2 cm lateral to pelvic sidewall/brim

• anterior: symphysis pubis including external iliac nodes

• posterior: include S3 vertebrae

advantages of pre-operative RTT over post-operative RTT

• sterilize tumor bed (sealing blood vessels to reduce tumor spill)

• debulk tumor to increase operability

• treating fresh and well oxygenated organ

advantages of post-operative RTT over pre-operative RTT

• ability to have accurate surgical staging

• accurate histopathology and grading

most common sarcoma of the corpus of the uterus

leiomyosarcoma

functional unit of kidney

nephron

triangular shaped area at the base of the bladder immediately behind the urethral orafice

trigone

PSA use and normal range

screening tool for prostate cancer

0.4 - 4.0

common grading system for prostate cancer

Gleason’s grading system

condition of undescended testicles at birth that is an etiologic factor for testicular cancer

cryptorchidism

primary side effects of prostatectomy

incontinence and impotence

moving strip technique

• Lines 2.5 cm apart are marked on the front and back of pt

• day 1-single strip tx'd on the front and identical field on back

• thereafter- 1 strip added daily until 4 strips have been tx'd

• the 10 cm strip is moved up 2.5 cm each day until the last strip is reached

• field is then reduced by 1 strip until-on the last day- a single 2.5 cm strip is tx'd

• shield kidneys at 1500 rad and partial liver at 2000 rad

• 2250-3000 cGy, w/ pelvic boost to 5000 cGy

kidney that tends to be lower on the body and why

right kidney due to being pushed down by the liver

D&C meaning and AKA

dilation and curettage AKA aspirational curettage

pap smear classifications

• class 1: normal

• class 2: atypia

  • non-typical cells

  • inflammation

  • infection

  • 6 month followup

• class 3: dysplasia

  • disordered cell develoment

  • 3-6 month followup

• class 4: carcinoma in situ

  • malignant cells but not yet invasive

• class 5: malignant

location of mastoid tip

C1 body

location of gonion of the mandible

C3 body

location of thyroid cartilage

C5 body

location of esophagus (proximal end)

C6 body (lower border of cricoid)

location of trachea (proximal end)

C6 body

location of T1 body

1.5 inches superior to sternal notch

location of sternal notch

T2 body

location of sternal angle (angle of Louis or Ludwig)

1.5 inches inferior to sternal notch

T4/T5 disc space

location of heart/mitral valve

3rd intercostal space left sternal margin

location of trachea (distal end)

T5 body

location of inferior scapular angles

T9 body

location of xiphoid process

T10 body

location of diaphragm (mid-point)

T10 body

location of stomach (cardiac orifice - supine)

T11/T12 disc space