hsc 340 12 9
TRANSCRIPT
HSC 340 12-19-10
Gastrointestinal Cancer
Genitourinary Cancer
Gynecological Cancer
Gastrointestinal Cancer
• Esophagus
• Stomach
• Pancreas
• Rectum
• Anus
Esophageal Cancer
• Usually squamous cell
• Males more than females
• Cure rates <10%
• Accounts for 1% of all US cancers
Esophageal Anatomy
• Cervical esophagus
• Upper thoracic
• Middle thoracic
• Lower thoracic
Esophageal routes of spread
• Spreads longitudinally through lymphatics– Upper– Middle– Lower
Esophageal CA Treatment
• Surgery only- poor control
• External beam only- curative and palliative
• Chemo, radiation
• Chemo, radiation & surgery
• Curative vs. Palliative
Esophageal Radiation Therapy Techniques
• Cervical Esophagus– Lateral opposed, Obliques
• Thoracic Esophagus– AP:PA, Obliques or AP:PA & Obliques
combo
Esophageal Immobilization & Positioning Devices
• Prone sometimes used to pull esophagus away from sc.
• Supine more common
• Arms above head, may-be hard to hold if elderly
• Vac-lok, body casts
• *problems w/arms at sides…3 pt set-up
Esophageal Doses
• Palliative– 30 Gy over two weeks to 50 Gy over five weeks
• Preoperative + chemo– 30 Gy over three weeks to 45 Gy over five weeks
• No surgery– Above dose with a boost to 60-65 Gy
• HDR and LDR are options….
Stomach Cancer
• Majority Ulcerative Adenocarcinomas
• High incidence in Japan
Stomach Anatomy
• Begins at Gastroesophageal Junction and ends at pylorus
• Many critical structures surrounding organ
Stomach CA Routes of Spread
• Direct Extension
• Widespread
Stomach CA Treatment
• Surgery & Post-op Radiation Therapy with Concurrent chemo
• Radiation alone in palliative cases (unresectable)
Stomach Radiation Therapy Techniques
• AP:PA
• Doses:– 40-45 Gy w/ 5FU– Boost to 50-55Gy if needed
Stomach Immobilization and Positioning
• Supine
• Arms above head
• Vac-lok, body cast
• Contrast?
Pancreatic Cancer
• Ductal adenocarcinoma
• Occur in the head of pancreas
Pancreas Anatomy
• Three sections– Head, tail, body– L1-L2
Pancreatic CA routes of spread
• Direct extension
• Lymphatics
Pancreatic CA Treatment
• Surgery (you want the cancer in the tail!)
• Surgery, Post-op Radiation Therapy, Combination Chemotherapy
• Unresectable tumors- palliative radiation therapy and chemotherapy
Pancreatic radiation therapy techniques
• Three field (AP, Lats), four field (AP:PA, Lats), IGRT –couch rotation used to create unique fields that spare structures
• Doses– 45-50 Gy with combo chemo
– Limit lateral fields to 18-20Gy to preserve kidneys
– 60 Gy in 3 two week courses (20 Gy/week) for palliative with field reduction @ 45 Gy
Pancreatic Immobilization & Positioning
• Supine
• Arms above head
• Vac-lok, alpha cradle, body cast
• Contrast- swallowed and/or injected (to see kidneys)
Rectal Cancer
• Adenocarcinomas
• Men = Women
• Rectal bleeding
• 2nd most common cause of CA death in US
Rectal Anatomy
• 13-15 cm long
• Upper, middle and lower valves divide into sections
Rectal CA routes of spread
• Direct extension
• Wide spread dissemination
Rectal CA Treatment
• Surgery
• Surgery + Radiation Therapy + Chemo
• Pre-op, post-op, pre-op & post-op
Rectal CA Radiation Therapy
• Three field (PA and lats) patient prone
• IGRT
• Doses– 45 Gy– May boost to 50Gy
Rectal Immobilization and Positioning
• Prone
• Belly board (to help “drop” small bowel)
• Arms above head
• Contrast- Oral for sm. Bowel, rectal
• Rectal marker
• Anal marker
• Vaginal marker
Anal Cancer
• Squamous cell
• 3cm in length
Anal CA Routes of Spread
• Direct Extension, Lymphatics, Blood stream
Anal CA Treatment
• Surgery
• Chemo and Radiation
Anal CA Radiation Therapy
• AP:PA, IGRT
• Doses– 45 Gy with Chemo– Boost to 50-55 Gy if large tumor– 60-65 Gy radiation only– e- beams may be used if inguinal nodes have
disease
Anal CA Immobilization and Positioning
• Supine
• Vac-lok, body cast
• Marker on lowest pt. of tumor
• Vaginal marker
Genitourinary Cancer
• Bladder
• Prostate
Bladder Cancer
• Blood in urine
• Cigarette smoke common cause
• Transitional cell carcinoma
Bladder CA Routes of Spread
• Direct Extension
• Lymphatics
Bladder CA Radiation Therapy
• Radiation therapy alone
• Surgery & Radiation Therapy
• Surgery, Chemo & Radiation Therapy
• 3 most common:– Preop radiation followed by cystectomy– Radiation after transurethral resection– Transurethral resection, chemo, radiation
Bladder CA Radiation Therapy Techniques
• Four field technique, IGRT
• Dose:– Pre-op 45-50Gy– No chemo, no surgery 45-50 Gy with a boost to
65-70 Gy– Trials
Bladder CA Immobilization & Positioning
• Supine
• Contrast- Bladder (air introduced to see anterior surface of bladder)
• Arms on chest
Prostate Cancer
• Most common cancer in men
• Adenocarcinoma
• 60+
• PSA, Gleason Score
Prostate CA Routes of Spread
• Local invasion
• Lymphatics
• Bone
Prostate CA Treatments
• Observation
• Radical Prostatectomy
• Implant Therapy
• External Therapy
• Combination Implant & External
• Hormone Therapy for Metastatic disease
Prostate CA Radiation Therapy Techniques
• Four field, IGRT
• Doses:– 75-81Gy with conedown off rectum if possible– Post-op 60-66 Gy
Prostate CA Positioning and Immobilization
• Supine/Prone (study done)
• Vac-lok
• Arms on chest holding ring
• Contrast- bladder, nodal, rectal**, sm. Bowel
Gynecological Cancer
• Uterine Cervix
Uterine Cervix
• Squamous cell
• Incidence of Invasive CA decrease due to PAP smear detection
Uterine Cervix Routes of Spread
• Direct extension
• Lymphatics
Uterine Cervix Treatment
• Surgery (TAH)
• Radiation Therapy (external & implant)
• Surgery, Radiation Therapy, Chemo
Uterine Cervix Radiation Therapy Treatment
• Four field to 40-45Gy
• Boost intercavitary
Uterine Cervix Positioning and Immobilization
• Anal marker
• Rectal barium
• Vaginal marker
• Bladder contrast
• Prone w/belly board to move sm.bowel